Evolent Clinical Operations Manager Tiffany Carter, MSN, RN-BC, leads a team of community health workers, health educators, social workers and Care Advisors supporting 2,500 high-risk members who are dually eligible for Medicare and Medicaid. In response to the COVID-19 pandemic, the entire team quickly mobilized to contact all these members to ensure they have everything they need to maintain social distancing, such as medications, food and durable medical equipment supplies.
One such interaction with "Rose," stood out to Tiffany. Rose lives alone with several ongoing health issues and doesn't have anyone to help her. While she certainly has medical needs, her primary concern was running out of food before her regular monthly food assistance benefits were replenished. Rose knew she was considered at risk of serious complications from COVID-19 and was terrified to leave her home to purchase groceries—even during senior shopping hours. She'd been at a loss, and Tiffany's call couldn't have come at a better time.
Tiffany helped Rose connect to a new emergency food program in her community that offered delivery of a week's worth of prepared frozen meals to seniors. Rose was instantly relieved. She had not previously known about the community resources available to her during this crisis, and she told Tiffany that she planned to call the service immediately.
The team's COVID-19 outreach effort, on top of normal member support and services, is stressful and at times overwhelming, but the team knows their hard work is making an impact. As local governments and community organizations quickly stand up programs to help individuals through the pandemic, her team provides a critical link, ensuring these members know about the new resources and can tap into them.
"The members are very thankful," Tiffany said. "I can hear them getting a pad and a pen to write down the information I'm telling them. It's encouraging to know we're offering some comfort and essential resources to them during this time."
Every day, members of Evolent's care management teams use their clinical expertise and problem-solving skills to help individuals overcome serious health challenges. The Heart of Care series tells stories from the field that highlight their dedication to patients. For more information, see the blog post by Evolent CEO Frank Williams.