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Home telemonitoring and healthy meals continue to expand
March 13, 2020

This article is for:

  • Cardiologists
  • Primary care providers
  • Discharge planners at acute care hospitals, rehabilitation hospitals, and skilled nursing facilities

We're expanding both our home telemonitoring program and healthy meals program for eligible Medicare Advantage members with congestive heart failure diagnoses. For a full overview of these programs, please see our previous articles.

What's changing?

Program Change details
Home telemonitoring

Program description:
Helps members self-manage their condition and may keep them out of the hospital or reduce readmission rates.

Southcoast VNA has joined and has started accepting referrals as of March 1, 2020.

See below for a full list of all home health care providers participating in this pilot program.

Healthy meals

Program description:
Community Servings will provide eight weeks of medically tailored, nutritious meals, plus nutrition care services from a licensed dietician nutritionist.

Medicare Advantage members who don’t live in an area where Community Servings delivers can now get meals delivered via UPS. This provides greater access to this program.

Home health care contacts for referrals for in-home telemonitoring

Home health care organization participating in-home telemonitoring program Contact for referrals
BAYADA Home Health Care Phone: 1-508-778-8100
Fax: 1-508-778-5022
VNA Care—VNA Care Network & VNA of Boston Phone: 1-800-728-1862
Fax: 1-774-778-1007
Home Health Foundation, a member of Wellforce, including:
  • Circle Home
  • Hallmark Health Visiting Nurse Association
  • Home Health VNA
Phone: 1-978-552-4444 or
Fax: 1-978-552-4401
(Fax their Express Referral Form)
Southcoast VNA Phone: 1-800-698-6877, option 3
Fax: 1-508-973-3241
Website: www.southcoastvna.org
These providers have a single contact for referrals
Brockton VNA
Visiting Nurse Associations of New England, Inc. (VNANE)
Phone: 1-774-404-2205
Fax: 1-508-480-0055
Email (must be encrypted): bcbs@vnane.org

Visiting Nurse Associations of New England, Inc. will contact us about your referral.
Community Nurse Home Care, Inc.
Community Visiting Nurse Agency, Inc.
GVNA HealthCare
Natick Walpole Visiting Nurse Association, Inc.
Norwell Visiting Nurse Association, Inc.
Porchlight VNA/Home Care
Visiting Nurse Community Health, Inc.
VNA of Southern Worcester Co., Inc.

Healthy meal referrals

  1. Contact Blue Cross Blue Shield of Massachusetts registered nurse, Kerry Nussbaum, at  1-617-246-4721.
  2. Fill out the  Referral for Health Management Programs & Services form. Check off Medicare Advantage Case Management and note the reason for the referral in the notes section. Please fax to the Medicare Advantage number listed on the form.


For questions about Blue Cross Blue Shield of Massachusetts’ program, call Tarcia Davis, RN, BSN, CCM, program manager in our case management department, at 1-617-246-4269.