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Blue Cross – Complex Care

Blue Cross Blue Shield of Georgia: Complex Care and What it Means

georgia-blue-cross-quotesOne of the biggest discussion points in the ongoing debate about health care reform is the need for preventative care. Certainly, it is important to advocate for a system of prevention including well-visits and pre-screening for conditions that can be quickly and inexpensively treated before they become larger (and more expensive) issues.

Another method of preventative care is underway through BCBS Georgia, entitled Complex Cases. Here, screening and research identifies those who may be most at risk for multiple health conditions. Such candidates are most likely to need long-term, comprehensive care—but some of that care can be forestalled with careful management of some of their high-risk issues. Such care is best delivered with one-on-one support from medical professionals, and this is what the Complex Cases program is all about.

Members who have been screened and are at risk are placed in the program and matched with a trained nurse care manager (backed by a medical director). Counseling is one-on-one and together nurse and patient actively manage lifestyle and wellness choices. Patients can thus take an active role in their own health, through well-informed decision making.

Many patients with complex conditions are on a variety of medications that can be both confusing and expensive. Working with the nurse care manager, such patients create strategies for adhering to the course of drug treatment—designed to prevent diseases from progressing to surgery.

Patients in the Complex Cases program have access to health management programs, research and material to foster open communication about their ongoing care, help with coordinating care across multiple doctors and providers, and informed assistance to help with making often difficult decisions about their treatment.

The program is tailored to each member, and nurses communicate in person, via phone, over email, and more. And those nurses are backed up by a team of professionals including social workers and dieticians, pharmacists and medical directors.

Over 500 “risk” markers are used to identify candidates for the program, and it is one more way that BCBS Georgia is trying to help manage care, provide good-quality options, and give each member control over their own health.