Case Management Program helps your patients with complex needs

Blue Cross Blue Shield of Michigan works hard to develop programs that help our members manage their health care conditions while controlling health care costs. One such program is the Case Management Program. Designed to support the doctor-patient relationship, it provides our members who have difficult-to-manage conditions with additional resources.

Note: This program doesn’t apply to MESSA members.

As a Blue Cross participating practitioner, you can play a key role in educating and referring members with complex health needs to our program. Here’s what you need to know:

• Your patients with Blue Cross insurance need to determine if they’re eligible for this type of service. One way they can do that is by calling the Customer Service number on the back of their ID card.
• You can refer Blue Cross members to our complex case management program by calling 1-800-845-5982.

In addition to your referrals, we identify members who may benefit from case management through:

• Health information telephone referrals
• Our disease management program
• Information from discharge planners
• Our utilization management program
• Information from the member or caregiver

How it works
Our nurse case managers assess the member’s situation and develop a care plan that includes the member, caregiver, doctor and specialists. The plan incorporates:

• The member’s goals
• Actions to help them achieve their goals
• Progress monitoring

Blue Cross tracks the outcomes of our Case Management Program on a quarterly basis and reports results annually. We’re proud of our program’s achievements on several key measures, based on 2015 data. Here are two examples:

• Members with diabetes who participate in our program closed the HbA1c testing gap.
• Members with heart failure, coronary artery disease or diabetes who participate in our program received LDL testing.

This year, we’re focused on making improvements on the following measure: Connecting members discharged from an inpatient admission with a practitioner within seven days of discharge.

This measure is important to ensuring that at-risk members receive the care and services they need to get and stay healthy. We appreciate your support in helping us achieve this goal. If you have any questions about this program, contact our provider consultant.