Medicare Plus Blue℠ PPO offers enhanced care management programs to members.
Our programs include:
- Care transition to home
- Case management
- Chronic condition management
- Blue Care ConnectSM
- Behavioral case management
- Quit the Nic
- 24-hour nurse line
Blue Cross Blue Shield of Michigan may contact you to coordinate care for members. Find out more about the care management programs we offer in the Medicare Plus Blue PPO Manual (PDF).
Care transition to home
The goal of the program is to reduce preventable 30-day readmissions. In this program, nurse case managers help hospitalized members make a smooth transition back home. After members leave the hospital, nurses continue to work with them to provide support. If necessary, they'll recommend them to another care management program, such as case management or chronic condition management. We help all other members with their discharge instructions and self-management information.
The goal of this program is to avoid unnecessary or preventable hospital admissions, readmissions and emergency room visits. Nurse case managers help members with complex health issues manage their conditions. Nurses work with members before, during and after a hospital visit. They provide support to members by phone, and they also coordinate care with providers. Nurses also identify gaps in care and develop a plan to get members the care they need.
Chronic condition management
Administered by Alere®
The chronic condition management program is a comprehensive disease management program. It teaches members how to manage these chronic conditions:
- Chronic obstructive pulmonary disease, or COPD
- Coronary artery disease, or CAD
- Heart failure
Members will get information on their health status and treatments options. They'll also get the materials and support they need to manage their condition.
Providers will get alerts on their members' health. Physicians can opt out having their patients participate in the program. All Medicare Plus Blue PPO members can take part in the program.
Blue Care ConnectSM
Blue Care Connect helps members learn how to manage their medical conditions and make informed decisions about their care. The program can also help to reduce the number of hospital stays and emergency room visits. Members work with a dedicated care manager who helps to support their specific needs. The care manager works with members, as well as their doctors and families to:
- Conduct a comprehensive home assessment
- Manage their conditions
- Provide home visits as needed
Behavioral health case management
Behavioral health case managers work with providers to coordinate mental health and medical care to members. They identify trouble areas where members should get more care and they develop a plan to get them that care.
Members qualify for this program based on claims, health risk assessments and a proper diagnosis. The type of case management varies based on the member's needs.
- 24/7 availability of case managers to support and educate members
- Coordination of discharge needs with case managers and providers
- Reminder calls to members about outpatient appointments after an inpatient stay
Note: All mental health and substance abuse inpatient, partial hospital, and intensive outpatient treatment admissions or extensions need preauthorization.
Quit the Nic
Quit the Nic is a telephone-based program designed to help members quit tobacco use. Blues members have access to counseling with registered nurses. The program aims to improve the members' quality of life. It also attempts to reduce costs and hospital visits for conditions associated with tobacco use.
24-hour nurse line
The 24-hour nurse line is a 24/7 resource for members to call if they have questions about their general health or a specific condition. When necessary, the nurse may refer members to other programs. They can also help with provider searches. Nurses maintain client confidentiality during calls.
Health and wellness
Our health promotion and wellness programs help members understand their health care issues. Members can view informative online articles, tools and quizzes. Members can access this program on the Health and Wellness screen on their account at bcbsm.com.
For questions about our care management programs, call our Engagement Center at 1-800-775-BLUE (2583). Nurse case managers may contact you to coordinate care and services.