Care Coordination

You are eligible for Transition of Care Services when you are scheduled for a planned inpatient surgical procedure or when you have an unplanned admission to an acute inpatient hospital or skilled nursing facility. Our services help you when you are being discharged home or to a lower level of care. We pay special attention to helping you move from one level of care to another, such as when you are discharged from a hospital or a skilled nursing facility back to your home.

It is important that you understand your discharge instructions and have everything you need at home to recover. We work with you to make sure you have follow-up appointments scheduled. We also make sure you receive all ordered medications and services, including oxygen and durable medical equipment. This ensures a smooth discharge and recovery.

Care Coordinators can help you by:

• Arranging services you need, including scheduling and keeping provider appointments
• Ensuring complete communication and coordination of services to provide safe, timely, high-quality care as you move out of an acute inpatient hospitalization stay
• Providing guidance before planned admissions, such as a scheduled surgery. Also, providing guidance after discharge when you have had an unplanned admission
• Understanding your conditions to reduce risks of relapse and support your ability to care for yourself
• Provide education related to medication safety and the importance of taking medications as the doctor ordered
• Reviewing and clarifying your doctor’s orders related to care, diet, and activity levels so you understand and can follow the plan of care

Care Coordination is an opt-out program which means that you don’t have to enroll. We will automatically enroll you if you are eligible and we identify an opportunity to help you. You may choose to opt out if you do not wish to participate unless you are enrolled in a Waiver program that requires care coordination. To enroll or opt out of the program, you may call Member Services.
 

Have you been to the emergency room and are not sure about follow-up treatment? Blue Cross and Blue Shield of Illinois (BCBSIL) has partnered with H.E.L.P. to provide resource information and aftercare support. We want to make sure you get the care you need.

We offer a special Complex Case Management program for members that have very complicated illnesses such as kidney disease, depression or substance abuse. If you qualify, you will receive targeted outreach by a care coordinator that specializes in helping members with these complex conditions. You will work with the care coordinator to develop specific goals aimed at improving your overall health.

The care coordinator supports you by:

• Scheduling medical appointments as needed
• Arranging transportation to and from medical appointments
• Obtaining and understand your medications
• Understand your specific disease and how to improve your health and quality of life
• Helping you in using your benefits to keep health issues from getting worse
• Offering learning tools to help you, your family and caregivers better understand any health conditions, prescriptions, over-the-counter drugs, and treatment

The Care Coordinator helps you to use your health benefits and community-based services to reach your health goals.

To enroll in or opt-out of Complex Case Management, call Member Services.

Special Beginnings helps pregnant moms better understand and manage their pregnancies and to deliver a healthy baby without complications. If you are pregnant or have delivered a baby within the last 84 days (as a BCCHP member), you are eligible for the program.

Program participants may be eligible to receive:

• Education on pregnancy, postpartum, and newborn care
• Program incentives just for going to prenatal visits and postpartum appointments
• Help finding a provider and assistance with issues with access to care
• A breast pump and extra benefits (Dental, Vision, Transportation)

For further information, see our Special Beginnings Maternity Care Program flyer. You can also call 1-888-421-7781 if you have questions about Special Beginnings. You may opt out of Special Beginnings at any time. To enroll or opt out of the Special Beginnings program, call 1-888-421-7781.

If you have hypertension (high blood pressure), diabetes or asthma, you are eligible for our disease management program. As part of our disease management program, you will receive support based on your level of need. A care coordinator will work with you to develop specific goals with the purpose of improving your overall health. If you are enrolled in the program, you work with your care coordinator to develop specific goals with the purpose of improving your overall health.

The care coordinator provides:

• Education and materials related to your diagnosis
• Assistance with understanding and obtaining medications
• Education regarding available benefits that would improve your health outcomes
• Referrals to community programs and resources for additional education and support such as improving access to healthy foods and community exercise programs

You may opt out of disease management at any time if you do not wish to participate. To enroll or opt out of the disease management program, you may call Member Services.