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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 Montana (BCBSMT) is an ally to its network providers who deliver quality care to its more than 240,800 members. To fulfill that promise, it employs dozens of 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. BCBSMT 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. David Lechner, BCBSMT’s vice president of health care delivery 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 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,” Lechner 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, BCBSMT bought retinal cameras and worked with provider groups throughout the state to perform eye exams on members with diabetes, which can damage blood vessels in the retina, causing blindness. One of the first members screened was diagnosed with diabetic retinopathy, Lechner says.

“The screening prevented this man from going blind,” he says. “No one expects an insurer to be altruistic in helping improve member outcomes.”

In another initiative, BCBSMT 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.

BCBSMT sent FIT kits to 2,269 eligible members, and 447 performed the screenings. It recommended 20 members schedule colonoscopies because their FIT kit results were abnormal.

However, Lechner believes members must have good mental health to achieve good physical health, no matter where they live. To improve mental health care access, leaders have worked with providers and policymakers to develop care models that will keep members closer to home and reduce obstacles to care, including expanded telehealth services.

Lechner 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