Complex care programs
Blue Shield of California and Blue Shield of California Promise Health Plan are pleased to offer eligible members with multiple, select chronic illnesses special programs to help them manage their complex care needs as effectively as possible.
ConcertoCare complex care services are available to eligible Blue Shield HMO or PPO commercial plan members and Medicare Advantage HMO or PPO plan members, including Medicare Advantage D-SNP members, and Blue Shield Promise Medi-Cal plan members, in select geographical areas.
Altais and BT Health are available to provide complex care management services to eligible Blue Shield HMO and PPO commercial plan members and Medicare Advantage HMO and PPO plan members, in select geographical areas.
Blue Shield determines member eligibility for these programs based on clinical criteria and geographical location.
ConcertoCare
ConcertoCare™ is an additional resource that Blue Shield has engaged to provide health care services for eligible members with commercial HMO or PPO, Medicare Advantage HMO or PPO, or Medi-Cal coverage who have been diagnosed with multiple, specific chronic illnesses residing in select geographic areas.
- ConcertoCare provides community-based, physician-led medical teams who specialize in house calls and home-based care to deliver medically necessary services for chronically ill patients.
- ConcertoCare’s tech-enabled in-home care teams leverage an interdisciplinary care model to address unmet health and social needs and improve patients’ quality of life, partnering with them, their caregivers, families, health providers and communities.
- The program offers 24/7 in-person and virtual access to medical professionals and in-home urgent care to participating members.
ConcertoCare is currently available to eligible members 18 years of age or older residing in the California counties listed below. The service area may expand in the future.
- Los Angeles
- Orange
- San Diego
- Riverside
- Sacramento
- San Bernardino
- San Luis Obispo
- Santa Barbara
- Ventura
Blue Shield and Blue Shield Promise determine which members are offered participation in the ConcertoCare program, and member participation is voluntary. Physicians or other health care providers for Blue Shield or Blue Shield Promise members may not refer their patients directly to ConcertoCare.
There is no cost to the member for participation in this program. There may be some specialty services that cannot be provided directly to the member by ConcertoCare, resulting in ConcertoCare referring the member to a provider within Blue Shield’s or Blue Shield Promise’s network who is not part of the ConcertoCare team. In those cases, the member’s standard copayment or coinsurance payment may apply, in accordance with the member’s benefit plan for services provided by a Blue Shield or Blue Shield Promise network provider.
Learn more about ConcertoCare
Review or download these resources to learn more about complex care management programs, including ConcertoCare:
- Presentation slides (6 MB)
- Frequently Asked Questions (PDF, 94 KB)
- Visit www.ConcertoCare.com.
Altais and BT Health Complex Care Program
Altais and BT Health also provide complex care services for eligible fully insured Blue Shield HMO, PPO commercial benefit plans and Medicare Advantage HMO or PPO plans.
Members may be offered this program by Blue Shield based on predetermined clinical criteria and geographic location. Altais serves as the business administrator for this Complex Care program, while BT Health provides comprehensive home-based and virtual care, including medical, behavioral, and social services support.
BT Health licensed physicians oversee the care provided by nurse practitioners, registered nurses, and other medical professionals providing complex care services, including 24/7 access for in-home urgent care. Complex care provided by Altais and BT Health complements the care of members’ primary care physicians or primary care providers.
This program is available to eligible members 18 years of age or older residing in the following California counties:
- Alameda
- Contra Costa
- Marin
- Napa
- San Francisco
- San Mateo
- Santa Clara
- Santa Cruz
- Solano
- Sonoma
Blue Shield determines which members are offered participation in the Complex Care program with Altais and BT Health, based on clinical criteria and geographical location, and member participation is voluntary. Direct referrals from healthcare providers are not currently accepted.
There is no cost to the member for participation in this program. There may be some specialty services that cannot be provided directly to the member by BT Health, resulting in Altais referring the member to a provider within Blue Shield’s network but not part of the BT Health clinical team. In those cases, the member’s standard copayment or coinsurance payment may apply, in accordance with the member’s benefit plan for services provided by a Blue Shield network provider.
Learn more about complex care management with Altais and BT Health:
- Presentation slides (3.4 MB)
Other care management programs
Eligibility for complex care programs is carefully determined by expert clinical care teams at Blue Shield and Blue Shield Promise, through evaluation of the individual needs of each member. Some members with complex care needs are offered programs that include 24/7 access to nurses and doctors providing care management, in addition to widely accessible benefits such as NurseHelp 24/7SM or Nurse Advice Line, and Teladoc Health. Certain members may also be eligible for DispatchHealth® and/or palliative care. Member participation in any of these programs is voluntary.
Members who are determined by Blue Shield or Blue Shield Promise to be eligible for care extending beyond these programs are offered additional resources that specialize in providing comprehensive and more complex home-based care.
ConcertoCare is a registered trademark of the parent entity of ConcertoCare of California, LLC, which complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Visit https://concertocare.com/notice-of-individuals-nondiscrimination-and-accessibility-rights to learn more.
Altais is independent of Blue Shield of California. Altais is contracted by Blue Shield to provide program administration services. My Health Medical Group d/b/a BT Health is managed by Altais to provide in-home and virtual care services. My Health Medical Group, Inc. (“BTHealth”) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Visit Non-Discrimination Notice - BTHealth (brownandtolandhealth.com) to learn more.
NurseHelp 24/7 is a service mark of Blue Shield of California. NurseHelp 24/7 and Nurse Advice Line are healthcare advice lines. Nurses do not provide medical services for treatment or diagnosis.
DispatchHealth is a registered trademark of DispatchHealth Management, LLC. complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Visit http://www.dispatchhealth.com/non-discrimination-statement to learn more.