BCBSNM condition management programs support physicians    
Our condition management (DM) programs are based on the belief that to optimize health outcomes, patients with chronic health conditions are best served by a collaboration of their physician’s professional clinical care and self-care (the actions patients take to manage their conditions).

While protecting patient confidentiality, our DM programs help support physician-patient relationships by:

  • Using techniques that help members with chronic health conditions become informed, motivated patients who engage in self-management; who appropriately access physician support and treatment; and who work to minimize morbidity, risk, and complications.
  • Providing care coordination that allows you to track key elements in the standard care of persons with chronic conditions, such as diabetic patients who may not have a current dilated retinal eye exam or asthmatic patients who may not be receiving inhaled corticosteroids.
  • Summarizing and disseminating current, nationally accepted clinical practice guidelines.
  • Referring members who may be dealing with chronic conditions and experiencing gaps in care that could be addressed through intervention and counseling to Blue Care® Advisors (BCAs).

BCAs are registered nurses or other health care professionals who reach out to at-risk and high-risk members and engage them in our DM programs, provide health counseling, and help them improve their health. BCAs contact members to assess their health status, identify their needs, and gauge their readiness to change. Working with the member and his or her physician, the BCA provides education on daily and long-term management of conditions, facilitates compliance with treatment plans and medications, and sets wellness goals.

In addition to the DM programs, which are components of the overall Blue Care Connection® program, eligible members also have access to the following:

  • Personal Health Manager: An online suite of wellness resources that your patients can take advantage of, regardless of health or fitness level, to help maintain their health, adopt healthier behaviors, and make informed health decisions.
  • 24/7 Nurseline: Around-the-clock, toll-free access to registered nurses who can answer general health questions and provide information for further resources.
  • Special Beginnings®: For expectant members whose coverage includes maternity benefits, this maternity program provides education and support from early pregnancy until six weeks after delivery.

For more information, or if you want to refer a patient to these DM programs, call BCBSNM toll-free at 1-866-874-0912. You can also review our programs and guidelines at bcbsnm.com.

Blue Review • December 2011 • bcbsnm.com