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Collaborating with providers to help members close gaps in care and achieve optimum health.

Focusing on Preventive Care and Chronic Conditions

Blue Cross and Blue Shield of New Mexico (BCBSNM) is an ally to its network providers who deliver quality care to the more than 710,000 New Mexicans carrying a Blue Cross and Blue Shield card. To fulfill that promise, it employs about 570 clinicians, including doctors, nurses, social workers and pharmacists, who help ensure members get the care they need. 

Last year, the company expanded an initiative aimed at closing gaps in care by targeting preventable conditions that most affect members’ health and well-being. BCBSNM focused on six areas of health — cancer screenings, immunizations, diabetes, cardiovascular care, behavioral health and maternal and infant health — to help nudge members to get recommended preventive screenings and manage chronic conditions.

Research published in the American Journal of Managed Care shows early disease detection enables prompt treatment that can prevent disease progression and poor health outcomes.

Dr. Latha Raja Shankar, BCBSNM’s chief medical officer, says the key to improving member health is educating providers, employers and members about the importance of preventive care and wellness. 

“We have to get members to go to a provider, and the primary care provider has to do the right thing for the members,” she says. “All of us want to do the right things.”

Part of the work involves using claims data and other information to identify members in need of recommended services and screenings and informing members and providers about those gaps by letter, email, phone or text message.

“If we find that there’s a population of folks that aren’t having their diabetes managed or the kiddos haven't had their immunizations, we directly will reach out to their clinicians and to those members and remind them of the importance of these services,” Shankar says. “They might just need some reminders that you’re 50 years old and it’s time for your mammogram or it’s time for your colonoscopy or your kiddos are headed to school. It’s time for their immunizations.”

For example, last year, BCBSNM used claims data and other information to identify about 300 Medicaid members diagnosed with diabetes possibly at high risk for complications. It offered to connect those members with our care managers, who could help them find doctors, diabetes education and community resources to better control their conditions.

Many members agreed to engage with care managers or other community care coordinators to get regular screenings, education, equipment or other services. BCBSNM plans to evaluate whether care management significantly helped improve member outcomes.

“It made sense to focus on members with diabetes,” says Dr. Diana Weber, BCBSNM medical director, adding that 12% of the state population has diabetes. “We would love all eligible members to be enrolled in care management.”

In another initiative, BCBSNM offered free at-home colorectal cancer screening tests, fecal immunochemical test (FIT) kits, to targeted member populations to screen themselves for colorectal cancer and return them for analysis. FIT kits are an effective and less invasive screening for colorectal cancer.

BCBSNM sent FIT kits to 619 eligible members, and 144 performed the screenings. It recommended eight members schedule colonoscopies because their FIT kit results were abnormal.

Additionally, Shankar and BCBSNM staff spoke at community events and encouraged members to try to eat healthier and exercise more to make small improvements.

“Those little changes go a long way,” she says.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association