Upon opening the Jvion web portal, I saw a member that was flagged as being at risk for kidney failure, heart failure, electrolyte imbalance, and medication non-adherence. To reduce his risk, the CORE recommended I assess the member for social support, health literacy, self-management challenges and barriers to care.

Within minutes of our first conversation, the man shared how frustrated he was by a recent failed attempt to pick up the new diuretic his cardiologist ordered to reduce the swelling in his leg. With the information in the Jvion portal, I knew he may have trouble advocating for himself, and decided to contact the health plan’s pharmacy customer service team for support with the member still on the call so we could work together to rectify this. During the call, we reviewed his medications and realized that his new prescription was for a medication he was already taking. The customer service rep showed that the man had not yet received his Bumetanide via mail order, and arranged an urgent shipment so he could resume his medication regimen as soon as possible.

Without a nudge from the CORE that this gentleman may struggle with the complexity of the healthcare system and lack support from family and friends, I probably wouldn’t have explored those areas first. This information helped me feel more confident and act more authoritatively up front to build our relationship and then pursue improving his self-management after obtaining his important medication. I definitely believe the CORE helped me curve his trajectory away from an avoidable admission.

Through member interactions like these, a national health plan found they could save $3.7 million a year in avoided admissions.