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There is so much more to being well than just receiving medical attention. How do we connect all the physical, mental and social resources a patient might need and put them at the center of their own care? Case managers and community health workers do exactly that.

Their work can improve quality of life, decrease hospitalization and lower costs through efficient care coordination. They connect the dots among providers, insurers, caregivers, medical equipment suppliers and many more people involved in a health journey. They educate patients and offer them support along the way.

These three professionals share how they provide personalized, whole-person care. They treat those they care for with dignity and compassion — like people, not just patients.

Caring for caregivers

Diane B. worked with a woman whose head, neck and mouth cancer robbed her of her voice. She was in and out of the hospital so much that she had lost the will to live. Her doting husband and daughter were working around the clock to make her comfortable.

Family members who become caregivers are often busy, inexperienced, and short on information and emotional support. It can be exhausting, and caregivers might not know what help is available to them.

“Many people don’t know what their plans cover,” Diane said. “I was able to convert a long-term care policy to at-home care for them, and I convinced the husband to let an aide help at night so he could get some sleep.”

Her research and actions delayed hospice care and gave the family more time to spend together.

Finding suitable housing

Natural disasters can complicate the job, as Trineca H. knows from experience. She was working with a man who had a leg amputated due to diabetes complications. While he was in the hospital, his girlfriend abandoned him and left him without a place to live.

“All the shelters had been shut down indefinitely because of flooding, and the discharge terms paid for only a few nights in a hotel,” she said.

This job is more rewarding than I ever thought possible. You get attached to people and hear their stories. Clients become like family or friends.

– Jamie L., case manager

She drove around the city for three days trying to find a solution. She finally found a nursing facility willing to take him in while his coverage and disability terms were worked out. She kept in touch to make sure he stayed hopeful and took his medications.

“If I can’t reach (patients) by phone, I will call doctors and family members and knock on doors,” Trineca said.

Giving the gift of a graduation

Never say never to Jamie L., a case manager with a nursing background. She helps people be proactive with their health by educating them about conditions like diabetes and about nutrition and food labels.

“This job is more rewarding than I ever thought possible,” she said. “You get attached to people and hear their stories. Clients become like family or friends.”

One of those friends needed help getting a customized wheelchair, and Jamie made it happen. The overweight woman was in her 80s and had arthritis and other mobility issues. She wanted to see her grandson graduate.

The chair she needed had been back-ordered so delivery was delayed. With Jamie’s persistence, the process was green-lighted in time for a proud grandma to attend graduation.

These three caring individuals aren’t alone in giving their all to treat people comprehensively and compassionately.

In a recent survey, 86 percent of Optum® Population Health Management Solutions members said the program helped them have a better, more positive health care experience. More than 80 percent said it helped them make better choices and feel more confident.

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