Comprehensive support across medical, behavioral, pharmaceutical and social needs

For the Core program, your employees with complex and chronic health care conditions will receive personalized support from a team of specialists that take a holistic approach to meeting and anticipating their needs. 

Led by the Nurse Care Manager, the team of specialists consists of multidisciplinary resources that work together to provide a holistic system of support to your employees. These resources include:

• Nurse Care Manager – Acts as the main touch point to uncover and manage the needs of your employees and coordinates with the other resources on the team to ensure a holistic experience.
• Medical Specialist – Provides medical insight on complex cases when a physician’s expertise is required.
• Behavioral Health Specialist – Coordinates with Nurse Care Manager to provide behavioral health care and support to members with behavioral health conditions.
• Pharmacist – Coordinates with Nurse Care Manager to provide prescription advice, education, reconciliation and more.
• Social Worker – Assists Nurse Care Manager to coordinate with community resources that address your employees’ social determinants of health.
• Dietitian – Assists Nurse Care Manager to provide targeted dietary and nutritional education and coaching
• Non-clinical Support – Takes on non-clinical care coordination tasks to ensure your employees’ non-clinical needs are met.

Coordination with local providers and community resources 

With the team of specialists included with the Core offering, your employees will receive a localized approach to care management through coordinated care with providers and local resources and understanding regional social determinants of health.

Your employees will also gain a deeper awareness of community resources, local behavioral health clinics and senior resource centers. Along with these strengthened relationships, the regionally aligned team, led by the Nurse Care Manager, will be able to:

• Collaborate with local providers more closely and develop strong relationships with provider staff
• Incorporate unique social determinants of health by region (e.g., average income, access to care and transportation) in addressing employee’s needs
• Maintain continuity of relationships with your employees to develop familiarity and trust over time
• Enhance coordination with out-of-state Blues plans
• Collaborate with internal partners to help close gaps in care and coordinate care for high acuity services

An easy-to-use app to help employees get answers for all their questions

With the Core offering, your eligible employees will have a dedicated phone number. One number, supplied by the Nurse Care Manager, gets them to a real person who can provide answers to their condition related questions. 

Your eligible employees will also have access to the BCBSM Coordinated Care app to get answers from their Nurse Care Manager. This app augments your employees’ experience through health-based checklists, the ability to set reminders for medications and appointments and through curated content based on your employees’ unique needs.

Enhanced analytics to identify and prioritize the most impactable members

Core offers robust analytics, supported by more than 30 unique data sources, to identify and prioritize members for care management with a focus on managing the most appropriate members for interventions led by the Blue Cross team..

In addition to the provided analytics, a team will be dedicated to review high-cost claimants to identify addressable cost, quality and care opportunities. This interdisciplinary team, led by a dedicated Medical Director, performs clinical reviews of all high dollar claimants ($150,000 and up within a 12-month period) and identifies care opportunities and makes referrals to appropriate teams or providers. This means we’ll be working to ensure that your employees are receiving the best care for the best price.