We know that delivering quality care matters as much to you as it does to us. At Blue Shield of California, we are committed to quality care for all our members, which includes partnering with you to support patients in managing their conditions and needs.

Health Management Programs for Blue Shield of California Promise Health Plan members

Population Health Management programs

Blue Shield of California Promise Health Plan has established a Disease Management Program to provide education, care coordination, and support to our Medicare and Medi-Cal members with certain chronic conditions.
Learn more about the program and referral process

Complex Case Management program

The Complex Case Management program applies to both Blue Shield Promise Medicare and Medi-Cal members. It allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.
Learn about the Complex Case Management program

Special Needs Plan Model of Care program

In compliance with the Centers for Medicare & Medicaid's final regulations on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Blue Shield Promise developed the Special Needs Plan (SNP) Model of Care for Medicare and Cal MediConnect members. The purpose of the program is to encourage early identification of the member's health status and allow coordinated care to improve their overall health.
Learn about SNP Model of Care program

Transitional Care Management for Special Needs Plan members

Blue Shield Promise has developed this program to deliver high-quality care to our members during care transitions.
Learn about transitional care management for Blue Shield Promise members

 

Health Management Programs for Blue Shield of California members

Download Health Management Programs Flyer (PDF, 37 KB)

Shield Support (care management)

Shield Support is a comprehensive care management program to help members live better with illness, recover from acute conditions, and have a more seamless healthcare experience.

Our team of nurses, behavioral health clinicians, social workers, health coaches, and other specialty clinicians provide personalized coaching, education and support to help members achieve overall health improvement.

Our program includes telephonic coaching, biometric remote home monitoring, online tools, in-person and online workshops, mailed educational materials and home visits based on member need and preference.

Our team supports members with a wide variety of health care needs, including:

  • Behavioral health
  • Cancer
  • Cardiovascular conditions, e.g. Coronary Artery Disease, Heart Failure
  • Catastrophic injury
  • Depression
  • Diabetes
  • LGBTQ health
  • Musculoskeletal conditions
  • Opioid use
  • Pain management
  • Respiratory conditions, e.g. Asthma, COPD
  • Stroke
  • Transplant process
  • Recent ER or hospital visits

View Shield Support information and sign-up instructions for members

Prenatal program

This program is designed to enhance quality of care and promote healthy behaviors before, during and after pregnancy. Members are offered:

  • 24/7 nurse support
  • a consult with a registered dietitian
  • a complimentary pregnancy test kit
  • educational materials
  • online resources
  • the choice of a top-rated pregnancy or parenting book
  • personalized nurse care management for those needing extra support
  • screening and referrals for mental and behavioral health

View Prenatal program information and sign-up instructions for members

How to refer patients to Blue Shield Health Management programs

To refer an individual member to the Shield Support or Prenatal program, download our single patient referral form. Email or fax the completed form to us.

To refer multiple members to the Shield Support or Prenatal program, download our bulk referral form, complete and email it to us.

Single patient referral form (PDF, 125 KB)

Bulk referral form (Excel, 61 KB)

Email:bscliaison@optum.com

Fax: (877) 280-0179