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Blue Shield of California Health Management Programs

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.

Shield Support (case management)

Shield Support is Blue Shield's new comprehensive, integrated care management program that provides short-term care coordination as well as ongoing complex case management to members with acute, long-term, and high-risk conditions including:

  • Complex, multiple co-morbidities and diagnoses, care from multiple providers and specialists, as well as significant psychosocial and/or financial needs

  • Newly diagnosed or advanced stage cancer, end-stage renal disease, stroke, septicemia, acute circulatory and digestive conditions, chronic pain, chronic respiratory conditions, HIV, amputation, and open wounds

  • Palliative care for members who are in the last twelve months of life due to a chronic or terminal illness, who are provided comprehensive management of their physical, psychological, social, spiritual, and existential needs

  • Transplant (solid organ and bone marrow) with support by specialized transplant care managers

  • Preterm infants in the Neonatal Intensive Care Unit (NICU) and post-NICU/pediatrics

  • Catastrophic injury such as trauma, severe burns, spinal cord injury, and acquired brain injury

  • Transitions to and from the hospital, to lower levels of care and home

A multidisciplinary care team, including medical, pharmacy, and behavioral health professionals, provides Shield Support. We maintain frequent contact with members and their caregivers and providers, and we coordinate the wide range of specialized care.

We prepare members for hospital stays and work to prevent readmissions by completing safety risk assessments, discussing follow-up care plans, reconciling medication, and facilitating adherence to prescribed treatment plans.

Shield Support includes frequent outreach by phone, mail, and email, as well as home visits. Services are tailored based on members' needs.

Disease management

We offer self-management tools and educational support to members with these conditions:

  • Asthma

  • Diabetes

  • Coronary artery disease

  • Chronic obstructive pulmonary disease

  • Heart failure

We send these members condition-specific workbooks, quarterly newsletters and a link to an online Care Center packed with useful resources. High-risk members also get periodic phone calls from a primary nurse who coaches them about medication usage, lifestyle modification and the importance of regular appointments and care.

Some high-risk members may take part in biometric home monitoring and send biometrics such as weight, blood pressure and blood sugar to their primary nurse for monitoring on a timely basis.

We also offer in-person and online workshops to members age 18 and older who have chronic conditions.

Prenatal Program

This program is designed to optimize a woman's health and quality of care before and during pregnancy, and offer case management if extra support is needed. The program aims to reduce the costs associated with high-risk pregnancies, while helping women have healthy pregnancies and healthy babies. If enrolled before pregnant, members will receive nutritional guidance and the opportunity to talk with a registered dietitian.

Members will also receive a complimentary pregnancy test kit. When pregnant, all members receive educational materials, Text4baby℠ information, and the choice of a top-rated pregnancy or parenting book. Members with high-risk pregnancies may be eligible for case management support.

Members receiving nurse case manager support are provided with:

  • Ongoing assessments and frequent contact to address goals

  • Support to set lifestyle goals, adhere to physicians' treatment plan, and keep physician appointments

  • 24-hour nurse support before and after baby's birth

  • Coordination with the members' providers and other resources if needed

Member identification and referrals

Using claims data, we proactively identify and initiate outreach to members who could potentially benefit from these programs. We have expanded our identification process for case management to include a predictive score based on individual health status and use. We also accept direct referrals to these programs.

To refer an individual member, download our single referral form (PDF, 57KB). Email the completed form or fax it to (877) 280-0179.

To refer multiple members, download our bulk referral form and email it to us.

If you have an urgent referral, call us at (877) 455-6777.

Our programs have high levels of member satisfaction, improve quality of life, and offer a proven impact on managing toward better outcomes, including lower healthcare costs. Thank you for your support and your continuing care of Blue Shield members.

Resources

Download our health management programs flier (PDF, 382KB)