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May – June 2019
A message from Dr. Aaron Friedkin, Dr. Duane DiFranco and Ann Baker
New care management program to provide integrated, holistic approach
The complex, fragmented U.S. health care system creates confusion for many of our members — your patients — especially those with chronic or complex conditions. Despite the best efforts of Blue Cross Blue Shield of Michigan and our participating health care providers, many people still need extra health care support and assistance with care coordination. That’s why we’re preparing to launch an all-new integrated care management program in 2020.
We built this new program with our members in mind. It’s intended to improve care coordination and reduce some of the frustration and financial strain your patients may experience when trying to navigate an increasingly complex health care system. Poorly coordinated care, as you know, can also result in higher health care costs, worse patient outcomes, inappropriate emergency room use and more frequent inpatient admissions.
The program takes a holistic, member-centric approach to help ensure the greatest effect on our members’ overall health and the cost of care. It will be deployed across all lines of business, including Blue Cross PPO, Blue Care Network, group and individual customers, and Medicare Advantage members.
It isn’t intended to replace the doctor-patient relationship in any way. Instead, the program has been designed to support you in your efforts to provide the best possible care for your patients.
Specially designated nurse care managers will lead multidisciplinary teams to:
- Help patients understand their treatment plan and options.
- Answer any questions they may have regarding their chronic conditions.
- Help coordinate their care with you and other health care providers, including pharmacists, behavioral health clinicians and social workers.
- Assist in getting additional resources they may need for their specific health care needs, such as transportation.
- Provide co-management assistance for members in Provider-Delivered Care Management, if necessary.
Participation in the program is completely voluntary for members. We’ll use enhanced analytics to identify members with chronic or complex conditions who can benefit from the program, as well as those who are at risk of developing chronic or complex conditions in the future. And, when necessary to support patient care, we’ll let the primary care doctor or specialist know if one of his or her patients is in our care management program.
What makes this program different?
We believe there are three things that set this program apart from what our competitors offer and from previous Blue Cross care management programs:
- Regional alignment of staff. Integrated care teams are regionally aligned, fostering the development of stronger relationships with providers where the member resides, surrounding communities and out-of-state Blue plans.
- Integrated clinical care team. The team is led by a nurse care manager who serves as the single point of contact for the member, family and care team. The team includes:
- Pharmacist
- Behavioral health specialist
- Social worker
- Medical director
- Dietitian
- Non-clinical support (for example, to help schedule appointments)
- Digital engagement. In addition to contacting members by phone, we’ll give members the opportunity to communicate with their care team through a secure mobile platform powered by Wellframe. Once they download the app, members can engage in private, two-way communications with their nurse care manager. The app also allows us to:
- Send them personalized content, including articles and videos, about their condition.
- Remind them to set up an appointment with their primary care physician or take their medication.
- Send them brief survey questions to better understand their current condition. If their survey response indicates that their condition is worsening, the nurse care manager will get a message to reach out to the member as soon as possible.
We expect that this program will deliver an unprecedented care management experience for our members. We hope it benefits you in your efforts to improve the health of your patient population.
More about health and wellness
Blue Cross also has a wellness program, Blue Cross® Health & Wellness, that provides members with a variety of health resources, including lifestyle coaching and tobacco cessation coaching programs. We wrote about it in a previous issue of Hospital and Physician Update.
About the authors
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| Aaron Friedkin, M.D. | Duane DiFranco, M.D. | Ann Baker |
- Aaron Friedkin, M.D., is vice president, Clinical Strategies, Health Plan Business.
- Duane DiFranco, M.D., is vice president, Medicare STARs and Clinical Performance.
- Ann Baker is vice president, Care Management.
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