January 2017
Government Programs: Care Coordination Information and Resources for Discharge Planners
Blue Cross and Blue Shield of Illinois (BCBSIL) would like to increase awareness of the care coordination services we make available to our Blue Cross Community OptionsSM members. This includes Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Community Integrated Care Plan (ICP)SM, Blue Cross Community Family Health PlanSM (FHP) and Blue Cross Community Managed Long Term Supports and ServicesSM (MLTSS).
BCBSIL conducts outreach to all MMAI, ICP, FHP and MLTSS members in an effort to encourage members to complete the annual health risk screening. The screening results, along with claims data, are used to determine if there may be potential gaps in care, particularly for members with complex medical conditions. Care coordination is offered to help identified members understand and utilize their health care benefits. If the member accepts care coordination, a BCBSIL care coordinator works with the member and an interdisciplinary health care team, including the member’s health care provider(s), to help alleviate barriers to care through regular phone calls and face-to-face visits.
How can a care coordinator help a discharge planner?
The discharge planner and care coordinator goals are similar: to make sure patients/members have access to resources that can help keep them as healthy as possible and out of the hospital. The care coordinator is able to pick up where the discharge planner leaves off by meeting the member in the community to support adherence to the discharge plan and related interventions.
The care coordinator will typically try to know the member’s social and medical history, and can help fill in some blanks to assist with discharge planning. For example, the care coordinator may be able to determine how many other facilities a member has been admitted to, for what reasons, and what the discharge plan was. The care coordinator may have Power of Attorney information, or reliable contact information to reach the member’s family. The care coordinator also may know what resources have been accessed for the member, what the member has been eligible to receive, and why the member may be ineligible for some services.
If you have a patient who is an MMAI, ICP, FHP or MLTSS member with a history of frequent ER visits, hospital admissions, or compliance/adherence issues, please ask if the member has a care coordinator, or call the care coordination line listed below to find out if a care coordinator has been assigned.
To contact a member’s care coordinator directly, or to request assignment of a care coordinator for an MMAI, ICP, FHP or MLTSS member, please call the BCBSIL Care Coordination line at 855-334-4780. For quick reference purposes, also refer to the Tip Sheet for Discharge Planners, available in the Related Resources on the Medicare/Medicaid page in the Network Participation section of our website at bcbsil.com/provider.
We appreciate the care and services you provide to our MMAI, ICP, FHP and MLTSS members.
The care coordination program is designed with the goal to assist health care providers and members in better coordinating care and improving health outcomes. The program is not a substitute for the independent medical judgment of a health care provider. Health care providers are instructed to use their own best medical judgment based upon all available information and the condition of the patient in determining a course of treatment. Regardless of any benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.