Living better is a comprehensive approach to identifying members with immediate health issues as well as those at risk for chronic conditions or complex health issues, and giving them support and tools to manage their condition or resolve their issues. Programs and services include:
Care Management (PDF, 235KB) provides a personalized approach to patient care. Our case managers help members with care coordination as well as ongoing case management.
High-risk Case Management (PDF, 231KB) supports members who are experiencing acute and complex needs, helping them get access to the right care at the right time.
Transplant Care Management (PDF, 280KB) supports quality and cost-effective outcomes for those members identified as potential transplant candidates.
Utilization Management (PDF, 221KB) helps members receive medically appropriate care.
Continuity of Care (PDF, 221KB) focuses on staying interconnected with the patient and the physician so there is continuity during a transition of care.
Behavioral Health Condition Management (PDF, 227KB) provides a variety of services to members who have both a behavioral health condition and a chronic medical condition.
Disease Management (PDF, 575KB) provides a whole-person approach to improving health.
Health Advocate1 (PDF, 68KB) gives member-focused guidance. A dedicated team of registered nurses and pharmacists helps your employees navigate the healthcare system, resolve problems, answer health and treatment-related questions, provide health counseling, and support coordination of care.
CareTips2 (PDF, 579KB) is a clinical messaging program designed to improve quality and care. CareTips provide personalized reports to members alerting them of potential gaps in their care, inappropriate medication usage and more.
Integrated Pharmacy Programs help better support members' health.
Shield Concierge (PDF, 312KB) provides one-on-one support to resolve customer service issues on the first call and to proactively identify programs that support the members’ engagement in their health.
Most of these programs are part of fully insured products and some of these are included for self-funded products or offered at an additional cost to both fully insured and self-funded clients. See your Blue Shield representative for complete details.
1 Available as a buy-up for fully insured and ASO groups with a minimum of 1,000 enrolled employees.
2 Effective 9/1/15, included in fully insured PPO except for IFP and Small Group. Available for purchase by fully-insured HMO and self-funded plans as a value-added service (buy-up).