2015 Year In Review

Once again, it is hard to believe that another year has come and gone.

This year has been a busy one for your One Care Ombudsman (OCO) Team. The OCO office had its first birthday this year and we have a lot to celebrate.

From January through September, 2015 the OCO:

  • Provided ombudsman services to more than 409 individuals
    • Responded to more than 297 inquiries

    • Investigated and resolved more than 110 complaints

  • Conducted more than 27 outreach activities, reaching more than 1,992 people

  • Produced ten educational videos (these will be launched early in 2016), and finally

  • Added more than 368 new measures to Massachusetts’ state/federal ombudsman database

Here are just three examples of how the OCO helped members in 2015:

  • A member’s authorized representative contacted the OCO requesting immediate access to a long-term support program in order to avoid emergency room services. OCO staff worked with the state and the One Care plan resulting in timely approval for the long-term support services the member needed.

  • While a member’s One Care plan had previously intervened with their pharmacy to resolve issues related to medication access, the member continued to face barriers at the pharmacy. OCO staff mediated a solution between the plan, pharmacy, and member. As a result, alternate solutions were discussed and reached – facilitating the member’s access to medications.

  • For more than a month, a member experienced problems related to obtaining homemaker services. OCO staff facilitated communications between the member’s Care Manager and the plan’s State Contract Manager. The member reported that within 24 hours of their call to the OCO, the member had been informed that their request for homemaker services had been approved, and communication within their care team improved thus ensuring they were being offered the services due to them.

As you and your loved ones share this time of year with family and friends, the staff at the OCO wishes you and yours a happy, safe and joyous holiday season!

Sincerely,

Your OCO Team!