SCMA MIT partners with PAI/Blue Cross Blue Shield

This service is offered at no cost to all physicians, employees, spouses, and dependents on the SCMA MIT health insurance plan.

 

About Population Health

Population health is the process of using big data analytics to define patient groups, protect members, and report on individual and group outcomes to ensure quality and accountability. SCMA MIT’s goal is to provide value to all members, regardless of health status. By using evidence-based tools, we can improve the patient experience and overall workforce health while lowering costs.
 

For the last 15 years, SCMA MIT has partnered with Planned Administrators, Inc (PAI) to administer our self-funded health plan.  PAI is a subsidiary of BlueCross BlueShield of South Carolina and provides our membership with access to the Preferred Blue Network.  Through this relationship, SCMA MIT has a dedicated population health resource team to assist in face-to-face consultations as well as collaborate with BlueCross BlueShield of SC partners.

 

The New Partnership

Through SCMA MIT’s new partnership, we will be able to collaborate with the member, family, facility, and even a member’s physician to assist with ongoing health maintenance needs, during and post-hospitalization to improve health outcomes of the member and reduce readmissions.

This means that we are caring for all members, from the healthiest situations to the most complex health situations through accessing needs, coordinating resources, and referring to other programs when needed. This also means we are able to reduce costs for our employees and offer the same level of services as larger employers.

 

What new programs will be offered?

1. Health Coaching

We understand that leading a healthy lifestyle isn’t easy.  You may not know where to start or to whom to turn for help.  In order to give you the resources you need to support your healthy lifestyle journey, members will be offered health coaching from a nationally accredited team of registered nurses, respiratory therapists, certified diabetes educators, behavioral health specialists and well-being professionals.  This team will serve as an extension of your physician.  Each health coach will work with members to reinforce and support the care plan that their physician has developed.

A care plan is a set of goals and evidence-based interventions created to assist a member in managing a condition.

 

2. Disease Management

Dealing with a chronic disease can be overwhelming and even lonely at times. It is our goal to provide resources to help members stay up-to-date with the best practices for living with their condition.  Chronic diseases, when under control, can help members achieve healthier lives, avoid visits to the ER, and unnecessary inpatient admissions.

All members will receive a welcome letter, quarterly educational newsletters, and best practice reminders for the specific condition.

 

3. Precision Care Solutions

Precision Care Solutions uses advanced, condition-specific projection models that allows to identify, outreach and help employees before they have a hospital admission.

By offering multiple solutions and prediction models, we can connect with members much earlier to identify and assist members. A registered nurse case manager will contact members to assess needs and share information about resources available.

 

What is the clinical team’s role at PAI?

 As mentioned earlier, we have a team of registered nurses and health coaches readily available to assist members. This team will focus on the following:

Assist member with locating community resources

Help members navigate the MH/SU treatment system

Offer support and advocate for members

Provide evidenced based education information to assist members in reaching goals and improve knowledge of their disease process

Assist members to understand their MH/SU benefits related to treatment options

Coordinate with members’ current treatment team and support network

 

How do you enroll in Disease Management?

Triage logic identifies members with chronic conditions and risk stratifies into low, medium and high risk. Members are also referred internally through Utilization Management and Case Management, by groups, or through self-referral.

All members identified for disease management receive quarterly newsletters and articles of condition education.

Engagement Team attempts outreach to schedule call with health coach within 10 days of identification. The engagement team makes 6 total attempts. A postcard requesting a response is sent after each attempt. (Postcards are sent either through digital or traditional mailings)

During the initial assessment, the health coaches establish interventions and goals with the member and collaborate with the member to determine preference for the frequency of interaction. To be most effective, the health coach encourages at least quarterly contact. Member is also encouraged to utilize digital tool Wellframe for communication.

 

Start Enrollment Today!

For more details on how to enroll please contact the BlueCross BlueShield of SC Health Coaching team at  855-838-5897.

For additional resources or to find a doctor in your area, log in to your health plan’s website and visit www.PAISC.com.

 

---

 

At SCMA MIT, we care deeply about staying on the forefront of health services, and we are excited for the new partnership with PAI. We hope that we can make a difference for our members and create a healthier workforce.