Certain members may also have access to programs and additional supports in the following areas:
We offer a program for chronic back and joint pain with Hinge Health. It’s available to commercial members in self-insured and fully insured accounts and to Medicare Advantage members.
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.
Resource
Member website (commercial members): https://www.hingehealth.com/for/bcbsmafi/
Member website (Medicare Advantage members): https://www.hingehealth.com/for/bcbsma/medicare/
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:
- Physical therapy
- A reduction or change in medication
- Nutrition counseling
- Healthy lifestyle coaching
- Appointments with nurse practitioners or physician assistants as needed
*Commercial members, except Federal Employee Program and plans administered by Blue Benefits Administrators.
Resource
Member website: http://Vorihealth.com/bcbsma
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.
Resources
- News article: New chronic kidney disease program for Medicare Advantage members
- Blue Cross Member Medicare Options website
- Square Knot Health
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.
- The Chronic Condition Plus program is designed to help individuals with several chronic conditions such as diabetes, pre-diabetes, and hypertension. The program will help manage their conditions through personalized care plans, virtual consultations with healthcare professionals, and continuous monitoring through connected devices.
- Available as an option to self-insured accounts with more than 500 employees.
- Transform Diabetes Care supports adults with type 1 or type 2 diabetes with glucose and blood pressure monitoring, preventive screenings, medication optimization and adherence, and lifestyle and nutrition management.
- Support is offered through CVS Pharmacy, CVS MinuteClinic, and CVS HealthHUB locations, as well as remote options.
- Available to self-insured accounts who use our pharmacy benefits.
Resource
Transform Diabetes Care member fact sheet
- Through a mobile app and a clinical support team, Virta Health helps members reverse their type 2 diabetes without surgery and achieve full remission without medication. They offer nutrition therapy, physician-led care, education, and coaching.
- Is available to qualified adult commercial HMO/POS and PPO members (does not apply to Federal Employee Program members). Eligible members need a smartphone to participate.
Resources
- Virta Health member website: virtahealth.com/join/bcbsma.
- Virta Health fact sheet for providers
For access to virtual specialty care for gastrointestinal conditions:
- Oshi Health’s multidisciplinary clinical support team consists of GI-specialized physician assistants or nurse practitioners, dieticians, GI behavioral health specialists, and care coordinators overseen by board-certified gastroenterologists. They serve as an extension of the member’s care team.
- Available to qualified adult commercial HMO/POS (referral required) and commercial EPO/PPO members (does not apply to Federal Employee Program members).
Resources
Oshi Health member website (commercial members)
Oshi Health fact sheet (for providers)
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. Available to self-insured accounts who use our pharmacy benefits.
Pharmacy Advisor
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. Available to self-insured accounts who use our pharmacy benefits.
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. Available to self-insured accounts who use our pharmacy benefits.
Medication adherence program
To support medication adherence, we offer a program for members taking select medications for chronic conditions. When members opt in they can reduce their out-of-pocket costs by filling their medication on time at an in-network retail pharmacy. Members will receive refill reminders and discounted cost information prior to picking up their medication.
Sempre Health, an independent company, will administer this program. Members do not need to change where or how they fill their medications, so prescribers do not need to do anything.
Who is eligible?
- Members in fully insured accounts who are 18+ years old and use the retail pharmacy for their prescriptions.
- Available to self-insured employers who use our pharmacy benefits.
- The program cannot be added to HSA compliant plans, Medicare, and qualified Health Plans.
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. Pharmacists from Blue Cross Blue Shield of Massachusetts’ Medicare Clinical Program are also supporting members with medication therapy management.
CVS Weight Management™
Self-insured employers may choose to include the CVS Weight Management™ program as part of their pharmacy benefits. We will reach out to prescribers of these medications if your patient has an active authorization for an anti-obesity medication. The patient must enroll in the program for continued coverage.
The program is available to members 18 years or older with an approved prior authorization for an anti-obesity medication or who are new to taking medication. Members will need to engage and actively participate in the program to receive continued coverage of their anti-obesity medication.
This program is designed to complement the care members are receiving from their health care providers and provide additional support for them in using weight loss medications.
Obesity & Weight Care Management by Teladoc
- The Obesity & Weight Care Management program is designed to help individuals achieve sustainable weight loss through personalized coaching and nutritional guidance.
- Available as an option to self-insured accounts with more than 500 employees.
Maven Maternity and Newborn Care Program
Maven
Clinic offers virtual guidance and support to members and their families throughout the maternity journey*, including:
- Pregnancy
- Doula care
- Postpartum and infant care
- Lactation support
- Return-to-work coaching
- Miscarriage and loss
- Partner support
*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?
- Coaching and education through telehealth consultations, and using video and instructional support
- 24/7 access on mobile devices
- Same-day appointments
- Online content, virtual classes, community forums
- Culturally diverse and conscious providers who speak multiple languages
Who is
eligible?
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 eligible 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.
Resource
Maven member website: https://www.mavenclinic.com/
Maven Menopause Program
Maven Clinic offers virtual guidance and support to members experiencing menopause and perimenopause, including:
- HRT support
- Early intervention
- Symptom management
- Mental health issues, such as anxiety and depression-related issues impacted menopausal people.
What services do they offer?
- Coaching and education through telehealth consultations, and using video and instructional support
- 24/7 access on mobile devices
- Same-day appointments
- Online content, virtual classes, community forums
- Culturally diverse and conscious providers who speak multiple languages
Who is eligible?
Qualified commercial HMO/POS and PPO members (does not apply to Federal Employee Program members) in fully insured plans with 51 or more eligible employees. Available as of July 1, 2024 and when employers renew their health plan with us.
