Program gives members tools to manage own health
Members empowered with information
Thanks to BlueHealthConnection, a new integrated care management program, more than a million members with coverage through Blue Cross Blue Shield of Michigan have just one source for answers about their health care needs.
The Detroit-based insurer has unified health care services and functions formerly performed through a number of separate programs, enhanced them, and put them under one umbrella.
Instead of treating areas handling disease management, case management, and a nurse help telephone line as separate functions, the insurer has created a seamless program to help the members get the care they need at the level of intensity they need in the most efficient manner.
The insurer aims to empower members with information, to get it to them as early as possible, and to help support patient-provider relations with new tools and more information.
"Patients are the greatest pivotal point in terms
of health care and how you improve it. To improve health, you have to drive it through the members. You can do this by educating them about their conditions early on. By empowering them and becoming their partner, you can ultimately improve their health outcomes," says. Jann Caison-Sorey, MD, associate medical director for preferred provider organizations (PPO) and care management.
The fact that BlueHealthConnection is a fully integrated program doesn’t mean that everybody does everything, points out Thomas Ruane, MD, medical director of PPO and care management.
Instead, the program pools all the insurer’s data and resources to help members navigate the health care system and to direct them to a level of assistance based on their individual need.
"Our program is designed to provide the right setting of care management for each individual," Ruane says.
Three main components
The program has three main components:
- Guided self-management, including wellness information and basic information about diseases, and symptom management. This is available to members through nurse counselors on the 24-hour nurse call line.
- Integrated case management and disease management programs to members who have or may develop high-risk chronic conditions.
- Complex case management services, both telephonic and on-site, to complex illness and injuries, including terminal conditions.
"We are spending a lot of time, effort, and energy to ensure that it is seamless for a member to move from one level to another, depending on their need," Ruane says.
The integrated program provides services in a non-HMO environment, focusing on members who have PPO or fee-for-service benefit plans, Ruane says.
Patients in PPO or fee-for-service plans don’t have an assigned primary care physician or requirements for referrals to specialists. Consequently, the patients may be seeing multiple physicians and care may not be coordinated, Ruane says.
In these cases, since the insurer has data from multiple physicians involved in the case, the health plan is in a good position to have the best information about what interventions the patients have had and which ones they may need, Ruane adds
"We were looking at an opportunity to use data more effectively. We believed we could deliver a program that got to the member at the time [he or she] needed intervention," he says.
Members who have the most severe conditions are offered the opportunity to participate in the case management program, which is not disease-specific.
Nurses who previously handled disease management in traditional ways with a lot of intensive interaction and have become experts in certain clinical conditions are being integrated with the Blue Health Line nurses to provide additional resources to support the patient as well.
"We are finding that the greatest opportunity for intervention doesn’t necessarily involve just the case manager," Ruane says.
Thanks to BlueHealthConnection, a new integrated care management program, more than a million members with coverage through Blue Cross Blue Shield of Michigan have just one source for answers about their health care needs.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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