Jan 10, 2022
An innovative COVID-19 outreach effort
Every day for the past few years, registered nurse and wellness coach Tracey Timmins has called people who are struggling with chronic conditions like diabetes or obesity to make sure they are getting the medical care they need, are feeling well emotionally, and have access to necessities such as groceries and their medications.
Then, beginning in the early days of the pandemic and continuing through the vaccine rollout, Timmins and her teammates started reaching out to a new group — people who live in some of the areas hardest-hit by COVID-19, and those who would be most vulnerable to serious outcomes if they became infected.
“Our members appreciated that we checked in with them and educated them about COVID and vaccine eligibility and access,” said Timmins, who works for Blue Cross Blue Shield of Massachusetts.
Timmins was able to make that personal connection thanks to an innovative program that melds cutting-edge data and analytics capabilities with old-fashioned telephone calls from nurse case managers.
To date, the health plan has reached out to more than 35,000 members to educate them about COVID.
Reaching out to the most vulnerable
Blue Cross’ COVID outreach initiative was born out of a commitment to take a proactive approach amid the health crisis, rather than wait for members to seek help.
“When the pandemic hit the U.S. in March of last year, we knew we wanted to help our members in every way possible,” said Dr. Jamie Colbert, an internist and senior medical director for delivery system innovation and analytics at the health plan, which is covering all medically necessary COVID-19-related testing and treatment, as well as the full cost of the vaccine, for its members. “We also knew our claims data and the expertise of our team of nurse case managers put us in a unique position to identify and proactively reach out to members at the highest risk for developing a serious health condition should they get COVID-19.”
Using internal claims data, data from the Massachusetts Immunization Information System, operated by the Department of Public Health, Census data and information from the Centers for Disease Control and Prevention, the Blue Cross analytics team led by Chief Data and Analytics Officer Himanshu Arora developed an algorithm to assign a risk score to each of its nearly 3 million members based on the likelihood of contracting COVID-19 and experiencing serious health impacts from the virus.
We wanted to find the answers to two simple questions: Which people are more at risk than others, and how can we lower both the risk of infection and the risk of becoming severely ill if infected?
"This effort is a way for us to answer these questions and identify insights we can use to help our members, accounts and providers during this health crisis.”
Then nurse case managers began calling those with the highest risk scores.
The calls often were greeted with relief.
“We’ve gotten a lot of great feedback from members who really appreciated the call,” said Blue Cross Vice President of Clinical Operations Kathy Gardner, who also is a registered nurse. “In the first half of the year when there was so much information out there about the surging Delta variant and vaccines, and things were changing so quickly, our members appreciated hearing from us and learning how to protect themselves and stay healthy.”
As the state’s largest not-for-profit health plan, over the past year, Blue Cross has helped support Massachusetts’ successful vaccination rollout, resulting in one of the highest vaccination rates in the country.
Gardner noted that mid 2021, when the majority of Massachusetts residents and Blue Cross Blue Shield of Massachusetts members had been vaccinated, the team changed course, and nurse case managers began integrating COVID education into the standard calls they make to members with chronic conditions, or roughly an additional 35,000 members.
During each call, Blue Cross nurse case managers share the latest information on the virus and the vaccines. They also make sure members’ basic health and safety needs are being met, such as access to food, transportation, prescriptions and medical care—whether in person or via telehealth. And they make referrals to community resources when needed.
“It’s a wellness education call,” Gardner said. “Our goal is to ensure members have the health information they need—about COVID and about their condition—to stay safe make decisions that are right for them and their family. We also want them to know that Blue Cross offers clinical resources if they have questions in the future.”
As the pandemic enters its third year and the Omicron variant spreads quickly, Arora says Blue Cross will continue to evaluate how best to educate and support members.
“People expect their health plan to pay their claims and answer questions about their benefits,” Arora said. “During the pandemic, we want to go beyond that.”
We want members to know we are using all of the capabilities we have to keep them healthy during these challenging times.