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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 Texas (BCBSTX) is an ally to its network providers who deliver quality care to its more than 6.9 million members. To fulfill that promise, it employs about 1,265 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. BCBSTX 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.

“At the base of this is how we get people established with a provider who can have conversation with them about maintaining their health, not illness,” says Dr. Mark Chassay, BCBSTX vice president and chief medical officer. “It’s a mistake to think a doctor only wants to see someone when they’re sick.”

Part of the work we do 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,” Chassay 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, BCBSTX used retinal cameras at large community events around the state, as well as in providers’ offices, to perform eye exams on dozens of members with diabetes, which can damage blood vessels in the retina and cause blindness. The screenings revealed several members had developed diabetes-related eye disease. Six of the cases identified were life-threatening.

“More than once, these scans identified someone at a vision-threatening level of disease,” Chassay says. “BCBSTX helped them take the first step to save their vision.”

Additionally, the company texted certain members with gaps in their breast cancer screenings to encourage and help them schedule mammograms.

In another initiative, BCBSTX 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.

BCBSOK sent FIT kits to 55,227 eligible members, and 8,302 performed the screenings. It recommended 405 members schedule colonoscopies because their FIT kit results were abnormal.

Chassay wants to help providers build relationships with patients while their healthy, not after they become ill.

“There’s nothing wrong when a provider gets to tell someone they’re healthy,” he says. “All of our efforts are really predicated on members establishing meaningful relationships with our provider partners.”

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