Medical management program offers advice by secured e-mail, telephone

Aim is to help members adopt a healthier lifestyle

A new, innovative medical management program by Blue Cross and Blue Shield of Illinois helps members take charge of their own health by providing interactive tools and information about health conditions, including opportunities to e-mail a nurse care advisor, personal trainer, registered dietitian, or health coach and get an answer back within one business day.

Blue Care Connection, available to all members, allows members to create their own Personal Health Manager, an interactive, web-based resource that gives them information they can use to make informed health care decisions. The system gives them the opportunity to access on-line health materials and receive targeted wellness information and reminders for preventive care and condition-specific milestones so they can better manage their health.

"The members have access to a system of electronic messaging that is totally protected. Only the member can log on and give their nurse care advisor access to their personal health manager," reports Colette B. Burke, RN, executive director for medical management at the Chicago-based insurer.

If employers choose a more comprehensive package called Blue Care Advisor for their employees, members have access to the Personal Health Manager as well as other interactive features, such as Ask a Nurse, which allows them to communicate with a nurse care advisor via secured e-mail or telephone and Ask a Trainer, which allows members to ask a physical trainer on-line questions about weight management and fitness activities. The member also can send secured messages to a registered dietitian and health coach. All responses are received within one business day.

Later this year, Blue Cross and Blue Shield of Illinois will extend the Personal Health Manager messages and reminders to people who don’t have a computer or don’t want to use the computer, via automated outbound calling to remind members of gaps in care.

"We want to reach the member and deliver the same services and information via telephone for people who are not comfortable with the computer. We still use the old-fashioned way of delivering information. If someone requests it, we can mail him or her specific written information about his or her condition," she says.

The members will have a toll-free number to dial at their convenience.

Participation in Blue Care Connection is strictly voluntary. The program has two goals: To educate the members so they can do the right things and enjoy a better quality of life and to stabilize their conditions and get them self-invested in wellness, with the ultimate goal of reducing emergency department and hospital visits.

Members start their interactive health management by taking a 15-minute health risk assessment. The assessment uses branching logic to generate additional questions for certain conditions. For instance, if the member has asthma, the assessment asks questions about taking a rescue medicine, knowing asthma triggers, having a written action plan, and using a peak flow meter.

The web site allows them to set up a personal health record that can be shared with designated people, including family members and physicians anytime and anywhere Internet access is available.

The company’s predictive modeling system allows it to examine claims data to identify the population that needs help and to tailor the Personal Health Manager to their needs. For instance, if an insulin-dependent diabetic logs onto his or her Personal Health Manager, he or she has immediate access to information on diabetes. The e-mail messaging system reminds the member when it’s time to get an eye exam or foot exam or other recommended services.

"What we are attempting to tackle is behavior changes. It’s not so much managing the condition or disease but giving the members the information they need to better manage their health," Burke says.

The system concentrates on educating members with chronic diseases about the importance of managing their conditions, how to recognize symptoms, and know what National Standards of Care are for their specific condition; in other words, what they should do to stay healthy. All information is written at an eighth-grade level with lots of graphics.

"We tell them that although they have diabetes, they can live a full life if they follow a certain lifestyle that includes exercise, a proper diet, and the National Standards of Care for Diabetes," she says.

The health plan can send members as many as five daily health updates to their Personal Health Manager web site. For instance, if there is new information about a drug a member is taking, the health plan forwards it to him or her and urges the member to discuss it with his or her physician.

"We built a technology system to reach the right people who need our help and to give them the tools they need to better manage their health," Burke says.

Unlike many medical programs, Blue Care Connection doesn’t ignore members who do not have chronic diseases.

"Even if the member is young and healthy, we send out reminders for preventative procedures, such as Pap smears, PSA test, colorectal screening, etc., telling them we want them to stay healthy. We offer total health management — something for everybody whether they’re young and healthy or living with a chronic condition," she says.

The web site encourages members to log on to online libraries such as the Annotated Dissection of Anatomy of Medicine (ADAM), which is the medical encyclopedia for the National Library of Medicine.

The health plan started rolling out Blue Care Connection and Blue Care Advisor in January.

"Employers love it. They like the idea of connecting their employees one-on-one with a nurse who can give them support and the education they need specific to the condition they’re living with," she says.

Members who are eligible for Blue Care Advisor may e-mail or call a nurse care advisor, who is a registered nurse trained in specific condition management, wellness education, and how to work with members to embrace lifestyle changes.

They receive additional training on communication skills that help them get the members to engage in healthy behavior.

"Their training gives them the skills to sell the idea that it will be worth it to the member and that they will feel better if they give up cigarettes, start eating right, start walking every day, or whatever they need to do to have a better quality of life," Burke says.

There is a dedicated team for this web-based program. The nurse care advisor educates members on the importance of medication compliance, regular doctor visits, following National Standards of Care for their specific condition, eating right, and getting fit. The health plan identifies the members who need outreach by the nurse care advisor from both its predictive modeling software, which utilizes claims information, and through the members’ completed health risk assessment.

"The outreach part is very important to us. We have a Blue Cross member and a Blue Cross nurse working together to improve the member’s health and quality of life," she says.

With these members, the nurse care advisors make outreach calls and work directly with the member to set goals and manage their condition.

Members are encouraged to call or e-mail their nurse care advisor whenever they have questions.

The nurse care advisor works with the member to help set goals and achieve them.

"We encourage members to plan ahead and not to walk into a situation where they’ll go off their diet, for instance, and then decide it’s no use getting back on track," she says.

Members work with the same nurse care advisor until they can verbalize that they understand the importance of their condition-specific milestones.

The member will continue to receive reminders via his or her Personal Health Manager.

"Now the members know they have a Blue Cross nurse they can talk to who can help them prepare for their next doctor’s visit and be there for them after the visit if there is something they don’t understand. The nurse gives them the information and help they need to get on with their life," she says.

The interactive system allows a Blue Cross nurse care advisor to bond with members who choose to be a part of the program and to support the members in a very personal way, Burke says.

"In the past, we mailed out brochures and magazines and newsletters, but it’s hard to know how many people read them and how meaningful they were," she adds.

In the future, the Personal Health Manager will include information for all new mothers, listing milestones for newborns, including vaccination information, growth and development information, and to create an awareness of when their baby’s condition warrants a call to the doctor.

"We want our members to be savvy consumers and educated about the health and well-being of their little ones," Burke says.

"The parent will have a personal record for each child as they go to the pediatrician. If they are on vacation and the child gets sick, she’ll have all the information she needs available on the Internet," she adds. That’s what it’s all about . . . Giving the right information to the right person at the right time so they can take charge of their health."