Connecting multiple sclerosis patients with personalized care

Published October 8, 2019

In the U.S., nearly a million people are living with multiple sclerosis, a chronic disease involving the body’s immune and nervous systems, and experts estimate the number of diagnoses may be growing. MS is a complex, rare condition, and patients don’t always experience the disease in the same way. “Multiple sclerosis is one of those conditions that affects everyone uniquely,” says Andrew Krueger, MD, senior medical director of director of Accordant®, Blue Cross and Blue Shield of Vermont’s (BCBSVT) partner for comprehensive care management services. That’s why BCBSVT developed a holistic, personalized approach to managing care for members with conditions like MS. 

A helping hand, when and how it’s needed 
MS can affect a patient’s vision, ability to walk, fight off disease and much more. Medications can cause serious side effects. Krueger says patients may also experience depression. “And depending on the stage of a patient’s disease,” says Krueger, “patients may need a range of help at home.” Given those needs, an MS patient could be seeing a team of doctors and caregivers—spread out across long distances—to manage daily living. 

That’s why coordinating care is essential. And it’s why BCBSVT’s program pairs a nurse with each enrolled member for as long as needed. The goal, says Angela Inman, head of nursing at Accordant, “is to educate, support and collaborate across providers to help patients feel empowered and knowledgeable” about their disease. Nurse case managers maintain close contact, speaking with patients once a week or more. That relationship may help nurses detect subtle changes, such as whether or not a new medication is working. The nurse might then reach out to the patient’s doctor for guidance or to schedule an appointment. Social workers are also available to help pair patients with an array of community resources, such as transportation to appointments, help modifying a home for a wheelchair or home meal delivery.

In Vermont, meeting the needs of rural members
Vermont is small but rural, and sometimes the nearest specialty medical care is hours away. So BCBSVT places a special focus on patients who may need more help staying healthy at home by expanding the team of experts tracking a patient’s status. If a patient needs specialty care at a larger hospital in Boston, Mass., for example, care managers can ensure all of a patient’s doctors are informed and help patients prepare for any appointments. 

Supporting caregivers, too
People with MS may have a family member or friend providing care at home. And BCBSVT ensures caregivers are considered part of the team. They receive education about the disease, help developing a plan for their loved one’s disease flare-ups and advice on when to call a physician. Just as important is the need for caregivers to take care of themselves, which is why social workers can also find respite care for caregivers if needed.

Coordinating care may not be able to slow the progression of the disease for patients with certain forms of MS, but Dr. Andrew Krueger says “it can help patients stay happier and healthier by keeping them out of the hospital and receiving care at home.” A nurse’s close supervision can help manage side effects. And all of those efforts can help keep costs like co-pays, down for patients. 

Blue Cross and Blue Shield of Vermont is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.