Population health management programs

Blue Shield of California Promise Health Plan has established a Disease Management Program to provide education, care coordination, and support to our members with certain chronic conditions.

The following Population Health Management Programs are available:

  • Asthma
  • Heart failure
  • Depression
  • Diabetes
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease (COPD)


Blue Shield Promise refers to these programs as "population health management." Participation in these programs is free and voluntary for all program-eligible Blue Shield Promise members.

These programs provide members with the education necessary to better manage their conditions. Our Disease Management nurses work closely with the members and their doctors to keep them as healthy as possible and avoid unnecessary hospitalizations. The nurses assist the members in coordinating their care and obtaining all required preventive health screenings.

The programs are administered by Blue Shield Promise, which automatically identifies members with these medical conditions who meet specific criteria, offering them participation in these programs.
 

Benefits to the member

  • Regular nurse calls from our disease managers to review the member’s health status and provide support and education
  • Phone support via our toll-free number is available for members to speak with our disease manager about their condition and answer any questions they may have
  • Reminders to members to obtain preventive health screenings, exams, and tests, as needed
  • Educational mailings to members of materials to help them understand their chronic condition
  • A Peak Flow Meter (for asthma only) for ages 5 and under, to help better manage and monitor the member’s condition 
     

Benefits to the physician

  • Member compliance with physician treatment plan
  • Detailed reports informing you of a member’s status changes, or concerns that may require physician intervention
  • Comprehensive member medication profile
  • Care coordination with the primary care provider and specialists

If you want additional information or would like to discuss population health management programs with our Disease Management Program Manager, call
 Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.
 

Referral form

To refer a Blue Shield Promise member to any of the population health management programs, use the referral form:

 Population Health Management referral form (PDF, 212 KB)

Medical care solutions

Review medical care solutions for Blue Shield Promise plans.

Medi-Cal Provider Incentive Program

Our Med-Cal Provider Incentive Program provides incentives for network physician practices and independent physician associations (IPAs) to support and encourage high standards in health care for our valued Medi-Cal plan members.

Complex Case Management

Our Complex Case Management program allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.

Transitional Care Management for Special Needs Plan members

Blue Shield Promise has developed the Transitional Care Management Program to deliver high-quality care to our members during care transitions. This program meets all regulatory requirements.

Behavioral Health Services

Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.

Quality Improvement Program

Blue Shield Promise created a Quality Improvement Program (QIP) for all lines of business. This program allows us to identify opportunities for improvement of care and services to our members and providers.

Health education for providers and members

Blue Shield Promise assists you in meeting health education state requirements by providing appropriate health education materials for you to distribute to your patients. These multilingual materials are available in the state-mandated topics.

Provider Connection

Access network provider tools on Provider Connection website.

Health Care Options: 1-844-580-7272, thứ Hai đến thứ Sáu, từ 8 giờ sáng - 6 giờ chiều. Người dùng TTY nên gọi số 1-800-430-7077.

Để biết thông tin về Blue Shield Promise Cal MediConnect Plan và các tùy chọn Cal MediConnect khác dành cho dịch vụ chăm sóc sức khỏe của bạn, hãy gọi cho Sở Dịch vụ Chăm sóc Sức khỏe theo số 1-800-430-4263 (TTY: 1-800-735-2922), hoặc truy cập https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan là một tổ chức chăm sóc được quản lý, thuộc sở hữu hoàn toàn của Blue Shield of California, cung cấp các Chương trình Medi-Cal và Cal MediConnect.

© 2002-2023. Dịch vụ Bác sĩ California, tên thương mại là Blue Shield of California Promise Health Plan. Đã đăng ký Bản quyền.

Dịch vụ Bác sĩ California, tên thương mại là Blue Shield of California Promise Health Plan, là đơn vị được cấp phép độc lập của Blue Shield Association.

Mạng lưới nhà cung cấp có thể thay đổi bất cứ lúc nào. Quý vị sẽ nhận được thông báo khi cần..

Blue Shield of California Promise Health Plan tuân thủ luật hiện hành của tiểu bang và luật dân quyền liên bang, đồng thời không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, tổ tiên, tôn giáo, giới tính, tình trạng hôn nhân, giới tính, bản dạng giới, khuynh hướng tình dục, tuổi tác, hoặc khuyết tật.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, Long Beach, CA  90806

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