Our care management program offers support for patients, health care providers

Last year, we launched our reimagined care management program to help support your patients who may need assistance with care coordination or health care support in other areas. Blue Cross Coordinated Care, now called Blue Cross Coordinated Care Core℠, is part of a broader portfolio of health care solutions.

It’s been deployed across all lines of business, including:

• Blue Cross and Blue Care Network commercial customers (individual and group)
• Our Medicare Advantage members (Medicare Plus Blue℠ and BCN Advantage℠)

“The purpose of this program is threefold,” said Lisa Zmijewski, manager, Coordinated Care Advocate. “First, we want to help our members — particularly high‑risk members with chronic or complex conditions — navigate the increasingly complex health care system. Second, we want to assist health care providers in their efforts to improve the health of their patient population, and last, but not least, it’s a program that can help to better manage health care costs.”

Poorly coordinated care, she pointed out, can result in higher health care costs, less satisfactory patient outcomes, inappropriate emergency room use and more frequent inpatient admissions.

As part of this program, specially designated nurse care managers lead multidisciplinary care teams to:

• Help patients understand their treatment plan and options.
• Answer any questions patients may have regarding their chronic conditions.
• Help coordinate your patient’s care with you and other health care providers, including pharmacists, behavioral health clinicians and social workers.
• Assist in getting additional resources patients may need for their specific health care needs, such as transportation.
• Provide co-management assistance for members in our Provider‑Delivered Care Management, as necessary.

Participation in the program is completely voluntary for members. We use enhanced analytics to identify members with chronic or complex conditions who can benefit from the program, as well as those who may be at increased risk due to a recent diagnosis and related gaps in care.

When necessary to support patient care, we notify the primary care provider or specialist if one of his or her patients is in our care management program.

“It isn’t intended to replace the doctor-patient relationship in any way,” Zmijewski said. “Instead, the program has been designed to support health care providers in their efforts to provide the best possible care for their patients.”