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Just a call away: Insurer keeps clients safe and healthy with telephone program during pandemic

Joseph Boughter, 69, a member of Community Health Plan of Washington’s Medicare program, called in with a question but ended up getting a handful of masks when he told a local representative about concerns going to stores because he’s part of a high-risk group. (Dan Pelle / The Spokesman-Review)

Earlier this month, Joseph Boughter had a question about why he couldn’t order masks from a supply catalog offered through his Medicare plan.

Boughter, 69, knew he was in a higher-risk group regarding the coronavirus, so he called community outreach specialist Cindy Hogberg. She works in Spokane with Community Health Plan of Washington, a not-for-profit insurer for Medicare and Medicaid, also called Apple Health.

Using the “whole-person, community-based approach,” she worked one-on-one to solve the catalog order issue. Then Hogberg had someone drop off a few masks at Boughter’s door.

“I thought it was strange; they offer just about everything else – gloves or diapers – but not masks,” said Boughter, a retired Vietnam veteran. “It’s a catalog for over-the-counter pharmacy needs, and there is so much that Medicare allows that we can order.

“I think it was more of an oversight, and Cindy made a call right away to her boss, and she said they’re now going to put it in within a few days. I think she had a meeting that day, but since I didn’t have any masks, she had her husband drop some off. They’re very responsive.

“If you go to Costco or anywhere, just to get into the store you need a mask. In my age group, we’re in the vulnerable population. It kind of stressed me out to not have something we’re supposed to have.”

Even without his concern about the masks, Boughter would’ve been talking with Hogberg over the phone. Since March’s stay-home orders and as many businesses shut down, CHPW employees began a project of making direct phone calls to each one of its members to check on any wellness needs. In Spokane County, the undertaking will require calls to more than 27,000 members.

CHPW leaders hope the model continues beyond this crisis – with employees regularly picking up the phone and asking if members need any help with health problem-solving, Hogberg said.

She said it has connected Spokane-area members to food distribution options, prescription mail delivery and other care needs, even personally dropping off masks.

“As you know, people are staying at home, so reaching out to each member is the best way we can see how people are doing and is there anything we can help them with,” said Hogberg, who is calling people in Spokane, Pend Oreille, Stevens and Ferry counties.

Statewide, the not-for-profit serves about 265,000 members through Medicaid and Medicare programs, and, as of May 18, CHPW had completed 75,742 phone calls to members.

In making calls, CHPW workers are asking about any health care concerns wrapped around the COVID-19 crisis, widening unemployment, increased food insecurity and overall needs such as seeing a doctor or getting prescriptions during pandemic shutdowns.

If Hogberg or other not-for-profit’s workers discover during a call that someone doesn’t have enough food, they refer to resources for free community pantry distributions. The group also might connect members to SNAP or to other agencies.

Any health concerns are typically problem-solved by CHPW employees within a day or two, Hogberg said. A Spokane team includes two case managers who are nurses. Other staff supports in behavioral health and community resources.

CHPW has a few employees available statewide who can speak different languages, as well, such as Chinese and Vietnamese, Hogberg said, so all the calls are more personalized.

“We are calling at least one time per person, and it started when Gov. Inslee issued the ‘Stay Home, Stay Healthy’ order,” she said. “It’s difficult for people who are getting laid off; they’re having anxiety, lacking resources, food and knowing – where do they get pharmacy supplies?

“There’s been a lot of anxiety about how do they get to the doctor; if we are reaching out, we can help to direct them. We are a community plan, and we believe in being there for people.”

Hogberg gave a recent example of how one of her calls went to a member who has an infant using a peripherally inserted central catheter line for a gastrointestinal-related condition.

Although the member had kept up virtual appointments for the baby with a nutritionist, Hogberg learned from her direct call about concerns of whether the baby was thriving because the member didn’t have a proper scale for weight checks.

“After the call, we were able through insurance to get an infant scale for her to do the weight checks,” Hogberg said. “Now, she’s thriving, and they know that the PICC line is working. They’re better able to manage her health needs.”

From the calls, Hogberg said she’s learned that many members weren’t aware of community resources to get a phone or food. Others didn’t know it was possible to have medicines mailed to their home.

“We’re allowing 90-day refills so they don’t have to worry,” she said. “That doesn’t generally happen in the Medicaid program because that is a month-to-month program, but we are allowing that 90-day refill. We’re going to continue to do the 90-day for certain medications.

“A lot of people weren’t aware we could even mail their medication.”

Through another call, Hogberg connected with an individual who is diabetic and couldn’t find alcohol swabs to use during insulin injections. The wipes were among medical supplies in short supply or out of stock, she said.

“We were able to get one of the local clinics to write a prescription for alcohol wipes, and they were able to get it filled at the pharmacy,” Hogberg added. “The pharmacy can’t sell them retail, but they can sell them with prescription, so it’s been things like that.

“It’s been great to reach out to these members. Most of them are very grateful that we are reaching out, that we care about them and that we do have a way to connect them to resources.”

It’s helped also “with a lot more of the social determinants of health,” she said. “It is something we will work into our process somehow after the pandemic.”