The Omaha-based Blue Cross Blue Shield Nebraska serves 500,000 lives across the Cornhusker State. With strong relationships with providers across the state, BCBSN’s leaders continue to try to advance their progress in care management, population health management, and plan member engagement.
In that context, BCBSN’s leaders have been working in improving their care management operations, through enhancing the touchpoints of their plan members, as they transition to post-surgical care, and across their ongoing chronic condition care management. In that regard, they’ve tasked their care managers to more fully engage with plan members, making using of a mobile-based solution to amplify care management so that it’s an ongoing touchpoint for patients in the longer term — with some excellent results. For example, BSBCN plan members have been able to meet 96-percent medication adherence, post-surgery, while case managers are now spending less than half the time it took previously to reach health plan members (from eight minutes down to 3.5 minutes), using that mobile solution.
The leaders at BCBSN have been partnering with the Boston-based Wellframe, which offers mobile patient engagement and care management software. Wellframe’s care programs turn health management into an interactive, personalized, and educational daily to-do list delivered to patients’ mobile devices.
Susan Beaton, R.N., vice president of provider services and care management, at BCBSN, spoke recently with Healthcare Informatics Editor-in-Chief, Mark Hagland, regarding the insurer’s leveraging of mobile technology to support its care management and wellness efforts. Below are excerpts from that interview.
Can you tell me a bit about BCBSN’s overall population health management and care management strategy, and how this mobile-leveraged care management initiative fits into that overall strategy?
About four years ago, we decided to look at our traditional care management programs, which were based on reaching out to members who needed our assistance, but it was done by invitation through the email, through a physician, referral pattern; but we knew times were changing, and that our members needed real-time interaction, and meeting them where they needed us to be. And at that time, we didn’t have a mobile platform, and knowing that we needed to make that switch, knowing that health happens at home and at work, and we knew we needed to meet members where they were, and that’s usually away from their home phone. That’s when Jake [Jacob Sattlemair, CEO of Wellframe] and Joann Schaefer, M.D., our executive vice president—who was at that time our CMO—first touched base.
And it went fast. Once we started to meet, we realized that Wellframe was really something special. They were able to take a look at what we were doing, and identify what their tool was able to do for us and our members. And in 2015, we were up and running on a pilot program for our nurses and members. Their goals were very similar to ours; we’re very agile and innovative. It became a great collaboration.
What was the core focus of the initial pilot?
We looked at our program that helps our members when they discharge from the hospital and go back home, and looked at how we could interact with them by phone. At that time, that was one of our greatest needs, and that’s where we started. So it launched, and it was successful. We were looking at the interactions our nurses were having with our members: it was real-time, it was relevant.
It was care management-type counseling over the phone?
It was both educating them about their medical condition, and answering benefits questions over the phone. Their medical condition, their pharmaceutical needs, and their benefits. Initially, it was about 1,000 members a month discharged from the hospital, with seven nurses. And it really went very fast, and has expanded ever since. We’ve ended up putting every single one of our care management offerings onto the Wellframe platform.
We have Transitions of Care, Health Coaching, Chronic Disease, Catastrophic Case Management, Maternity Management, Presurgical and Postsurgical Care Management; and Emergency Management will be next. We found we needed to offer everything via both our traditional mode and the Wellframe platform. So it’s been continuous development ever since.
Have you encountered any challenges in developing this?
Well, sure, with any program, you always have challenges, but we were able to address those with Wellframe, and Dr. Schaefer, and our nurses, etc.
Have you used this solution to work on readmissions reduction at all?
We started with a basic measure in terms of interventions. Over half of our members no longer have home phones. So if we were using traditional measures and tried to reach a home phone or send them a letter in the mail, we found that we were often not connecting. Using this mobile solution, we found that our engagement rates immediately went up. Before, we were lucky to get maybe one or two communications every couple of weeks. Using the dashboard, though, they would chat in real time. And nurses were able to get alerts from Wellframe in real time, letting them know what communications had taken place. It was through an app or via the website, that they were reaching out.
We started out simply; for most plan members/patients, the most confusing thing is remembering what their discharge instructions were, so Wellframe was able to build into the platform to help the member understand the discharge instructions. Did they have any questions? We knew that members… Let’s say somebody went home from the hospital after surgery. If they needed follow-up care or medication adherence education, we were able to send them information—so, four pieces of content of information. What was fantastic was we were able to verify that they had consumed the content, and if they had questions. That was a fantastic advance for us. We were able to get instantaneous feedback. And a couple of times a week, we would find out how they were doing with their follow-up routine, and if they had questions, etc. Through the continuous questionnaire format, or even via live chat, we were able to get feedback from them. We know members are busy, too, and we were able to get them information conveniently, and we knew members were responding to us. We wouldn’t have gotten that via traditional means, so that was a fantastic learning.
Another incredibly important element is following up with a primary care physician visit after discharge; and 77 percent of the time, we had confirmation that they had seen their PCP. Either we would ask them directly, or we would check claims or visit appointments.
Are you going to expand this in some way?
The next step that we just rolled out in February—when we try something that turns out to be successful, we know it’s important to support our physicians. And knowing that members also reach out to their physicians, we knew we needed to incorporate this tool into our communications with physicians. So in February, we were able to incorporate this into our work with one of our ACOs, in terms of communications with physicians.
So this has been rolled out to physicians so they can communicate with you?
It’s live now, in that particular ACO.
How many physician practices is it live in?
It’s being launched through a care management organization that’s working with that ACO. It’s one large physician clinic that is involved.
What have the biggest learnings been so far, in terms of engagement with patients/members and physicians?
One of the learnings has been what we’ve learned internally. Members very easily explained what they needed to be successful. They love the new technologies, and love interacting with the nurses. They still get compassionate nursing, but it’s real-time, and it enhances interactions. We have to interact with members wherever they are—at home, at work, on the go. We really needed a tool to achieve that, as we continue to do everything we do already that enhances our patients’ health. And once we got those up and running, it was so quick; and getting the next piece in, and when our nurses can see the difference they can make.
When we can get a 400-percent increase in touchpoints, that just energizes the nurse case managers more. We inspected the information, took in the feedback, and made the changes. It’s been a fantastic experience. So, our nurses and members first, then, how we interact with physicians. And then, what will happen with members who just have benefits questions? So each year has brought new innovation and change. We have to be able to change like that for our members.
Is there anything you’d like to add?
Wellframe was able to take away some of the pain points we had had around not being able to reach our members—for example, if they were traveling away from home, they weren’t getting letters. So Wellframe has been able to alleviate those obstacles. And we were able to reach more members, have more meaningful engagements, increase their capacity; and it drives cost savings; and helps our members understand their benefits; and where to get highest-quality, low-cost care, and how to use the system. Those have been the biggest learnings. This is what our members want.