Member Case StudyRoberta's path to mobility and independence with Cleo

Roberta's story

Roberta* is a 71-year-old member of a Medicare HMO C-SNP. Despite having a strong support system, good humor, and a solid foundation of faith, Roberta faced significant physical challenges that threatened her independence.

Roberta required a walker for ambulation and was experiencing acute on chronic pain and physical deconditioning following a recent right knee replacement (her left knee was replaced four years ago). Living alone on a fixed income (income <$10k/year), she struggled with ADL/IADL deficits (bathing, transportation, shopping) and was at continued risk for falls, despite a long history of remaining fall-free. While she had completed her wellness exam, she lacked remaining preventative care (due for bone density screening and mammogram) and urgently needed reliable transportation and pain management.

Her vision was simple yet powerful: To regain independence and improve overall wellbeing through effective pain management, improved mobility, reliable transportation, and access to preventative care.

*Names haves been changed to protect the identity of the member.

Getting set up

Roberta connected with Cleo Medicare Coach, Rusti. Her Health Pulse results placed her at Medium Risk, but her acute needs prompted the Coach to engage more frequently (every 2-3 weeks) than the recommended schedule.

The immediate focus was on addressing her post-operative pain and coordinating resources to restore her mobility and access to care.

Focus Areas: Pain management and increased mobility post-R knee replacement; securing reliable transportation; and accessing overdue preventative care.
SMART Goals: Initiate in-home physical therapy (PT) with approved prior authorization by August 31; explore and utilize at least one non-emergent transportation resource by August 31; schedule and attend bone density and mammogram screenings by October 1.

Securing care

The Coaching Plan centered on leveraging Roberta’s health plan benefits and coordinating with providers to foster independence and improve her quality of life. The Coach performed multiple high-value interventions that addressed physical deconditioning, transportation, and ADL deficits simultaneously.

Restoring mobility and managing pain

The Coach directly addressed Roberta’s need for physical therapy, which was blocked by administrative hurdles:

The Coach conducted a three-way call with the health plan’s customer service to navigate copays and financial assistance for physical therapy.
A subsequent three-way call with Roberta’s PCP coached the member through requesting orders with necessary prior authorization requirements, resulting in the approval and initiation of in-home physical therapy.

Solving ADL deficits and malnutrition

Recognizing that Roberta’s deficits extended beyond mobility, the Coach secured comprehensive home support services:

The Coach facilitated a three-way call with a home health agency to enroll Roberta in services to assist with ADLs, securing 104 hours/year with no copay.
The Coach assisted Roberta in obtaining supplemental benefits for in-home meal kits (10/month) and in-home podiatry care (6 visits/year), both free of charge, directly addressing her nutritional and self-care deficits.

Securing reliable transportation and screenings

To get Roberta back into the community and to her appointments, the Coach focused on multiple transportation solutions:

The Coach initiated a request for transportation vouchers through the health plan’s supplemental benefits and provided independent, community-based resources for non-medical needs.
This successful coordination allowed the member to schedule her bone density scan and mammogram (planned for late September) with reliable transportation.

Success metrics achieved

Through comprehensive support and swift navigation of her health plan benefits, Roberta achieved all her short-term goals, setting a strong trajectory for long-term health and independence.

Mobility Services Secured: Approval and initiation of in-home physical therapy.
Full Preventative Access: Scheduling of preventative services (bone density scan and mammogram) with reliable transportation.
Supplemental Benefits Utilized: Successful initiation and utilization of in-home meal kits and podiatry care.
High Quality Care: Member accessed high quality care and reported satisfaction with her health plan.

Health & quality of life improvements

Immediate ADL Support: Successful approval and initiation of home health aide services and in-home meal kits to solve ADL/IADL deficits.
Improved Community Access: Successful utilization of non-emergent transportation for healthcare and community access.
Improved Quality of Life: Member reported improved self-reported quality of life due to the coordinated support.
Health Goals Underway: With in-home PT initiated, she is on a path to sustainable pain reduction and increased physical mobility.

Empowerment and support

By coordinating critical services like in-home PT and home health aides and removing the barriers of cost and transportation, the Coach helped Roberta move from physical deconditioning and dependence toward achieving her goal of regaining independence and enjoying her community outings once again.

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