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.

Health management programs for Blue Shield of California members

Health Management Program overview (PDF, 51 KB)
 

Special Needs Plan Model of Care program

In compliance with the Centers for Medicare & Medicaid Services (CMS) final regulations on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Blue Shield developed the Special Needs Plan (SNP) Model of Care for Medicare members. The purpose of the program is to encourage early identification of the member's health status and allow coordinated care to improve their overall health.
Learn about SNP Model of Care program
 

Care management

Care management is a comprehensive program that endeavors to help members live better with illness, recover from acute conditions, and have a more seamless healthcare experience.

Our team of nurses, behavioral health clinicians, social workers, health coaches, and other specialty clinicians provide personalized coaching, education and support to help members achieve overall health improvement.

Our program includes telephonic coaching, biometric remote home monitoring, online tools, in-person and online workshops, mailed educational materials and home visits based on member need and preference.

Our team supports members with a wide variety of healthcare needs, including:

• Assistance with navigating the healthcare system
• Behavioral health
• Cancer
• Cardiovascular conditions, e.g. coronary artery disease, heart failure
• Catastrophic injury
• Depression
• Diabetes
• LGBTQ health
• Musculoskeletal conditions
• Opioid use
• Pain management
• Palliative care
• Recent ER or hospital visits
• Respiratory conditions, e.g. asthma, COPD
• Social services
• Stroke
• Transplant process

View care management information and sign-up instructions for members

Musculoskeletal and pain management provides personalized support for members with chronic pain, and musculoskeletal disorders. The program includes coordination with the member’s medical and behavior health providers, online tools, and educational resources.

Behavioral health condition management provides personalized support for members with chronic medical conditions and co-occurring depression. The team works collaboratively to provide guidance, education, and support to members and caregivers and helps members to locate appropriate resources for their specific behavioral health condition.

Maternity management provides clinical support and coaching for pregnant members and their spouse/partner through pregnancy, loss/miscarriage, and three months postpartum through the Maven Maternity care management program. Members who enroll in Maven Maternity will have access to:

• A dedicated care advocate, who will help the member find care, navigate their health benefits, find the right in-network providers, and more.
• On-demand access to Maven’s virtual network of providers, available 24/7/365, spanning over thirty specialties, including OB-GYNs, nurse practitioners, physical therapists, doulas, midwives, lactation consultants, infant sleep coaches, mental health specialists, and career coaches.
• Clinically approved content and virtual classes curated to the member’s specific point in their journey. Examples of content include “What you need to know about the glucose screening test during pregnancy” and virtual classes such as “Breastfeeding 101.”

View Maternity program information and sign-up instructions for members
 

How to refer patients to Blue Shield health management programs

To refer an individual member to the care management or maternity program, download our single patient referral form. Email or fax the completed form to us.

To refer multiple members to the care management or maternity program, download our bulk referral form, complete and email it to us.

Single patient referral form (PDF, 119 KB)

Bulk referral form (XLS, 61 KB)

 Email: CMReferral@blueshieldca.com

 Fax: (877) 280-0179