CHATTANOOGA, Tenn. — Faced with rising health care costs and unhealthy employee populations, many companies are making health care cost containment a key part of their business strategy. To meet this increasingly difficult challenge, BlueCross BlueShield of Tennessee is piloting Custom Care Solutions(CCS), a unique approach that customizes individual patient care for improved quality while controlling employers’ health care costs.

“We have many employer groups looking for ways to contain health care costs without unduly inconveniencing employees or reducing benefits,” said Jim Gray, vice president of sales and account management for BlueCross. “With Custom Care Solutions we’ll be able to not only help employers lower their costs, but also help those individual members with the greatest need to better control their own illnesses.”

CCS is a care management program for members who have a complex health issue or chronic condition. However, according to Dr. Ken Patric, corporate medical director for BlueCross, CCS’ innovative design offers several advantages over traditional predictive modeling and disease management tools used in the industry today.

“Advantages are found in its proper focus on high cost members and the true efficiencies of individualized care management,” Patric said. “Examples of these efficiencies include refined software that can accurately and quickly identify members most in need of help, as well as match them with the doctors best able to treat their individual medical conditions.”

Unlike other traditional disease management programs that identify members based on a series of medical claims, CCS’ identification methodology can, in many cases, proactively identify a member from a single claim for an illness with a high-projected cost.

In addition, CCS identifies members with high care costs without regard to a member’s specific disease, thus the program covers all conditions. Traditional disease management programs cover only a limited number of specific conditions.

“BlueCross realizes that although all companies are faced with health care issues, their needs are not all the same. That’s why Custom Care Solutions is so beneficial. It addresses the needs of each company’s unique workforce,” Gray said.

The CCS customized approach is also found in its benefit structure, which allows members to choose their care management program. Members with complex or chronic conditions can select either a traditional PPO catastrophic case management program or CCS, which provides improved plan benefits at the time when they are most needed. Both programs are voluntary.

In order to receive the higher benefits, members must remain compliant with their prescribed treatment and seek service from the assigned specialty care provider. The health savings generated by treatment outcomes will allow BlueCross to provide the greater benefits while still delivering bottom line savings to the employer.

Once enrolled in CCS, members will receive services including intensive nurse care management intervention, treatment and pharmacy coordination, health education and condition monitoring. All members are assigned a personal, dedicated team comprised of a catastrophic nurse care manager, nurse care coordinator, regional medical director, regional pharmacist and specialty care provider.

“As medical costs continue to rise, use of highly personalized programs like Custom Care Solutions will become even more crucial for businesses looking to contain costs and improve their employees’ health,” Patric said.

In most companies, the small number of employees who suffer from catastrophic and chronic diseases incur the largest percentage of businesses’ insurance claim dollars. In fact, BlueCross internal data show that 8 percent of this covered population accounts for 55 percent of total health care spending.

The CCS pilot program will take effect Jan. 1, 2005. Companies seeking to learn more about CCS and its future availability can call Jim Gray at (615) 386-8519 or contact their BlueCross account manager.

About BlueCross

BlueCross BlueShield of Tennessee's mission is to provide its customers and communities with peace of mind through affordable solutions for health and healing, life and living. Founded in 1945, the Chattanooga-based company is focused on reinventing the health plan for its 3 million members in Tennessee and across the country. Through its integrated health management approach, BlueCross provides patient-centric products and services that drive health improvement and positively impact health care quality and value. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company's website at www.bcbst.com.