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New Approach to Health Management

Delivering on our promise to make quality health care affordable requires a new way of thinking about managing member health and developing outside-the-box solutions to serve members with common chronic conditions. To better help these populations, we are launching a state-of-the-art in-house care management service. This new service includes a highly trained team of clinicians, specially developed member engagement and management tools, and a powerful health management system.

New Approach to Chronic Condition Management
We continuously evaluate all our services and programs to find opportunities to improve member health, enhance clinical quality outcomes, and decrease the cost of health care. Throughout, we've made changes that allow us to more precisely identify which members we can most efficiently help, and to target our programs and resources most effectively. We will continue to serve all members, of course, but our proprietary algorithms and identification models allow us to offer special attention based on our analysis of member claims and needs.

Helping Members with Common Chronic Conditions
Analysis has shown that five common chronic conditions account for a disproportionate amount of health care spending:

  • Asthma
  • Chronic obstructive pulmonary disease
  • Coronary artery disease
  • Diabetes
  • Heart failure

We have built a program that can help members stay on track when their condition is stable and better manage their health when there are opportunities to improve their condition. By providing access to the right information and care management services to the right member at the right time, we can help in very cost-effective ways. This means excellent service—with careful and responsible use of resources and attention to the premium dollars and administrative costs that we are entrusted with managing.

Providing Case Management Service In-House
In order to best meet our goals and yours, we are bringing all chronic condition management services in-house by the end of 2012 as part of a more integrated and personalized model of care. Our new Chronic Condition Management program will work hand in hand with our new, improved in-house care management programs and allow us to better manage members with complex and co-morbid conditions. The goal is to maximize these members' engagement toward the sustained behavior changes that lead to better health.

We Will Be Notifying Affected Members
As we integrate the services we offer and discontinue the use of vendors to deliver certain programs and services, the members currently managed under our existing program and in need of further care management services will be seamlessly transitioned into our new in-house program. All affected members will get a letter notifying them of these changes. Additional updates related to our integrated health management model will be available online.

If you have any questions, please contact your account executive.

Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
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