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The Industry
Xerox Client
Xerox has adopted a care management model
that empowers members based on social and
environmental factors in assessments and
care plans. We assess not only the person’s
physical or mental symptoms and problems,
but also their surrounding family, healthcare,
community and social support structure.
The person’s perceived gap of
available resources and existing
personal and support strengths
form the basis for health
improvement opportunities
and collaborative care plans.
For example, one of our state clients’ program
members was identified as a high user of
emergency room (ER) services. The member
often experienced chest pain that resulted
in his caregivers taking him to the ER. Upon
assessment, a care manager found that
he lived with an overwhelming fear about
his heart problem. He had a pacemaker to
manage his condition as well as unique needs
resulting from developmental challenges and
living with limited access to specialist medical
care. He did not understand the regulatory
function of his pacemaker nor did he
know how to manage his concerns and
healthcare needs.
While the member lived in a suburban area
with some access to care, his family lived
in a rural area with very limited access to
healthcare resources. As the member’s
condition worsened, the family no longer
felt comfortable inviting him to their home
for visits as they could not take him to an ER
quickly. The feeling of isolation and lack of
family support compounded the member’s
fear, escalating his number of ER visits.
The assessment of these factors and medical
needs resulted in a care plan that involved
the member’s developmental disabilities case
manager, his providers, direct caregivers,
family, cardiologist and additional community
supports. The collaborative care plan and
