How Blue Cross Coordinated Care℠ Helped Member Navigate Serious Health Issues, Financial Stress
Jake Newby
| 4 min read
Navigating the health care system can be overwhelming, especially for those with complex medical needs and chronic conditions. Blue Cross Coordinated Care℠ was built to stand in participants' corner when they are most vulnerable, and help them receive the care they need, when they need it.
The multi-faceted Blue Cross Coordinated Care program, offered by Blue Cross Blue Shield of Michigan, guides participants through every step of their health care experience, from the doctor’s office to the pharmacy, to specialized treatment centers and community resources. Blue Cross Coordinated Care℠ is leading to improved clinical outcomes and reduced utilization for participants managed in the program, resulting in significant savings of more than $3,000 per managed member compared to similar unmanaged members*.
Rebecca**, a 64-year-old BCBSM member, is just one of those participants who has seen improved health outcomes and better understanding of her conditions. Rebecca was hospitalized with a blood clot in her lung, respiratory failure, lymphedema and a severe skin infection. Even prior to this scare, Rebecca’s complex medical history included high blood pressure, high cholesterol, diabetes, obesity and other conditions. To complicate matters further, she was without a primary care physician (PCP) at the time and was confused by her discharge instructions following four months of hospitalization.
Not only did Rebecca require home health care (HHC) as she began the rehabilitation process, she also needed labs drawn to refill blood thinner medications. Naturally, Rebecca was worried about the cost of medication. In addition to her physical ailments, Rebecca was also diagnosed with depression and needed counseling.
How members like Rebecca benefit from Blue Cross Coordinated Care℠
These physical, mental and financial problems were too overwhelming for Rebecca to handle on her own. Because of the complexity of her case, Rebecca was contacted by a nurse care manager while she was in the hospital and was enrolled in the program, which features a multi-disciplinary care team that includes nurses, social workers, pharmacists and dietitians, that addressed her clinical and behavioral health needs. High-risk members, like Rebecca, enrolled in Blue Cross Coordinated Care℠ had a 19% reduction in medical spend compared to members not in the program*.
Without a PCP, it was almost impossible for Rebecca to manage the care she required. Her care manager connected Rebecca with a doctor close to her home that was certified as a Patient-Centered Medical Home, who was able to help her coordinate and manage her complex care needs. Rebecca is now part of the 84% of Coordinated Care members with a PCP*.
According to the Agency for Healthcare Research and Quality, only 12% of American adults are proficient in health literacy, which is the ability to obtain, process and understand basic health information and services. When someone’s health literacy is limited, they may struggle to seek appropriate care and understand medical billing.
Health literacy and finances were two areas of concern for Rebecca, who leaned on the Coordinated Care team to facilitate pharmacy copay assistance and help her understand her conditions, as well as signs and symptoms of progressing disease, so she could avoid future health crises. Members in Blue Cross Coordinated Care℠ had a 32% reduction in inpatient admissions when compared to members not in the program*. This means members supported by Coordinated Care are less likely to require overnight hospital stays.
Here are some of the program benefits Rebecca received over the course of treatment and rehabilitation:
- A nurse reviewed and helped her understand the hospital discharge instructions.
- She was connected with a hospital case manager before discharge to ensure she had what she needed prior to discharge.
- An in-home assessment was completed to assess her environment.
- Her care team ensured home health care arrived after discharge.
- She consulted with a clinical pharmacist for copay assistance.
- She consulted with a social worker to facilitate transportation services.
- Her care team scheduled an appointment for her with a new PCP within a week of her discharge.
- Her care team helped connect Rebecca with a new behavioral health provider for her depression.
- Her nurse educated her on conditions, fall risks, and alternative sites of care to decrease emergency room visits and hospitalizations.
- Her nurse educated Rebecca on support resources, which includes virtual care, a hypertension management program through her employer, the Livongo diabetes management program, mail service pharmacy, online health coaches, and behavioral support resources.
Months after first connecting with the program and receiving personalized support from the program, Rebecca has avoided emergency room visits and hospitalizations, improved mobility and safety and improved her understanding of her medical condition and needs to remain out of the emergency room. Rebecca’s health has improved and her health care experience has been simplified.
To learn more about Blue Cross Coordinated Care’s portfolio of programs and how they can benefit your company, visit www.bcbsm.com/care-management.
*Blue Cross Coordinated Care program outcome evaluation
**The name “Rebecca” was used fictitiously to protect the member’s identity.
