When Premera’s internal systems noticed a 50-year-old member from Pasco, Washington wasn’t getting the care they needed, there wasn’t a clear sign of crisis. Instead, what our team noticed was a subtle pattern of missed and delayed care.
Living with Type 2 diabetes, arthritis, and other chronic conditions, the member was struggling with medication side effects and finding it difficult to attend follow-up appointments due to work commitments. Their A1c, a key measure of blood sugar control, had not been checked since March 2024, when it was well above recommended levels.
Premera’s systems and teams monitor for situations like this one, which prompted our care managers to reach out and identify ways we could support the member in getting the care they needed.
Moving the right direction with help
Despite some initial hesitation, the member opened up during a third outreach call with a Premera case manager. They shared that they had stopped taking one of their prescribed medications due to side effects and felt that they were falling behind on other areas of care as well
Premera’s case manager listened without judgment and helped the member get enrolled in Premera’s Diabetes Management program through the Wellframe app, even though the member reported not feeling “tech-savvy.”
Over the next few weeks, the case manager continued to follow up with the member, working together to develop realistic diet and exercise goals. The member enrolled in supplementary programs to support their progress toward a healthier lifestyle and reconnected with their primary care provider to discuss alternative medications.
An unexpected emergency
Then, on April 29, the member visited the ER. Tests performed there and subsequent follow-ups revealed that they had a malignant thyroid cancer.
During a follow-up call, the member expressed not only fear about their diagnosis, but also heartbreak over missing their daughter’s upcoming wedding. The member’s case manager was there to offer continual support, ensuring the member they would have Premera’s team at their side through the difficult path ahead.
From stabilization to surgery
A follow-up appointment with the member’s primary care provider proved to be a turning point. The doctor addressed the member’s history of inconsistent medication use and adjusted their prescriptions accordingly. They also referred the member to a new facility with extended hours so they could get lab work done on a schedule that better suited their life.
With surgery approaching, Premera’s case manager helped the member enroll in another program that would guide them through planning for the operation.
While their surgery was successful, recovery included more pain than expected, and the member remained engaged with their case manager, who checked in frequently and helped them access tools and resources for pain management.
A remarkable turnaround
Since their first interactions with Premera’s case manager, this member has taken control of their health despite encountering significant setbacks. Today, they are sticking with their medications, attending regular follow-up visits with their healthcare providers, and completing routine labs, which confirm their blood glucose levels have stabilized in a healthy range.
The member continues to focus on weight loss and overall wellness, and continues to be supported by their case manager. With reliable support in the form of ongoing calls, messages, and check-ins, the member reports feeling more in control of their health and well-being than they have in the past.
“I was scared I wouldn’t make it to the wedding,” they shared. “Now, I’m healing and finally making progress.”
At Premera Blue Cross, care means listening and meeting people where they are. That’s what it is to be in your corner.
To learn about all the resources your Premera health plan affords you and how you can best utilize them, visit our website and login or create an account today.
