Certain members may also have access to programs and additional supports in the following areas:
For our Medicare Advantage members with multiple chronic conditions, we offer Landmark Health. Landmark’s providers—physicians, nurse practitioners, and physician assistants—go to patients’ homes of patients to help keep them well, and provide urgent care when needed. This service does not replace the care provided by the member’s PCP.
We offer commercial members in fully insured accounts a program for chronic back and joint pain with Hinge Health. This program will also be offered to Medicare Advantage members starting on January 1, 2024.
Hinge’s pain management program helps adults proactively manage joint and muscle pain through a 12-week, coach-led, digital experience that aims to reduce anxiety and depression, improve strength and mobility, and introduce alternatives to surgery. Participants will continue to have access to all components of the Hinge Health Program, including coaching and/or facilitated social interaction and educational content for 12 months following their engagement in the Hinge Health Program.
We’ll identify eligible members based on claims history for qualified diagnosis codes. Members will then be able to enroll via the Hinge website.
Hinge’s program does not replace the physical therapy benefit for our members, and no claims will be submitted.
This program offers exercise therapy, not physical therapy.
Member website (commercial members): https://www.hingehealth.com/for/bcbsmafi/
Member website (Medicare Advantage members): https://www.hingehealth.com/for/bcbsmamedicare/
Members 18 and older* have access to virtual visits with Vori Health’s care team for back and joint pain. They are listed on our Find a Doctor & Estimate Costs tool as a Physical Medicine provider. A referral is needed for HMO members and the member’s cost for this virtual care provider depends on their plan.
After an initial telehealth visit, Vori’s care team will develop a treatment plan that may include:
*Commercial members, except Federal Employee Program and plans administered by Blue Benefits Administrators.
Member website: http://Vorihealth.com/bcbsma
Square Knot Health, for select Medicare Advantage members
We are partnering with Square Knot Health, an independent company focused on patients with advanced chronic kidney disease (Stage 4, 5, and end-stage kidney disease). This program supplements the care that our Medicare Advantage members receive from their existing doctors by educating, assessing, and mentoring them as they consider treatment options, including transplantation.
Through claims data and other analytics, we navigate members to these care solutions that help complement the care they’re already receiving from their health care providers. Members can learn more on our Diabetes page or call us at the Member Service number listed on their ID card.
As always, members can find doctors, specialists, and durable medical equipment providers (for diabetic equipment and supplies) using our Find a Doctor & Estimate Costs tool.
Transform Diabetes Care
Cost Share Assistance with PillarRx
Offers members savings on high-cost specialty medications through drug manufacturer coupon programs. (Self-insured accounts with 100+ subscribers can opt-in to this product; Fully-insured employers can opt-in with 51+ subscribers; it is a core benefit on merged market plans).
Drug Savings Review
The program uses pharmacy claims to help deliver prescription drug savings and medication optimization through proactive provider outreach (Standard benefit for self-insured accounts).
Uses pharmacy claims and social determinants of health data to identify members at risk for non-adherence. Pharmacists provide counseling to members on their medications. (Standard benefit for self-insured accounts).
Medical Cost Avoidance
Analyzes pharmacy and medical claims, plus other data to identify gaps in care. Program engages members in individualized interventions to remind them of the importance of preventive screenings, vaccines, and helps prevent hospital readmissions. (Standard benefit for self-insured accounts).
This medication therapy management program is offered as a service to eligible Medicare Advantage members. It’s offered through pharmacy benefit manager CVS Caremark and Outcomes Inc.
REACH (Recovery, Education, and Access to Community Health)
This program is offered at no cost to our members, through our partnership with Carelon Behavioral Health. REACH is designed to help patients with mental health difficulties and/or substance use disorder by arranging care with health care providers to ensure patients feel supported when they leave the hospital. Learn more about REACH.
Maven Clinic offers virtual guidance and support to members and their families throughout the maternity journey*, including:
*The maternity journey includes during pregnancy and within the first three months postpartum; members who recently experienced a pregnancy or infant loss, and a partner of someone pregnant, recently postpartum, or who has recently experienced a pregnancy or infant loss.
What services do they offer?
Qualified commercial HMO/POS and PPO members (does not apply to Federal Employee Program members). The Maven maternity program is a core offering for fully insured employers with 51 or more employees. Self-insured accounts can pick from the maternity and newborn care program or offer additional programs that Maven offers in these areas: fertility and family building; parenting and pediatrics; and menopause.
Maven member website: https://www.mavenclinic.com/