Care Management Success Stories

Examples of the care manager/member partnership

At Tufts Health Plan, care management is an integral part of every plan we offer. Our care managers work hard every day to identify members who need a little extra help. They then proactively reach out to those members to help keep them on track. Here are two examples of this unique partnership in action. 

From fear to optimism

A 49-year-old female member was newly diagnosed with breast cancer. She was referred to care management for education regarding her diagnosis and treatment options, understanding of her benefits, help with choosing providers (including a new PCP and an oncologist) and to see what support was available to help her cope with her diagnosis. 

“…feeling much more optimistic about her future”

The nurse care manager (NCM) provided the member with extensive education on treatment options and diagnostic and genetic testing. She enrolled the member in the MyConnect app to access Member Services, who could answer her benefit questions and assist with the selection of new providers. This also provided a quick and easy way to send her NCM a message in between calls. The member then began seeing a behavioral health provider to help her cope with everything.

Once a plan of care was established, the NCM was able to educate the member on her specific treatment and what to expect. She had surgery and will continue her treatment with radiation. She now reports feeling much more optimistic about her future.

Changing habits changed her life

A 61-year-old female member began working with a health coach in November 2019 to find healthy options for decreasing her blood pressure and stress levels. She felt the two hours she spent commuting each day - along with the stress at work - was taking a toll on her health and how she approached her wellness.  Being a life-long learner, she was open to any resources her coach could provide around healthier eating, increasing her activity, and decreasing her stress.

After discussing the benefits of plant-based food plans with her coach, she started to incorporate more food from the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets. She also began walking more, both on her home treadmill and outside. She and her health coach set a goal of 4,000 steps in the morning before her workday began. Being home- based for work since the start of the pandemic, the member was able to fit more walking breaks into her day which helped to decrease her stress levels along with her blood pressure. 

“…increased her average steps to 10,000 a day”

Empowered by her recent lifestyle changes she decided to establish a health-focused connection with her co-workers, and developed a successful virtual walking challenge with them - in the process, she increased her average steps to 10,000 a day. She also spoke with a counselor once a month, and rekindled many friendships by organizing a weekly Zoom cocktail hour. 

The member continued to work with her health coach via the MyConnect app, and was able to maintain her 10 lb. weight loss with healthy eating, physical activity, and a low-stress lifestyle. She reports feeling a great sense of work-life balance, and more in control of her overall health and well-being.