PROVIDENCE – Blue Cross & Blue Shield of Rhode Island now offers full-time on-site nurse case managers at each of its Your Blue Store locations, fulfilling the need for guidance in managing their medicines and health among people with multiple or complex conditions, the insurer announced this week.
Members can now walk into any of BCBSRI’s three stores – in Warwick, Lincoln and East Providence – and ask to speak to a nurse to assess their wellness needs, medications, primary care providers and help find ways to better manage their health conditions.
“We found that many of our members, particularly those who have multiple conditions, are on various medications, or have a high utilization of emergency services, really needed additional assistance managing their health,” said Smita Wadhwani, director of case management at BCBSRI. “When people engage with our care coordination team, they speak with a nurse about their health and assess their needs, medications and whether they have a primary care provider. They then work with that nurse to create a personalized plan to get them on track to managing their health by arranging follow-up medical appointments, understanding their medications or coordinating health screenings to further the health goals identified by their provider.”
The embedded nurse case managers serve a broad array of specialties and can connect members with dietitians, social workers and other BCBSRI health care providers, as well as to a health advocate if they need assistance with access issues, transportation to a medical appointment or medication costs. They can also assist in locating providers who are accepting new patients and help schedule an appointment. Your Blue Store also features a case management pharmacist who is available to work directly with members to make medication recommendations, look for generic alternatives, or identify any duplication issues.
The benefit of the service extends beyond the opportunity to meet face-to-face with a case manager.
“For example, if someone with diabetes visits a Your Blue Store for a customer service issue, a representative may mention that a nurse is available,” said Wadhwani. “That nurse can work with the member to create a healthy nutrition and lifestyle plan while supporting their blood-sugar management, and refer them directly to the array of fitness and educational classes offered at the stores.”
The in-store nurse case managers work most frequently with members who have visited their primary care provider and need ongoing assistance. Examples of this assistance:
- A serious illness such as lung disease, heart disease or stroke.
- A serious injury.
- An ongoing health problem that is not under control, such as asthma or diabetes.
- A newborn or child with a complicated medical condition.
- Difficulties in accessing care because of cost, transportation, cultural or other social issues.
“Members tell us that our nurses have helped them find cost-effective care, learn how to take medications correctly, stay out of the hospital or emergency room, make a safe transition from the hospital to home, or receive assistance in getting connected with a doctor,” said Wadhwani.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
