By addressing hidden financial and social barriers, we didn’t just ease a patient’s stress | we restored her access to life-saving medication and daily stability.
Situation During a routine CCM outreach call, unaddressed stressors: an unaffordable $400 deductible for her vital medication (Eliquis), unmanaged leg pain due to an unreachable specialist, and mounting utility bills that threatened her financial independence.
Intervention
- Prescription Cost Relief: Connected the patient directly with high-impact assistance foundations (Eliquis 360, PAN, HealthWell) and mapped out a step-by-step navigation strategy.
- Socioeconomic Support: Integrated Georgia-specific senior safety nets (LIHEAP and GA Power Senior Program) into her care plan to permanently lower home utility expenses.
- Clinical Advocacy: Facilitated specialist follow-ups to resume her pain management regimen and educated her on community food and home support services.
Outcome & Impact
- Prescription financial strain eliminated through targeted assistance programs
- Home utility safety nets established to protect ongoing financial stability
- Specialist care re-engaged to address unmanaged chronic pain
- Patient expressed deep emotional relief, stating she felt truly blessed and no longer alone
Value Delivered
- Overcame critical SDOH and financial barriers to sustain long-term medication adherence
- Prevented potential disease progression and avoidable acute care utilization
- Strengthened patient trust and retention in the Chronic Care Management program
- Delivered holistic care coordination that addresses whole-person health