Supporting Members in Getting the Care They Need
April 23, 2026
Primary care teams can help our members get timely access to the care they need. Members may need help navigating care. Your guidance and support can improve the patient experience, which in turn may improve health outcomes, according to the Agency for Healthcare Research and Quality. Consider the following care navigation tips based on the needs of your patients.
Getting needed care and getting care quickly
Hold open same-day appointment slots for routine and urgent care, as recommended by AHRQ.
Inform patients about their options for care when no appointments are available or your office is closed, such as partners or urgent care services. Remind them about their telehealth benefit through MDLIVE®. Members may visit MDLIVE.com/HealthSpring.com or call 1-866-918-7836. TTY users, call 1-800-770-5531.
Review the proactive plan of care that outlines a patient’s care needs and progress, as recommended by AHRQ. This may include discussions about orders for tests and any prior authorization requirements to ensure patients understand next steps.
Getting appointments with specialists
Identify the high-quality in-network specialists who can see your patients. Referrals are only required for Medicare Advantage HMO members in Central Florida, South Florida, Nevada, Oklahoma and Texas. No other members need referrals for outpatient visits with in-network specialists. Learn more.
Consider helping members schedule appointments with specialists and ancillary tests before they leave your office.
Learn more: Access to care and specialists is part of the Consumer Assessment of Healthcare Providers and Systems survey. If you get questions from members who have received the CAHPS® survey, please encourage them to respond.
Learn how you can affect results, and see our Stars Guidebook for more information. You can access the guidebook in Availity® Essentials in the HealthSpring Medicare Advantage payer space or request a copy from your HealthSpring representative.
More resources to explore
AHRQ TeamSTEPPS training on communication and teamwork; health literacy toolkit; care coordination atlas; guide on laboratory testing process; and building effective care teams
Our culture of caring self-guided webinars offer no-cost continuing education credit
Centers for Disease Control and Prevention communication strategies
The above material is for informational/educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their evidence of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.