Care Counselor Program Empowers Members to Take a Role in Managing their Chronic Diseases

Anthem Blue Cross and Blue Shield

The Anthem Care Counselor Program was developed in response to several national trends, including one detailed in a report from the Robert Wood Johnson Foundation indicating that one-third of the chronically ill in America are not receiving the information and services needed for successful self-care and management of their illness.

Program Elements

• The focus of the Care Counselor Program is to empower targeted members to assist with the management of their chronic conditions and to encourage specific evidence-based behavioral changes to promote the health and well-being of members.



• In this model, case management efforts are collaborative in nature, driven by the members’ goals for improved health and level of readiness to change, throughout the continuum of care.



• The program seeks to improve the quality of care for eight chronic conditions: hypertension, coronary artery disease, hyperlipidemia, diabetes, congestive heart failure, chronic obstructive pulmonary disease, stroke and chronic kidney disease. This is accomplished by:
• direct and continued contact with targeted members during a 12-15 month period



• the development of a care plan



• involvement of family members



• assistance with navigation of the healthcare system


• These activities are guided by a predictive model to identify at-risk members, assessment protocols, member-specific interventions promoting evidence-based clinical guidelines and ongoing follow-up and monitoring of progress of the member's case management plan.

Program Results

• Compared to a group of members not offered the program, statistically significant increases in adherence to accepted standards of care and a trend toward decreased utilization and costs have been observed among program participants.



• Anthem Care Counselor Program has been expanded to include the three states in Anthem's Midwest region: Ohio, Indiana and Kentucky.

Contact

Mary Beth Newman, MSN, RN, 513-336-5457, mary.beth.newman@anthem.com