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BCBSIL Care Management Programs: Case Management and Disease Management

Posted May 31, 2018

Blue Cross and Blue Shield of Illinois (BCBSIL) Case Management and Disease Management staff work with enrolled BCBSIL members* to increase members’ knowledge about their condition and try to help members better manage major health events when they occur. Case Management and Disease Management staff support the member and provider relationship and aid in communication between the member and provider. Members are encouraged to discuss issues and questions with their provider, develop a shared-decision making partnership with their provider and take an active role in managing their own health.

Member compliance with provider treatment plans are monitored by the Case Management and Disease Management staff including appointment attendance, compliance with medications and completing ordered tests. Program interventions are designed to coordinate with the activities of the member’s treating provider, specifically the member’s primary care physician and/or appropriate specialist.

As provider, you may refer a member for these care management programs at any time by calling the number on the members’ ID card. The clinician will collaborate with you to provide our members with available resources and additional support. The BCBSIL Case Management and Disease Management Programs are intended to supplement the service and treatment that members receive from their health care providers.

*This article does not include members with HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM and Blue FocusCareSM, Blue Cross Medicare AdvantageSM (HMO and PPO) products.

The BCBSIL Case Management and Disease Management Programs are not a substitute for the independent medical judgment of health care providers. Health care providers are instructed to use their own best medical judgment based upon all available information and the condition of the patient in determining a course of treatment.