Healthy Outcomes: New, Integrated Health Management Solution

Release Date: November 13, 2012

Effective January 1, 2013, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will launch Healthy Outcomes, our new suite of health management programs, for our commercial members with select health conditions.  This confidential program is available to eligible members at no cost and will replace our current Member Health Partnerships^SM program.

Members currently participating in one of these programs will be re-identified for the Healthy Outcomes program that best meets their specific health care needs. We will continue to offer value-based benefits to eligible members, such as nutritional counseling, a deductible waiver for diabetic supplies, and a copayment reduction for some asthma medications. We are working with the health and wellness vendor, Alere, to administer these new, integrated and flexible health and wellness solutions, including:

• Healthy Outcomes Case Management – personal outreach for high-risk members
• Healthy Outcomes Condition Care – disease management support and education for members with moderate health issues or one of five chronic conditions (coronary artery disease, chronic obstructive pulmonary disease, congestive heart failure, asthma, or diabetes)
• Healthy Outcomes Maternity—our program for eligible expectant and new mothers
• Healthy Outcomes Wellness—range of programs to engage, educate and guide members on the path toward better health

If you have Blue Cross NC patients who participate in the Healthy Outcomes program, you’ll receive individual patient reports from Alere, including these condition-care reports:

• Pre-Visit Report—faxed one to two days prior to appointment; provides between-visit summary of relevant clinical data
• Alert Report—faxed when urgent problems are noted and need to be brought to your immediate attention
• Medication Gap Report—Faxed when medication gaps are identified to help support patient’s overall plan of care and includes all known prescriptions for patient

As an in-network physician, you also have access to the Patient Care Summary via Blue e^SM.  This report provides an essential snapshot of your patient’s health such as any overdue screenings or tests, a three-year medical history including any specialist visits, a 12-month record of the patient’s prescription drug history, as well as whether or not Blue Cross NC Case Management is trying to reach the patient.

If you have a Blue Cross NC patient who may benefit from the Healthy Outcomes program, please encourage him or her to contact us at the toll-free number listed on their Blue Cross NC ID card.  This program is not available to State Health Plan, Federal Employee Program, Blue Medicare^SM members, or to members whose ASO employer groups do not offer disease management services.

If you have any questions, please contact the Provider Blue Line^SM at 1.800.214.4844.