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Integrating CM was a long, complicated process
Insurer decided to create the program in-house
Before Blue Cross Blue Shield of Michigan developed its BlueHealthConnection representatives of almost every department in the company spent considerable time deciding exactly how to integrate all of the Detroit-based insurer’s patient care services.
Almost every department in the corporation was involved in implementing the program, according to Kevin Kihn, RN, project manager for medical care management
"This has been a gigantic undertaking in terms of resource coordinating, trying to pull together the best of what we have with multiple enhancements and tie it together in an integrated system," says Thomas Ruane, MD, medical director of preferred provider organizations and care management.
One of the biggest decisions was whether to develop a fully integrated program, to partner with an external company to develop the program, or to contract with a variety of entities for disease management, Ruane says.
The company decided to handle all the patient care components internally and to create the integrated program instead of hiring outside vendors for disease management.
"It didn’t make sense for us to put a middle man in the system and have it chopped up with one or two diseases being handled by one vendor. We felt like we had the opportunity to have
a more comprehensive program by handling it in-house than if the customer was going to a number of external vendors," Ruane says.
The insurer did establish a relationship with partner organizations for assistance in integrating the various parts of their care management program.
For instance, they hired Franklin Health International to further train the nurse-case managers to improve their operating efficiency. The organization already had a contract with Franklin Health for complex case management of the sickest part of the population.
"We learned that they had a particularly well organized system for delivering case management and subsequently contracted with them to train the nurses in our system," Ruane says.
They contracted with an outside vendor for a work management system to help coordinate all parts of the program, and another outside vendor to analyze member data and point to the biggest opportunities to make the biggest impact in disease management. Reports show gaps in care such as lack of screening tests or patients who have a combination of diagnoses but are not receiving recommended treatment.
The insurer uses the information to make proactive calls to members before their problems need intensive management.
"Our case management interventions are not limited to the disease management category. Other methodologies are used to identify other kinds of cases where there is an opportunity for intervention," Ruane says.