It’s Debra Coughlin’s job to help patients like Percy* understand and follow their doctors’ advice.
Coughlin is an Optum performance and quality specialist who works with Percy’s Medicare Advantage Insurance plan. When the plan realized Percy wasn’t refilling his medications on schedule, Coughlin went into action to figure out what was going on.
She called repeatedly, left messages and finally got the older man on the line.
“Right off the bat, I could hear the frustration in his voice,” she remembers. “He told me he was tired of driving to the pharmacy every 10 days!”
COVID fears endangered member’s health
While running to the pharmacy three times a month would be inconvenient in normal times, it felt potentially dangerous to Percy in the age of social distancing and stay-at-home orders. That’s why he wasn’t picking up his medication refills.
Fear of contracting COVID-19 was inadvertently putting Percy’s health at risk.
Coughlin discovered he was running dangerously low on two critical medications — one to control his cholesterol, the other his blood pressure.
“He asked me if I could help him get a 30-day refill,” she recalls. “And I said, ‘Actually, what I’d like to get you is a 90-day refill.’”
Investigating problems with electronic health records
Coughlin went to work making phone calls and digging into the case, but telephones and email aren’t the only tools at her disposal.
Using remote access to Percy’s doctors’ electronic health records (EHRs), Coughlin figured out what was wrong. It turns out a doctor had approved 90-day refills months earlier, but that approval wasn’t being applied at Percy’s neighborhood pharmacy.
Coughlin tracked down the exact date of the approval, which helped the pharmacist find it in her system. The pharmacist made the change allowing for 90-day refills.
Coughlin went a step further and lined up free home delivery for Percy.
The Post-it note Debra Coughlin keeps tacked to her desktop provides inspiration
Improving health and reducing costs
When Coughlin and her colleagues solve problems for Medicare Advantage members, it’s a win-win-win situation — for patients, doctors and health plans.
Not only is Coughlin improving Percy’s health by helping him get his prescriptions safely, she’s also helping his Medicare Advantage plan provider be more effective and efficient.
Thanks to Coughlin’s intervention, Percy is less likely to end up in the emergency room. That’s one way quality and performance specialists help keep health care costs down.
Another way involves helping health plans meet federal quality ratings. When plan members follow their doctors’ orders, take their prescribed medications and get regular health screenings, members not only stay healthier, but their plans may also be eligible for rebates — money back — from the government.
The government also scores Medicare Advantage plans to help seniors know which plans might best meet their needs. Plans with higher ratings can attract more members and help keep those members engaged and healthy.
Peace of mind for seniors
The next time Coughlin was on the phone with Percy, she could hear a distinct difference in his mood.
“As soon as he heard my voice, he seemed very happy, and his voice was much lighter,” remembers Coughlin. “I could sense the relief in his voice. He seemed excited to tell me about the pharmacist’s call and the ins and outs of home delivery service.”
What drives Coughlin to go to such great lengths to help patients? She explains in the video below.
*Optum respects members’ privacy; that’s why we changed the name of the member helped by Debra Coughlin.