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 members with certain chronic conditions.

The following Population Health Management Programs are available:

  • Asthma
  • Heart Failure

Blue Shield Promise refers to these programs as "population health management." Participation in these programs is free and voluntary for all program-eligible Blue Shield Promise members.

These programs provide members with the education necessary to better manage their conditions. Our Disease Management nurses work closely with the members and their doctors to keep them as healthy as possible and avoid unnecessary hospitalizations. The nurses assist the members in coordinating their care and obtaining all required preventive health screenings.

The programs are administered by Blue Shield Promise, which automatically identifies members with these medical conditions who meet specific criteria, offering them participation in these programs.

Benefits to the member

  • Regular nurse calls from our disease managers to review the member’s health status and provide support and education
  • Phone support via our toll-free number is available for members to speak with our disease manager about their condition and answer any questions they may have
  • Reminders to members to obtain preventive health screenings, exams, and tests, as needed
  • Educational mailings to members of materials to help them understand their chronic condition
  • A Peak Flow Meter (for asthma only) for ages 5 and under, to help better manage and monitor the member’s condition 

Benefits to the physician

  • Member compliance with physician treatment plan
  • Detailed reports informing you of a member’s status changes, or concerns that may require physician intervention
  • Comprehensive member medication profile
  • Care coordination with the primary care provider and specialists

If you want additional information or would like to discuss population health management programs with our Disease Management Program Manager, call
 Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.

Referral form

To refer a Blue Shield Promise member to any of the population health management programs, use the referral form:

 Disease management referral form (PDF, 360 KB)

Medical care solutions

Review medical care solutions for Blue Shield Promise plans.

Medi-Cal Provider Incentive Program

Our Med-Cal Provider Incentive Program provides incentives for network physician practices and independent physician associations (IPAs) to support and encourage high standards in health care for our valued Medi-Cal plan members.

Complex Case Management

Our Complex Case Management program allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.

Transitional Care Management for Special Needs Plan members

Blue Shield Promise has developed the Transitional Care Management Program to deliver high-quality care to our members during care transitions. This program meets all regulatory requirements.

Behavioral Health Services

Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.

Quality Improvement Program

Blue Shield Promise created a Quality Improvement Program (QIP) for all lines of business. This program allows us to identify opportunities for improvement of care and services to our members and providers.

Health education for providers and members

Blue Shield Promise assists you in meeting health education state requirements by providing appropriate health education materials for you to distribute to your patients. These multilingual materials are available in the state-mandated topics.

Provider Connection

Access network provider tools on Provider Connection website.

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有關 Blue Shield Promise Cal MediConnect Plan和您的醫療保健的其他 Cal MediConnect選項的資訊,請致電醫療保健服務部1-800-430-4263(聽障和語障專線:1-800-735-2922)或訪問 https://www.healthcareoptions.dhcs.ca.gov/.

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