04
October
2019
|
10:36 PM
America/New_York

When Life Strikes, Horizon Gives Members Shelter from the Storm

5 MINUTE READ

Summary

Health care is more complicated than ever, and New Jersey’s largest health insurer is finding new ways to help members with everything from medical care to grocery shopping.

By Vincent Alonge, Vice President Enterprise Operations


Jacquelyn Acropolis isn’t a meteorologist, but she’s the type of person who is well acquainted with perfect storms. You might even say she thrives in them.

Take just a recent example: Jacquelyn had to work through “a million dead ends” to help a wheelchair-bound Horizon Blue Cross Blue Shield of New Jersey member overcome a hurricane of health and logistical challenges, eviction from his home and no food in his kitchen. Putting first things first, she took it upon herself to do the member’s grocery shopping and stock his fridge with meals.

Jacquelyn is a care manager for Horizon BCBSNJ who serves in the Managed Long-Term Services and Supports (MLTSS) program. MLTSS is a program that provides the tools, services, and support needed to help someone live safely and independently in their own community. Without MLTSS, most of the people who qualify for the program would end up living in a long-term residential care facility.

The program is distinguished by the challenges of the 20,000 Horizon members it serves, many of whom are often in a distressed state and require someone who can coordinate many different services to ensure that their complex health and personal needs are met.

“The lives of the people who first enter this program are often in upheaval, and our mission is to bring them to a more secure level of safety, a higher standard of care and a better quality of life,” said Carol Cianfrone, Director of MLTSS Clinical Operations.

In many cases, MLTSS members are in a fight against cancer, Alzheimer's disease, heart and lung conditions, blindness, deafness, or in the throes of drug or alcohol addiction. “The profile of the people we’re serving means that our care managers are challenged from the start to go above and beyond, often thinking “outside of the box” to meet their members’ needs and help them overcome very complex obstacles,” Cianfrone said.

It is this spirit of challenge that attracted Jacquelyn to the MLTSS program. “I really love this job,” Jacquelyn said. “Working for the MLTSS program is probably the best decision I ever made. I see every day how much we are helping people, the difference we make, and it’s truly gratifying.”

Jacquelyn joined Horizon BCBSNJ in 2017 after working as a social worker in child welfare services and later as a counselor at an addiction clinic. Today, she is one of 234 MLTSS Horizon care managers, a combination of social workers and nurses, who work with members in the field arranging and delivering a wide range of services, such as personal care, medical and non-medical transportation, behavioral health and addiction services, and nursing home care.

That range of services was put to the test when Jacquelyn was introduced to “Mark,” a wheelchair-bound, recent amputee who was assigned to MLTSS in November 2018.

Mark’s life was in turmoil. Not long after losing his leg, he lost his brother, who also had been Mark’s caregiver. Mark had to fight off grief while also fighting to obtain the very basics he needed to survive on his own.

He received help from the local board of social services in applying for food stamps, social security benefits and cash assistance to buy necessities. But, gaps in support were opening everywhere.

Foreclosure notices filled Mark’s mailbox, his kitchen cabinets were emptying, he had trouble getting his prosthetic leg fitted properly, and panic was setting in. That’s when Jacquelyn arrived.

Jacquelyn and her Horizon MLTSS team moved quickly to understand Mark’s challenges and began taking care of not only his medical needs but everything Mark would need to thrive on his own.

“We worked on getting his food situation settled but ran into a million dead ends,” she explained. “A grocery store that offered home delivery wouldn’t accept an EBT (Electronic Benefits Transfer) card; another store that accepted EBT cards wouldn’t deliver. Arranging transportation and getting Mark out of his home so he could shop for himself was proving to be a real challenge.”

Jacquelyn and her team were able to arrange for his food delivery immediately. The following week, Jacquelyn took Mark’s grocery list and did the shopping herself.  Then she took care of lining up ongoing services that made sure Mark got his groceries on a regular basis.

As Mark’s care manager, Jacquelyn helped Mark in every way possible, from simple things like helping him get to his medical and wellness appointments, to more complex challenges like working with several medical vendors until she succeeded in getting Mark’s prosthetic leg properly fit and setting him up for rehab.

MLTSS is just one way that Horizon’s people work closely with members to help them understand and get the most from their benefits while navigating the health care system to achieve their best health.

More than half of Horizon’s 5,500 employees are engaged in direct, person-to-person roles with members and customers. Nurses, case and care managers, member service representatives, account managers, personal health assistants and health educators all spend their time bringing to life Horizon’s guiding principle: “Care for our members.”  They answer questions, big and small, and solve problems, simple and complex. Above all, they share a common view that being New Jersey’s hometown health insurer means exceeding expectations in taking care of members, because they’re also neighbors, family and friends.  

When Rob Mills, a customer service representative in Horizon’s call center in Wall Township, NJ, took a call from a member who had just undergone throat surgery as part of his treatment for cancer, he never imagined that his work that day would earn him a national customer service representative of the year award. Rob’s call that day was unique in some ways, but Rob handled it the same way he does every call.

The member was calling with some questions about billing and post-surgery care. But the surgery was making it difficult for him to speak.  So with the member on the line, Rob placed calls to physicians and pharmacists and became the voice of the member, literally and figuratively, explaining what he needed, scheduling visits and arranging care.

Rob and Jacquelyn personify Horizon’s commitment to making Blue work for its members by going above and beyond to provide one-on-one help and advocacy, solve problems and calm that perfect storm. “With this position I can see day to day how much we are helping people. It’s nice to know that you are making a difference,” said Jacquelyn.