Making the Most of Life While Living With Complex Care Needs

Last update: Oct. 12, 2020

Alma’s* high blood pressure was first noticed during a wellness exam when she was 46. After that visit, she didn’t make any changes to her diet, exercise or take her prescribed medicines. Over the years, she had an emergency department (ED) visit for a heart attack and later experienced a stroke due to her hypertension. She now benefits from the care of our UnitedHealthcare Community Plan complex care team in Texas. Her blood pressure is now managed to help prevent further complications, such as renal disease and vision loss. And best of all, she’s able to spend time with her children and grandchildren in her own community.

We use complex care management for our members who are living with chronic and/or complex conditions and have a high risk of worsening health and repeat hospitalizations. These conditions may include heart disease, chronic kidney disease, asthma, chronic obstructive pulmonary disease, diabetes and hypertension.

Members in our Children’s Healthcare Insurance Program (CHIP) (excludes CHIP perinate members), STAR, STAR Kids and STAR+PLUS programs can benefit from this program. They can be referred by care providers and caregivers/family, or they can refer themselves. We also sometimes refer members based on where we see services are being used, such as the ED, and where preventive services could be put into place.

Our complex care approach involves a multidisciplinary team that begins with the member in a person-centered approach. This includes the family, primary care and other providers as well as hospitals. Together, we work toward increasing member involvement in the management of their long-term care and wellness. This way, the member has a clear plan of care to help them with medically necessary services, such as long-term services and supports (LTSS), behavioral health, equipment and supplies, rehabilitative therapies and transportation.

*Alma is a fictitious name that allows us to share member experiences while protecting their privacy. 

 

To learn more about this program, call Customer Services at 888-887-9003, Monday – Friday, 8 a.m. – 6 p.m. Central Time. 

 

Join us for a workshop series in Advancing Complex Care Philosophy: Tools for Healing-Centered Care, which is open for registration on OptumHealth Education:

This training consists of seven, 30-minute courses designed to go beyond the philosophies of complex care to develop a skillset and obtain tangible resources for empowering healing with individuals you serve. Each course is delivered live every Tuesday at 2 p.m. CST by a group of 14 subject matter experts. His series is accredited for up to 7 CEs.  See more at uhcprovider.com > Menu > Resource Library > Healthcare Professional Education and Training > CME Credit Courses and Programs > Go to Optum Education