Improving Member Outcomes

At California Health & Wellness, we are responsible for coordinating health services for people enrolled in the Medi-Cal Program. Our commitment is to positively transform the communities in which we live, work and serve through improved access to quality healthcare and support. Simply put – we’re here to help our members get well, stay well and be well.

Below are some stories of California Health & Wellness’s exceptionalism in the field with our members and how we aspire to deliver a positive difference in our members’ lives.

Two of California Health & Wellness’s Member Connections staff, were on a routine immunization check in Placer County and found themselves on a lonely track of a dirt road, surrounded only by trees and the greenery in the obscurity of the Sierra Nevada Mountains. All they knew was this road was leading them to the two year old member’s home.

When the two Member Connections representatives arrived at the member’s home, they needed to speak with one of her parents. The only parent home was the member’s father and he had communicated to California Health & Wellness staff that he was deaf, which had not been known before arrival. This would have presented a serious barrier in communicating the necessary information over to the parent about their child’s vaccination needs. Thankfully one of the member connections representatives was a newly hired American Sign Language (ASL) translator and was able to communicate with the father.

The Member Connection staff’s ability to communicate in ASL allowed him to convey critical information regarding vaccinations to the member’s father and ensure the health of his child.

When asked about the experience Member Connection representative stated, “I feel like it was definitely an exciting opportunity for California Health & Wellness to meet the diverse needs of our members, and their families. The Deaf community is vibrant, has roots in world history, as well as American history. There are so many positive aspects to the Deaf community; however the Deaf community experiences a lot of oppression, or Audism, which is discrimination and the notion that one is superior based on one’s ability to hear.”

He then added, “I think having this cultural component in California Health & Wellness means that more of our members will feel understood, respected, and equal. I believe the father felt that his language needs were being met, and that he knows he could reach out to our health plan and there would be no communication barriers between his family and California Health & Wellness.”

Without the Member Connection representative’s ability to communicate with the member’s father, information that may have been crucial for her health may have not been learned and understood. The ability for California Health & Wellness to extend its services beyond a physical location to the homes of members allows for incredible moments like these. Moments where individuals whom may have been too embarrassed and/or nervous because of their disabilities were sought out and taught valuable medical information.

Adolfo Valdez has lived with Type I Diabetes for more than 20 years and needs to inject himself with insulin four times a day. Last year he lost four toes on his left foot due to complications with Diabetes. He heard of a special molded shoe and insert that would help him following his surgery and asked his doctor about it, only to be told that it was not covered with his plan. If he wanted the shoe and insert, he would have to pay $800. Since he has a low income, he could not afford the equipment. Saddened by the news, he slipped into a state of depression.

Nurtur referred him to Program Coordinator Nancy Lechich to see if we could help with his Orthotics. During the conversation, Nancy discovered that Mr. Valdez was suffering from pain in his foot. Since he has not been able to walk properly for over a year, he has developed severe back pain as well, which has had a negative impact on his mental health. Nancy researched available resources and discovered that the special shoe he needed is covered through California Health & Wellness.

Mr. Valdez was overwhelmed by the good news. He told Nancy that he was raised to never question a doctor’s judgment. If the doctor said “It’s not covered,” then it’s not covered. Nancy used this opportunity to educate him on the many resources we have available to him and how we are always here to help him navigate the health care system.

Nancy had difficulty setting an appointment with his original doctor. To ensure we did everything in our power to get him what he needed in a timely manner, she worked with another specialist in Imperial County, Dr. Carlos Ferrari. In a short period of time, Mr. Valdez had an appointment to have a special shoe fitted, along with an orthotic insert for his right foot.

Within two weeks, Mr. Valdez will have the new custom equipment. He could not be happier with California Health & Wellness, and the fact that we did not stop until we found a solution for him.

“I have been so depressed, my back hurts because I have a boot they gave me when I left the hospital that has not helped at all and it’s all I have had for over a year,” he said. “One day I received a call from Nancy and she changed my life. She gave me hope and I am so thankful she called me and listened to what I had to say.”

Not only has Nancy and California Health & Wellness resolved a serious problem for Mr. Valdez, but we have also empowered him to make healthy decisions. He added, “I tell all of my friends and family to call California Health & Wellness if you have questions and need answers. They will help you.”

California Health & Wellness contributed to an entire Hmong community overcoming their biggest barrier to health care. On April 9, 2015, CH&W coordinated its first community Listening Session which was hosted by the Disability Action Center (DAC) in Chico, CA. The event consisted of 10 Hmong elders from the Hmong Disability Rights Council. The discussion uncovered that despite many challenges the Hmong community faces, their biggest barrier to health care was actually a broken water pump.

The community farmer had been growing fruits and vegetables not just for his family, but for an entire Hmong community, which consists of several CH&W members. The families of the community came from Laos, where they grow all the food they eat and also represents a large part of their culture and how they interact with each other.

When the water pump broke, the farmer was required to pull 24-hour shifts to water his land. The faucet that would dispense water would only send drops at a time which meant getting an adequate amount of water required hours of waiting. Often this meant dawn to midnight shifts of carrying a bucket to his crops and watering by hand. With this challenge, the Hmong community began purchasing processed food from the store which was literally making them physically ill, and by getting away from their culture’s way of life, had a negative impact on their mental health.

CH&W and the DAC offered to replace the broken water pump and help the community. For just $2,000, CH&W and the DAC replaced the water pump and transformed the mental and physical state of the community members back to where they needed to be.

California Health & Wellness is a company that provides more than just health care, we pride ourselves on ensuring the wellness of our members as well, hence the last portion of the name, Health & Wellness. Through one of California Health & Wellness’s partners, Nurtur, the plan was notified that one of its members had just previously lost their health benefits and needed help. Immediately one of our program coordinators got in contact with the member and uncovered a very peculiar situation, their illiteracy had prevented them from completing an income verification vital to the continuation of their health benefits.

After speaking to the member California Health & Wellness learned that the member and her son were both unable to read or write, while her husband could do both, he worked in another city and was unable to help with the current situation. The program coordinator then took it upon her to get in contact with the organization responsible for pulling her health care benefits. After a quick phone call, the coordinator was able to find a number for the member to complete her income verification over the phone.

After the member had been notified of the alternative way to complete her and her family’s income verification, the coordinator took it upon herself to ensure this problem never happens again. The coordinator suggested a method through pictures and audio recordings the member and her husband could create a catalogue of resources she would need to continue receiving health care while he was away.

Although her illiteracy may pose significant hurdles in her everyday life, at the very least California Health & Wellness and its staff were able to ensure that their member’s health and wellness were both kept intact.