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Case · 86

Enhanced Care Management

Finding a new doctor in days, not months

Member

Mr. Sherman

Service line

Enhanced Care Management

Location

Los Angeles County, CA

Duration

7 days from intake to first visit

01 —

The outcome

After switching insurance plans, Mr. Sherman struggled for weeks to find a new primary care doctor. His Lead Care Manager identified an in-network physician within hours and scheduled an appointment that same week.

Same-week appointment

Headline result for Mr. Sherman.

7 days

Intake to first visit

Down from a 90+ day wait on his own.

0

Missed medication days

Bridge refill prevented any further lapse.

−14

mmHg systolic BP

Recorded at 90-day follow-up visit.

100%

Visit adherence

Across the first six months of new PCP care.

02

Background

Where the member started.

Mr. Sherman, a 68-year-old Medi-Cal member managing hypertension and early-stage CKD, was reassigned to a new managed care plan during open enrollment. His previous primary care relationship of nine years was suddenly out of network, and three months of calls to the plan's member line had produced no confirmed appointment.

In their words —

I had been calling for three months and getting nowhere. Atlas Health Group called me back the same day and I was in a doctor's chair that week.

Mr. Sherman, ECM Member

03

The challenge

What stood in the way.

  1. 01

    No in-network primary care provider accepting new patients within 25 miles of his home.

  2. 02

    Two missed medication refills putting blood pressure control at risk.

  3. 03

    Limited English-language navigation skills for online provider directories.

  4. 04

    Distrust of the new health plan after months of unreturned phone calls.

04

Our approach

How we built the plan.

Move 01

Same-day intake call with a Lead Care Manager fluent in his preferred language.

Move 02

Direct provider-to-provider outreach instead of relying on the public directory.

Move 03

Warm handoff between the LCM, the new PCP's front desk, and the pharmacy.

05 —

The solution

Step by step, what we actually did.

  1. 01

    Hour 1 — Intake and risk triage

    LCM completed a whole-person assessment, flagged the lapsed antihypertensive, and prioritized a 7-day appointment target.

  2. 02

    Day 1 — Direct provider outreach

    Called three in-network internists directly; secured confirmation from a clinic 11 minutes from his home.

  3. 03

    Day 2 — Medication bridge

    Coordinated a 14-day emergency refill with the dispensing pharmacy while the new PCP intake was processed.

  4. 04

    Day 5 — Appointment and transport

    Booked the visit, arranged covered NEMT transportation, and prepared a one-page medical history packet.

  5. 05

    Day 30 — Continuity check-in

    Confirmed prescriptions were filled, labs were ordered, and a 90-day follow-up was on the calendar.

06

Services involved

The full network on this case.

Enhanced Care ManagementMedical TransportationCare Coordination