Care Managers work to improve patient health through advocacy, education, and coordination of care.
The best analogy for a Care Manager is an air traffic controller. Air traffic controllers don’t physically land planes, but their direction and coordination ensure landing goes smoothly.
Similarly, Care Managers can direct you to care and services to ensure your health needs are being met. You can think of them as care traffic controllers.
Impact in action
Here is an example of a recent Blue Cross Blue Shield of Arizona member’s experience with a Care Manager:
A BCBSAZ member was having trouble getting specialized prescription food that needed to be administered through a feeding tube. The member and family were frustrated since they had multiple specialty service needs, and they were having trouble communicating to get the services the member needed. Additionally, the member needed supportive therapies like occupational therapy (OT) and physical therapy (PT) to improve strength and stability after a life-altering event. The member was assigned a BCBSAZ Care Manager who helped with the following:
- The Care Manager worked with the pharmacy team to review the medical necessity of the specialized food the member needed. The prescription food was approved and delivered to the member’s home. The provider of the food worked with the member’s family to appropriately deliver the food via the member’s tube.
- The Care Manager worked to find in-home providers for PT and OT based on the specialized needs of this member.
- All providers, including the food delivery provider and the PT and OT staff, were well informed and able to meet the needs of this member on the very first visit because the Care Manager prepared the providers for the member’s very specialized needs.
Everyone’s health needs are different but, as you can see from this example, BCBSAZ Care Managers can find unique solutions through communication, collaboration, and coordination. Many members with complex conditions are unaware they have access to this resource that can help them navigate the healthcare system at no additional cost. To further explain the role of a Care Manager and how to utilize one if needed, we sat down for a Q&A with Sharon Unterreiner, who manages BCBSAZ Care Managers.
Q&A
Q: What is the role of a Care Manager at Blue Cross Blue Shield of Arizona?
A: A Care Manager at BCBSAZ is an independent licensed health care professional like a Registered Nurse or Licensed Clinical Social Worker, who works with members to improve healthcare outcomes and assists with navigating the healthcare system.
Our staff has a variety of experiences in specialties such as behavioral health, oncology, cardiology, neonatology, rehabilitation, high-risk pregnancy, and more. Our Care Managers have an average of 16 years of clinical experience, thus having the skills and expertise to combine industry-standard goals with the member’s personal goals.
Q: Can you explain how BCBSAZ Care Managers take a personalized and holistic approach to helping members, families, and caregivers arrange healthcare services?
A: Care Management refers to a comprehensive suite of services and activities that help members with chronic or complex conditions manage their health. Care Management’s overarching goal is to improve patient health through advocacy, education, and coordination of care both with teams internal to BCBSAZ, like our Medical Directors, as well as providers in the community. Ultimately, Care Management is helping members with self-management skills and increased healthy behaviors (i.e., eating, exercise, sleep hygiene, etc.) so they can manage their health throughout their life.
Our team takes a holistic approach to Care Management. We want to consider the whole person, including their medical and behavioral health needs, their family needs, and social determinants of health (which can include items like food, transportation, financial assistance, community support, and more). We know that these items impact health outcomes and may need to be solved to help the member get their healthcare needs met.
Q: Are Care Managers assigned, or can you ask for one?
A: There are “no wrong doors” to getting Care Management services. We reach out to members identified through a variety of ways to offer help with their healthcare journey.
Also, members and their families can request Care Management services by calling the number on the back of their insurance card.
Q: Who would best benefit from a Care Manager?
A: There are many situations where a member might benefit from working with a Care Manager. For example, members who are returning home from a hospital stay, those who have been diagnosed with a serious health issue, or those who are hitting roadblocks in the health system and need help navigating complex situations.
Q: Is Care Management a free benefit available to all members?
A: Care Management is available to most members at BCBSAZ. This is a free service that is included in their benefit plan. Care Management is typically described in their benefit book and their health plan administrators will be able to remind them. We send some members reminder cards to highlight different benefits including Care Management.
Q: Once you have a Care Manager – will you always be interacting with that same manager?
A: We try to assign the same Care Manager if members have previously worked with one of our clinicians. We think once a member builds a trusting relationship with a person, they are often the best ones to continue working with them. The Care Manager’s goal is to empower members by giving them the tools, education, and resources to manage their health.
Q: What is the first question a member should ask their Care Manager?
A: The first question I would ask is, “Here is what is going on with me, how can you help?”
Q: Should members reach out to a Care Manager as a first step before searching for treatment facilities, specialists, etc. because a Care Manager can help with that?
A: Yes, Care Management can help with that. We rely on a member’s treatment providers to establish the treatment plan and Care Managers help to support that with things like education about benefits, referrals to in-network providers and facilities, community resources, and help with social determinants of health.
Q: Can members use their Care Manager for as long as needed?
A: We will work with members for as long as they need and help them with skills to manage their condition and navigate the healthcare system effectively on their own. They can always reach out if they need help with another event or condition.