Care Counselor Program Empowers Members to Take a Role in Managing their Chronic Diseases

Anthem Blue Cross and Blue Shield

The Anthem Care Counselor Program was developed in response to several national trends, including one detailed in a report from the Robert Wood Johnson Foundation indicating that one-third of the chronically ill in America are not receiving the information and services needed for successful self-care and management of their illness.

Program Elements

The focus of the Care Counselor Program is to empower targeted members to assist with the management of their chronic conditions and to encourage specific evidence-based behavioral changes to promote the health and well-being of members.

In this model, case management efforts are collaborative in nature, driven by the members’ goals for improved health and level of readiness to change, throughout the continuum of care.

The program seeks to improve the quality of care for eight chronic conditions: hypertension, coronary artery disease, hyperlipidemia, diabetes, congestive heart failure, chronic obstructive pulmonary disease, stroke and chronic kidney disease. This is accomplished by:

direct and continued contact with targeted members during a 12-15 month period

the development of a care plan

involvement of family members

assistance with navigation of the healthcare system

These activities are guided by a predictive model to identify at-risk members, assessment protocols, member-specific interventions promoting evidence-based clinical guidelines and ongoing follow-up and monitoring of progress of the member's case management plan.

Program Results

Compared to a group of members not offered the program, statistically significant increases in adherence to accepted standards of care and a trend toward decreased utilization and costs have been observed among program participants.