Going above and beyond to help high-need patients

Better experience

Going above and beyond
to help high-need patients

Aspire social worker Reba Pinner embracing patient Patricia Graham

Many patients with life-threatening or complex conditions cycle in and out of hospitals, yet don’t receive the personalized care they need, including social and emotional support. Anthem is broadening the scope of healthcare and delivering better outcomes for these highly vulnerable people.

Prakash Patel, MD, Executive Vice President and President of Anthem's Diversified Business Group, Anthem

Anthem’s expanded and integrated capabilities for high-need patients go above and beyond what is traditionally considered “healthcare” – things like opening an emergency food pantry, providing home visits to lonely seniors, or supporting people recovering from substance abuse with an innovative, home-based protocol.

Case in point: When Aspire nurse practitioner Pamela Sisk visited her patient, Patricia Graham, she quickly saw a person in distress. While Patricia had recently been added to the list for a critical liver transplant, the hospital and physicians who would do the surgery were based in Charlotte, NC – far from her home in Greenville, SC. That meant Patricia wouldn’t be eligible to use transportation services through local agencies.

“It was just unfathomable that she would have to literally go to the state line, get out of the car and get picked up by another service for what would be more than 20 visits,” says Pamela. “I just had to do something, so my first phone call was to our social worker, Reba Pinner, to see if she could help.”

Contacting the local American Cancer Society chapter, Reba was able to secure not only transportation for the two-hour drive, but also coverage for lodging and meals for every visit. “It was the best news we could have imagined,” says Lora, Patricia’s daughter and primary caregiver. “This transplant meant the difference between life and death for my mother. Being able to keep up with all of the appointments to maintain her status on the list meant we would have more time together.” Patricia has since had the transplant and has been recovering well.

Reba and Patricia share a light moment

“Our mindset at Aspire is that our patients should focus on their health and we’ll take care of the rest,” says Reba. “There is really nothing more rewarding than to be able to take the burden off the shoulders of our patients and their families.”

In fact, Aspire treats thousands of patients in need of palliative and end-of-life care across 26 states. The model, which has generated high patient satisfaction rates, includes integrated care teams that include physicians, nurse practitioners, social workers and community health workers.

Meeting needs, from food to mental health

CareMore Health leads the industry in providing preventive and highly coordinated care to manage chronic disease and address the medical, social and personal health needs of Medicare and Medicaid patients.

The Fort-Worth, Texas CareMore Care Center that opened its doors in July of 2018 to serve the Medicaid and Medicare populations in the Dallas-Fort Worth area, illustrates this commitment. CareMore associates realized that a large percentage of their patients were identifying as food insecure, so they subsequently created space in the Care Center to house the H.O.P.E. (Helping Our Patients Eat) Pantry, which includes a refrigerator, freezer and shelving to store fresh produce and healthy packaged foods.

While not in the blueprint when the Care Center was built, “the food pantry is what was needed for our community and our patients, and that’s what CareMore does,” says Karim Kaissi, CareMore’s general manager in Texas, who shares more in the video below.

When it comes to keeping patients out of the hospital or reducing the time they have to stay in the hospital, CareMore consistently demonstrates impact on complex care patients compared to the Medicare average:

fewer inpatient admissions & lower inpatient length of stay
lower inpatient bed days
fewer acute hospital readmissions

“Our goal is to improve overall outcomes for people with complex and chronic conditions,” says Prakash Patel, MD, Executive Vice President and President of Anthem’s Diversified Business Group, Anthem. “That’s why, through our acquisition and integration of Beacon Health Options, we are building on our current capabilities and creating one of the most comprehensive behavioral health networks in the country.”

At Anthem, the commitment to expecting more of ourselves means our consumers can also expect more from us. Our companies are making significant progress in addressing the things happening outside the exam room and hospital that influence the health of millions of high-need patients.