Empowering Member Decision-Making in Chronic Disease Prevention

Blue Shield of California’s latest partnership focuses on empowering member decision-making for better chronic disease prevention and management, specifically for chronic kidney disease.

“Through this program, we have an opportunity to better support and empower our members by making sure they have the information to better understand their condition and be aware of treatment options,” Seth Glickman, MD, Blue Shield of California’s chief health officer, told HealthPayerIntelligence in an emailed interview.

The partnership is especially timely as kidney care continues to be a major driver of national healthcare spending and a major risk factor for severe coronavirus symptoms, Glickman noted. The disease hits underserved populations hardest, including communities of color, seniors, and women.

These considerations have driven other payers to implement new chronic kidney disease strategies as well.

“Blue Shield of California was happy to find an opportunity to address the diagnosis, treatment, and education to create a greater level of health equity,” Glickman shared.

As the first step of this program, Blue Shield of California will use data analytics technology from vendor partner Cricket Health for risk stratification of the payer’s claims data. After identifying members who are at-risk for chronic kidney disease or who have the condition, the vendor will reach out and offer members a place in the program.

Enrolled members will have access to a multidisciplinary care team as well as virtual care options to receive assistance with chronic disease prevention, slowing disease progression, and adverse event prevention, such as reducing hospital admissions.

In this program, members can receive remote care by phone or through virtual care online.

The partnership will require coordination between the member’s original care team and the third-party vendor’s providers. Strong care coordination has been linked to member satisfaction.

To smooth this coordination, the member’s original care team will receive regular updates from the third-party vendor regarding four areas of the member’s care.

The vendor’s care team will update the original care team on the member’s enrollment in the program, clinical progress such as blood pressure, medication lists, and other health updates, member’s treatment preferences, and alerts about urgent changes in the member’s condition.

Additionally, Blue Shield of California and the third-party vendor have been meeting with providers to ease the introduction of this program, Glickman added.

“Support and empowerment of members is key in all stages of their healthcare journey so that patients are comfortable making informed decisions about their care best aligned with their preferences and lifestyle,” Glickman emphasized.

Payers can support member decision-making power in many ways.

Offering access to a team of specialty care providers allows members to ask questions and receive authoritative information on their condition as well as coaching about how to slow disease progression.

In chronic disease management, however, the ability to empower member decision-making does not lie in medical support alone, Glickman said. Members also benefit from peer support.

Through Blue Shield of California’s new partnership, members will get access to a mentor who has experienced the care process that the member will undergo.

“Patients have access to a community platform where patients with similar health issues can share experiences,” Glickman explained.

To ensure that members are receiving effective care, Blue Shield of California will measure both quality and financial metrics, Glickman said. These include member engagement metrics, number of hospital and emergency room admissions, level of healthcare spending, and dialysis data such as the number of optimal starts and use of home healthcare for dialysis.

The partnership also aligns with Blue Shield of California’s overall strategy to leverage technology for personalized, comprehensive care. The partnership is part of the payer’s Health Reimagined program, which recently launched. The program aims to bring high-tech, high-touch solutions to Blue Shield of California members.

“As we continue to implement new ways to create personalized, high-quality care for our members, we put people at the center of all we do; this is a core tenet of design thinking and remains our north star and guiding principle,” said Glickman.