Blue Cross NC Partnership Aims to Improve Fall Prevention for Members

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a partnership that would aim to improve fall prevention for members.

The payer partnered with the Green & Healthy Homes Initiative (GHHI) to create healthy housing environments for middle-aged and senior Blue Cross NC members.

“Everyone should have access to a healthy home—an important driver of health—where they feel safe,” said John Lumpkin, vice president, drivers of health strategy at Blue Cross NC. “By trying new ways to improve health and partnering with organizations like Green & Healthy Homes Initiative, this gives more North Carolinians the opportunity to be healthy.”

The program performs an evaluation of the home environment to assess fall risk and provide repairs if necessary. Repairs could include lowering a threshold that might trip a member or installing grab bars, safety tub bars, and toilet seat frames to help the member stabilize themselves.

Many repairs will be covered under the health plan. Some will require member payment.

Members will also receive information about how to avoid falls. GHHI will call the member after the intervention, giving them the opportunity to ask questions or share their satisfaction.

Eligible members would be 45 years of age or older living in Durham, Orange, Wake, Forsyth, Guilford, Mecklenburg, Union, Brunswick, or New Hanover counties. They must meet an established set of criteria to be considered at-risk for in-home falls. The criteria include risk factors such as low-bone density, cancer, vision or balance issues, as well as a history of falls.

The payer will perform outreach to ensure that qualifying members are aware of their eligibility. One method of outreach will be to send emails or postcards to members who qualify, giving them the opportunity to engage.

Another way that the payer will engage members in the program is by screening them for fall risk. At least seven providers are participating in the program. When these providers identify members who are at risk for an in-home fall, the providers or Blue Cross NC care management team will share information with the member about the GHHI program and offer the opportunity to participate.

The program’s enrollment period ends when 900 members have signed up. If the payer does not reach that threshold, the enrollment period will end in June 2023.

One of the five social determinants of health domains is the “neighborhood and built environment.” Members’ living spaces can significantly impact their overall health and wellbeing.

Members in Medicare Advantage plans are more likely to have access to benefits that address these kinds of needs. Payers can build on the Medicare Advantage flexibilities to offer home improvements, grocery benefits, and more.

Additionally, referrals and screenings are pivotal to addressing members’ social needs. The Centers for Medicare and Medicaid Innovation (CMMI) noted that incorporating these measures into payment models along with social risk adjustment, direct funding of social services, and more are critical to resolving health equity challenges.