Charleston, W.Va.: The West Virginia Association of Health Plans (WVAHP) announced the winners of its third annual iCare Awards on December 2nd at a ceremony held at Little Creek Golf Course. WVAHP is a trade association made up of the managed care organizations (MCOs) that service West Virginia’s Medicaid program. The iCare Awards are given to front line employees of WVAHP member-MCOs who have demonstrated exemplary care and service to West Virginia Medicaid members in helping them achieve positive outcomes in their healthcare delivery.
“Managed care focuses on delivering quality healthcare and improving health outcomes through their coordination of care approach,” said Ben Beakes, executive director of WVAHP. “The healthcare professionals of our MCOs are committed to finding solutions that best fit the needs of their members. Most do not realize that our employees are registered nurses, peer support specialists, case managers, and social workers that want to serve their fellow West Virginians.”
“If you listen to the stories of our iCARE winners you will see there isn’t always a simple solution. Most of the time it is a team effort centered around a common goal. Our Medicaid members have experienced better health outcomes because of the care and commitment of these healthcare professionals,” Beakes said. “WVAHP is proud to honor and recognize the 2021 iCare Award Winners.”
The Winners
The 2021 iCare Awards recognized the winners for one or more of the following characteristics: innovation, care management, and/or community engagement.
iCare 2021 Award Winner:
Lori Fizer, Aetna Better Health of WV – “Run to the Fire”
Fizer works with her member “Cory” through a new program called the Children with Serious Emotional Disturbance (CSED) Waiver. CSED is designed to provide intensive services in the homes and communities of children with behavioral health diagnosis. At a very early age, “Cory’s” parents lost custody of him, and he spent most of his young life in different placement facilities, shelters, and treatment centers. Just recently his biological mother passed away from COVID. In June 2021, “Cory” was court ordered to begin living with his grandmother. Fizer worked with “Cory’s” DHHR worker and his grandmother to begin CSED services - weekly therapy, support services, assist with needs, review plans, and communicate with providers. Several weeks after “Cory” started services, his grandmother’s home caught fire. The home was a total loss, and the family was left with just the clothes on their backs. Fortunately, no one was injured, and everyone made it out safely. When Fizer learned about the fire, she immediately contacted local churches, and HUD services, while others coordinated efforts with other organizations and began a Go Fund Me account for the family. “Cory” and his family have been able to get through this traumatic event and continue to work well together. This is a great example of how important teamwork and coordination of care can be in a member’s life. Watch her story here.
iCare Runner-up Winners:
Kimberly Messer, Aetna Better Health of WV – “Sounding Board”
Michelle Tracy, The Health Plan – “Doing What’s Right”
Andi Dearien, UniCare Health Plan of WV – “Making Connections”
Messer had an 18-month-old member who was in the foster system. The mother had SUD issues and the child was born with extensive health problems – neonatal abstinence disorder, fetal alcohol syndrome, congenital plagiocephaly, hydronephrosis, and cerebral palsy. The child was placed in kinship foster care with the maternal aunt and uncle who wanted to adopt her. The member has a team of specialists and is receiving services from birth to three, physical and occupational therapy, children with special health care needs and much more. Just recently the child received her first set of glasses and the foster mother said, “it opened up a whole new world to her.” She also told Messer, “you are like my therapist and my sounding board” and was very thankful for every call and assistance on benefits. Messer is grateful for a successful partnership. Watch her story.
Tracy was the case manager to a young lady who suffered a head injury due to a motor vehicle accident. Tracy followed her through her hospital stay, acute rehab and assisted with her transition home. Member was doing well, and the case was closed. Fast forward two years and Tracy was reassigned to this member but this time it was unfortunately for anorexia and the prognosis was not good. After exhausting many attempts to find an inpatient eating disorder facility in WV, Tracy was able to get the member transferred to the Renfrew in Philadelphia. Once discharged the member would need extensive out-patient care for adults with eating disorders and was eventually placed at Chestnut Ridge for therapy. The member’s mother was very thankful for Tracy’s help and the member is now working two part time jobs, living a productive life, and has had no further admissions. Watch her story.
Dearien had a member “David” that had recently been discharged from the hospital after having a stroke. While in the hospital he developed congestive heart failure. Sadly, he had no help at home, no family and no one to help coordinate his needs. Dearien was able to provide “David” with case management services and make his life at home much safer for his health condition. Dearien spoke to three different agencies in Welch, WV and was able to get a handrail installed on the steps leading up to his house, and a shower bar and new toilet installed in bathroom. Dearien also contacted the Commission on Aging and increased the number of days someone came in to help “David” and placed him in the Meals on Wheels program. “David” can now safely and successfully continue to live at home. Watch her story.
iCare Honorable Mention:
Karen Dominick, Aetna Better Health of WV – “Do Not Stop”
Sheri Meyer, The Health Plan – “Team Approach”
Cynthia Morris, UniCare Health Plan of WV – “Path to Success”
Dominick is a Peer Support Specialist and had a member “Joe” that suffered with alcohol use disorder. “Joe” wanted to achieve sobriety but struggled asking for help. He dealt with financial hardships and did not have reliable transportation so attending appointments was difficult. In the beginning, “Joe” and Dominick spoke twice a week to establish goals, focus on recovery and implement healthy coping skills to minimize his cravings for alcohol. “Joe began expressing interest in finding work, so he and Dominick discussed options suited to his situation. After several months of continued peer support, Joe began applying for jobs. In August of 2021, “Joe” began showing signs of depression due to a few job opportunities that did not work out. Dominick continued her outreach to “Joe” and eventually he resumed peer support. In October 2021, “Joe” received a job offer that was fully remote and was able utilize his skillset working for Google. Watch her story.
Meyer’s member “Freddy” had multiple health issues including diabetes, morbid obesity and is reliant on his electric wheelchair. “Freddy” was scheduled to have a heart cath one Friday at 6am which was a problem since he was dependent on the bus system and the bus didn’t run that early. His plan was to go to the hospital late Thursday evening and sleep there so he would be on time for his appointment. Meyer knew this was not a safe option and called the doctor in hopes of getting “Freddy” a later appointment. Unfortunately, that was not possible. Meyer called the hospital’s pastoral services asking for help. The vice president of the hospital called Meyer and expressed his concerns about “Freddy’s” situation. He explained to Meyer that the hospital’s ambulette service that transports dialysis patients was willing to add “Freddy” to their schedule. They began running at 5am and were accustomed to helping people of his size. Meyer was tearfully thankful for the good news.
In 2021, Morris accepted a position for the NICU case manager. Morris had experience in high-risk obstetrics and NICU case management. UniCare had a robust SUD program for their pregnant members but no case manager. Morris presented a proposal to combine the two programs and with leadership approval, she is now managing the NICU infants, maternal SUD members, and infants with neonatal abstinence syndrome. The program is growing, and Morris can reach mothers in their pregnancy to begin building a trusting relationship that will continue through delivering the baby. Watch her story.
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About WVAHP: The WVAHP is a trade association comprised of West Virginia’s Managed Care Organizations, including Aetna Better Health of West Virginia, The Health Plan, and Unicare Health Plan of West Virginia. The WVAHP was formed in 2016 with the goal to provide assistance to the state of West Virginia in its transition to managed care Medicaid delivery, reduce costs of administering West Virginia’s Medicaid system and improve the health of West Virginia’s Medicaid recipients.