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Condition Care

PW_E183015

About the Program

Depending on their benefit plans, some members have additional resources available to help them better manage chronic conditions. The ConditionCare program is designed to help participants’ improve their health and enhance their well-being. The program is based on nationally recognized clinical guidelines and serves as an excellent adjunct to physician care. 
The ConditionCare program helps members better understand and control certain medical conditions like:  
Diabetes (Type 1 and 2)
Chronic Obstructive Pulmonary Disease (COPD)
Heart failure
Asthma (pediatric and adult)
Coronary Artery Disease
 
A team of nurses with added support from other health professionals – such as dietitians, pharmacists and health educators – work with members to help them understand their condition(s), their physician’s orders and how to become a better self-manager of their condition. Members are stratified into three different risk levels. 
Engagement methods vary by risk level but may include:  
Education about their condition through mailings, telephonic outreach, and/or online tools and resources.
Round-the-clock phone access to registered nurses.
Guidance and support from nurse coaches and other health professionals.
 
Physician benefits:  
Saves time for the physician and staff by answering patient questions and responding to concerns, freeing up valuable time for the physicians and their staffs.
Helps support the physician-patient relationship by encouraging participants to follow their physician’s treatment plan and recommendations.
Provides the physician with updates and reports on the patient’s progress in the program.
 
Nurse coaches encourage participants to follow their physician’s plan of care; not to offer separate medical advice. In order to help ensure that our service complements the physician’s instructions, we collaborate with the treating physician to understand the member’s plan of care and educate the member on options for their treatment plan. Providers may receive a quarterly report for patients who are currently enrolled in the program including the member’s current educational goals. 
Program Referral 
If you would like to refer a patient into the program, download this referral form and fax it back to the number provided. Depending on their benefit structure, some members may not be eligible for this program. If you have any questions or comments about the program or would like to check a member’s eligibility for the program, call toll free 877-681-6694. You may also use this number to refer a patient into the program if you do not have access to a fax machine. Our nurses are available Monday-Friday, 8:30 a.m. to 9 p.m. CST, and Saturday, 9 a.m. to 7:30 p.m. CST. 
In accordance with this organization’s policy, you have the right to: 
Have information about our organization, including programs and services provided in conjunction with the sponsoring organization, its staff, and its staff’s qualifications and any contractual relationships that our company has with other organizations that provide services to your patients.
Decline to participate in, or work with this organization’s programs and services to optimize the health status of your patients, if contractually possible.
Be informed of how this organization coordinates its interventions with your treatment plan for your individual patients.
Know how to contact the person responsible for managing and communicating with your patients.
Be supported by this organization to make decisions interactively with patients regarding their health care.
Receive courteous and respectful treatment from our staff.
Communicate complaints to us.
© 2014 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.