Coordination for Many Health Problems


Care coordination diagram including primary care, laboratory, hospital, pharmacy, specialist

Care Coordination


An older adult couple, both with multiple chronic conditions, has chosen to enroll in MI Health Link in Macomb County. The couple had been overwhelmed and unable to manage their needs without support. They do not drive and had problems getting to doctor visits because of limited access to transportation. To supplement needed rides, they would save up for taxi rides and limit their appointments to the transportation they could afford. As a result, they fell behind on needed medical care. Husband had not been to the neurologist and the wife had not received needed OBGYN care. Both had not been to a dentist in over a year. In addition, the husband had an untreated hearing loss. These conditions, combined with the lack of natural supports to coordinate the care they both needed, became overwhelming.
Through MI Health Link, they now have a care coordinator to assist them with their needs. Their dual integration program provides them with unlimited access to medical transportation removing that barrier to health care. Their care coordinator scheduled an appointment with their Primary Care Physician (PCP) for complete physicals and has discussed the hearing impairment need for EENT, OBGYN and neurology follow up. The plan PCP will work with the care coordinator to assure the couple gets the medical care they need.
Care Coordination is a vital component in assuring this couple is able to live in the community and experience good health outcomes. They have both commented how much better this program is when compared to what they had experienced before. They are very happy with their health plan, love their care coordinator, and are telling others to join their program too.