One Member at a Time
When you are an Optima Health member, you have a team dedicated to your medical care and well-being. Your doctors, Optima Health medical support team, and Care Coordinator work together to address your healthcare needs. We can also help connect you with healthy food, safe housing, job resources, and other assistance.
Get to know more about how Optima Health makes a difference to our members and the community we serve.
A Little Extra Love Goes a Long Way
Making sure you are okay matters to us. Jacqueline, an Optima Health member, recently praised the care she received from our team after a sudden emergency room visit. At 16 weeks pregnant, Jacqueline had just become unemployed, but kept hope that she and her unborn baby would be in good hands with her Medicaid health insurance.
Health Care for the First Time in 15 Years
Andrea, 33, had lived without health insurance since she was 18 years old. She worked at least one, sometimes two, full-time jobs, but none had offered health insurance. Since she was a child, she suffered from respiratory issues which left her sick four to five months of every year.
New Housing Offers More Freedom and Fewer Health Problems
Angela credits the teamwork of her Care Coordinator, Transitional Care Coordinator, and Housing Specialist for giving her new independence and better health. They worked together to move her out of a long-term nursing care facility and into her own apartment.
One Member at a Time
Transcript
Daniella Harold, Care Coordinator, Optima Health Community Care:
My name is Daniella Harold. I’m a Care Coordinator for Optima Health Community Care. Most of the members that we see are vulnerable or emerging risk.
Randy Ricker, Vice President, Optima Health Community Care:
Optima Health Community Care is a new program to serve the special population of Medicaid recipients here in the state of Virginia. Optima has grown with the state of Virginia over a 22 year period in managed Medicaid and our population has grown to now over 180,000 Virginians covered under our core Medicaid plan.
Daniella:
As the Care Coordinator I will be there to support them. A lot of times in their previous interactions they haven’t had anyone care or they feel that no one cares. So they kind of feel defeated. I make sure to take everything in that they tell me and that I’m making sure that it’s being addressed and heard.
Amanda Becker, LCSW, Director of Behavioral Health and Addiction Services, Optima Health Community Care:
Sometimes the systems that we’ve developed to help people are so complicated that no one can manage them on their own. So as we added more and more Care Managers into people’s lives, it allows for you to get that communication going and be able to establish a model of care that actually is going to attend to the needs of that member.
Daniella:
The program itself is patient centered. It’s individualized to the member. We do an individualized care plan with them at the end of their assessment and that care plan outlines goals that they want to work on - short term and long term goals.
Randy:
That idea of having a member have goals for their life, you don’t do that in insurance! This is a different program. The member's experience is being heard and understood by somebody whose whole job is to get to know them and help them navigate the system. It’s transformative.
Daniella:
We start to build a rapport, we check in if they’ve got a doctor’s appointment coming up, make sure they have transportation to it because some don’t. We have members who sometimes don’t have housing. We have members who need food and pantry resources.
Amanda:
That Care Coordinator is looking from the top down and she, or he, is able to see all the different players that are providing care to this member on all the different levels. Where are we overlapping resources? Where are the gaps in care? What are - who’s not at the table that needs to be at the table? But also develop relationships with our member.
Daniella:
I want to make sure that they know if they call Optima Health Community Care, they’re going to speak to me and I’m going to get it done.
Randy:
Our mission, being part of Sentara Healthcare, is to improve health daily. And that’s a critical part of this program.
Daniella:
I think the most important thing to understand about the Optima Health Community Care program is that we are doing this for the members and we all have one goal, which is to make sure these members are healthy and that we give them the support that they need.
A Little Extra Love Goes a Long Way
Making sure you are okay matters to us. Jacqueline, an Optima Health member, recently praised the care she received from our team after a sudden emergency room visit. At 16 weeks pregnant, Jacqueline had just become unemployed, but kept hope that she and her unborn baby would be in good hands with her Medicaid health insurance.
After being in two car accidents, she decided to visit the ER to check on her baby’s health. Over the next few days, Jacqueline received some unexpected phone calls. “I had people calling me from Optima Health just to make sure I was okay and that my hospital visit was up to par. This has never happened before with my insurance," she said.
Jacqueline was thankful for the personal attention she received from Optima Health. Our team of care coordinators provided her with the support she needed through this tough time. Jacqueline shared, “Just feeling that little extra love helps me know I made the right choice in coverage. I will forever have Optima for my coverage as well as my children!”
Health Care for the First Time in 15 Years Means No More Missed Work Days Resulting in Promotion
Andrea, 33, had lived without health insurance since she was 18 years old. She worked at least one, sometimes two, full-time jobs, but none had offered health insurance. Since she was a child, she suffered from respiratory issues which left her sick four to five months of every year.
When Andrea was approved for SNAP benefits, she was surprised to learn she would also receive Medicaid. Even though she was sick with bronchitis when her member ID card arrived in the mail, she hesitated to use her benefits. She thought only people with serious diseases or disabilities had the right to Medicaid.
Andrea’s Care Coordinator helped change her mindset. She encouraged her to take advantage of the benefits, and completed her health assessment. Her Care Coordinator referred her to a dentist, a counselor, and other specialists she could trust. Since becoming an Optima Health member, Andrea has had regular teeth cleanings, weekly therapy, two pre-cancerous moles removed, physical therapy for a long-term pain issue, and an allergy test that confirmed the source of her respiratory issues.
“The solutions to my emotional and respiratory issues have been the most profound,” said Andrea. “I've been known as that person at work who can't be relied on because I call out so much. Between bronchitis, strep throat, and sinus infections, I can't even blame the people who felt that way. I'm thrilled to say that issue is behind me! I have not missed work since December 2019!”
Not only has Andrea not missed work, she was promoted. “The owner of the business even told me ‘Andrea, I've seen such a change in you this last year!’ I say with 100% confidence that I have health insurance to thank for that,” said Andrea. “This year has been by far the best one of my life, thanks to Medicaid and Optima Health.”
New Housing Offers More Freedom and Fewer Health Problems
Angela credits the teamwork of her Care Coordinator, Transitional Care Coordinator, and Housing Specialist for giving her new independence and better health. They worked together to move her out of a long-term nursing care facility and into her own apartment.
Since moving, Angela said she has “more peace of mind, more stability, better health, and I haven’t been sick for any reason at all since I’ve been home.” She has a Personal Care attendant who cooks healthy meals for her, which she said has helped her lose weight. Angela said she no longer runs out of clean clothes because her aide does her laundry every day. Now that she can schedule her own transportation, she never misses any medical appointments.
Angela also said she feels a certain amount of freedom in her own home. “My social life is better, just being out in the community, and not being confined. No curfews like at the nursing facility.” She said she attends church every Sunday, Bible Study, and can have visitors anytime she wants now.
“I can take care of myself and have more peace of mind. I am much happier and healthier than I have been over the last ten years, when my health declined.”