Aetna Member Story

Value-Based Teamwork 

Angie*, a care coordinator with Aetna Better Health® of Illinois, enrolled Tommy* into the plan’s care coordination program in September. He has several chronic health conditions and had been discharged from a nursing home four months earlier. Tommy hadn’t seen a doctor since that time and wasn’t able to get his medications because he didn’t have a photo ID. A family member was working to get Tommy’s state identification, but the lack of a photo ID created a challenge.

Tommy’s case was deemed high acuity and referred to an RN care manager. Before handing off the case, Angie and her manager contacted the nursing home to determine if his photo ID or social security card was on file, but they weren’t. They asked if the face sheet included a photo and learned it did. Angie’s manager reached out to one of the health plan’s value-based providers to determine if Tommy could be established as a new patient with the face sheet as identification.

The provider agreed to see Tommy for an initial visit while work continued to work on getting his state identification. He got an appointment scheduled and was able to have his medications refilled. Now, his Medicaid ID reflects the name of his new provider while he awaits his state identification.

*Names changed to protect privacy