Transitional Care Management for Special Needs Plan members
Hospital re-admissions contribute significantly to healthcare costs. Blue Shield of California Promise Health Plan has developed the Transitional Care Management Program to meet all regulatory requirements, and to deliver high-quality care to members during care transitions.
Transitional care management occurs any time a member moves from one care setting to another. When a member is admitted from home to the hospital or discharged from the hospital to a skilled nursing facility and eventually back home, they are experiencing transitional care management.
Blue Shield Promise’s Transitional Care Management team is composed of:
- Case managers
- Social workers
- Pharmacists
- Physicians
- Transitional care management coordinators
This team works closely with the member and/or their caregivers to assist them through each transitional care management process. Every time a transitional care management occurs, the primary care physician (PCP) receives notification in writing. Once the member transitions to their home, the transitional care management case manager (TCM CM), who is a nurse, will call the member and perform a comprehensive hospital discharge assessment and medication reconciliation. The TCM CM will also assist the member with making an appointment to see the PCP and any needed specialists. The case manager will share information with providers in order to coordinate care for the member.
We are confident that this program will be successful in lowering our re-admission rates and improving the quality of care our members receive. For more information, call:
Phone: (877) 702-5566, 8 a.m. to 6 p.m., Monday through Friday.
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.
Behavioral Health Services
Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.
Population Health Management
Our Disease Management Program provides education, care coordination, and support for members with certain chronic conditions.
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.