Payer Virtual Care Management Platform Prioritizes Holistic Care

Blue Cross Blue Shield of Rhode Island (BCBSRI) has introduced a new virtual care management platform to offer a more convenient way for members to receive care coordination services and to improve member communication with nurses.

The virtual program is not designed for urgent care services and should not be used as a replacement for primary care and specialist visits.

Rather, the payer launched this program to allow members to meet with nurses from the comfort of their own homes to discuss their healthcare needs. The video aspect can also help nurses identify unaddressed health issues a patient may have.

“Our nurses—who have primarily connected with members via telephone—are able to use an online platform to interact with members and assess their health needs, as well as educate them to successfully manage chronic conditions, such as diabetes or other health issues, including behavioral health,” Smita Mazumdar, RN, director of care management for BCBSRI, stated in the press release.

“The pandemic normalized care delivery through telemedicine and our virtual care management program leverages this sort of technology, which is a game-changer for the nurse-patient relationship.”

The virtual platform offers services to any BCBSRI member on a Medicare Advantage, an individual, or a group health plan who would like to receive care management support.

Members who were discharged from the hospital recently may also receive an invite for a virtual visit. A nurse can help the patient with discharge tasks such as getting medication, the press release explained.

The virtual care management platform offers the option for other key individuals to join the virtual visit as well, such as additional clinicians, dietitians, caregivers, and health advocates, in order to address members’ individual healthcare needs.

“So far, the data has shown the program to be most impactful in assisting members with scheduling primary care appointments and supporting member needs after being discharged home,” Mazumdar added.

Previous data on the program demonstrated positive outcomes. A quarter of members in the program received patient education about their health conditions. Half of these members avoided an emergency room visit.

Members who rated the program gave it five stars and a 100 percent member satisfaction rate.

The payer also aimed to address members’ social determinants of health through the virtual care management platform.

To further its holistic approach, BCBSRI resource specialists are available to join a patient’s virtual meeting. Resource specialists help patients with non-medical needs such as access to housing, transportation, and food insecurity.

Virtual care as a mode of care delivery can help address social determinants of health barriers by allowing patients with limited access to transportation to receive care from home.

Major payers have employed virtual care strategies to improve patient access to different types of care.

For example, Blue Shield of California’s Blue Promise and LA Care health plan offered telehealth services to members when their community resource centers closed in March 2020 due to the coronavirus pandemic. Similar to BCBSRI, their services provided members with social determinants of health resources.

Even after the community centers reopened, the payers worked to integrate virtual care and in-person visits for their members. They implemented telehealth hubs and offered free internet at their resource centers to help eliminate technology barriers.

Aetna and CVS Health also launched a virtual care plan that prioritizes primary care services. The program offers members zero-dollar copay virtual primary care visits as well as in-app text messaging and phone calls to communicate with nurses about questions or concerns regarding their visit.