New Care Management Takes On Complex Cases

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Patience is overrated when it comes to controlling health care costs. A new chronic care management program from Blue Cross Blue Shield of Georgia doesn't wait around - it reaches out, finds the people who need help the most and coaches them through a smart care plan. 
Employers know that waiting for health problems to happen is more expensive than keeping them from happening in the first place. ComplexCare is designed to do just that, by targeting and supporting members with multiple high-risk health issues - those at highest risk to incur future costs. With personalized goal-setting and motivation, the program's nurse care managers help members make smart decisions and avoid problems. 
We get involved
Each member in the program is matched with a trained nurse care manager who, in turn, is backed by a medical director. The experience is personalized and high-touch. Through one-on-one counseling, the nurse helps the member set lifestyle goals and become actively engaged in their own care. 
Members receive:
Personalized attention, goal planning, health and lifestyle coaching
Strategies to promote self-management skills and medication adherence
Resources for answering health-related questions concerning specific treatments
Access to other appropriate health management programs
Coordination of care between multiple providers and services
Assistance with making informed decisions about health care issues
 
The program fits the person
The experience is different for each member. Nurses may use phone calls, e-mail, fax or mail, depending on the severity and risk factors of each situation. The nurse uses collaborative goal planning with the member's health care providers. And when the need comes up, the nurse can also consult with one of our dietitians, pharmacists, exercise physiologists, social workers, and medical directors. 
It takes some digging
Candidates for the ComplexCare program are found through advanced predictive modeling techniques, using over 500 health risk markers. But we're not patient enough to stop there. We dig further by looking at utilization patterns, pharmacy and lab data, risk assessment results, and referrals from doctors and other health management programs. 
So individuals and employers* know we're working to keep their employees healthy. 
*Standard offering for fully insured accounts and available as a buy-up option for ASO and minimum premium accounts. 

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