Mr. Sherman · Enhanced Care Management
Finding a new doctor in days, not months
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.
Service line
Enhanced Care Management
Duration
7 days from intake to first visit
Location
Los Angeles County, CA
Outcome
Same-week appointment
By the numbers
Outcomes that prove it.
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.
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.
The challenge
What stood in the way.
- No in-network primary care provider accepting new patients within 25 miles of his home.
- Two missed medication refills putting blood pressure control at risk.
- Limited English-language navigation skills for online provider directories.
- Distrust of the new health plan after months of unreturned phone calls.
Our approach
How we built the plan.
- Same-day intake call with a Lead Care Manager fluent in his preferred language.
- Direct provider-to-provider outreach instead of relying on the public directory.
- Warm handoff between the LCM, the new PCP's front desk, and the pharmacy.
The solution
Step by step, what we actually did.
- 1
Hour 1 — Intake and risk triage
LCM completed a whole-person assessment, flagged the lapsed antihypertensive, and prioritized a 7-day appointment target.
- 2
Day 1 — Direct provider outreach
Called three in-network internists directly; secured confirmation from a clinic 11 minutes from his home.
- 3
Day 2 — Medication bridge
Coordinated a 14-day emergency refill with the dispensing pharmacy while the new PCP intake was processed.
- 4
Day 5 — Appointment and transport
Booked the visit, arranged covered NEMT transportation, and prepared a one-page medical history packet.
- 5
Day 30 — Continuity check-in
Confirmed prescriptions were filled, labs were ordered, and a 90-day follow-up was on the calendar.
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