A Calming Voice in a Time of Need

Loren was having a normal day when something went amiss. She was rushed to the emergency room with chest pains and later found that she had experienced a coronary occlusion. What surprised her was that she had always been in good health, was fairly young and did not have a history of cardiac problems. After being discharged, Loren’s husband, concerned for her welfare, called Blue Cross to better understand their treatment options. The customer service representative who took their call addressed their benefit issues and referred them to the Care Consultant Team. They were in need of answers from a qualified professional to help them understand what they were facing.

Enter Chris Carlee, a registered nurse and a member of the Chronic Condition Management Team at Blue Cross. This team of specialized nurses assists members in understanding and managing their rare and/or chronic conditions, such as asthma, cardiovascular disease, diabetes, multiple sclerosis and lupus. 

Chris’s main responsibility is serving as a point of contact for members with a cardiovascular condition and assisting them in their journey to better health. Loren’s tests during hospitalization revealed that additional outpatient diagnostic testing was needed to confirm possible causes.

Stressed and worried, Chris’s help was a godsend to the couple in getting the tests approved and scheduled. Chris personally called the specialist offices and imaging review vendor to facilitate the review process. Her diligence helped to get the tests scheduled and approved. Loren says, “Everybody thinks of Blue Cross as an insurance company. But my experience showed me that there were other purposes and ways I could get help from my insurance. Not only did Chris help me with getting the tests scheduled, she also gave me information about my benefit plan and education about signs and symptoms to watch out for.”

Chris says she was happy to help. “My goal was to be a calming voice to help her manage her stress and concern about her condition, while helping her navigate the healthcare system”. Part of that navigation involved helping Loren understand her benefits, coordinating services amongst multiple providers, providing Loren with community resources, telephonic education and health coaching on self-management tools/resources. Chris collaborated with co-workers, managers, social workers, and other BCBSF departments to help meet Loren’s healthcare needs.

Chris and Loren have one goal in telling their story – they hope that other Blue Cross members in similar situations will take advantage of the multiple services at Blue Cross to help manage their condition better. “I hope that members will reach out for help when they have questions about their health condition or when they need assistance in navigating the health care system. Just call Blue Cross Customer Service,” says Chris, “the phone number on your ID card, and explain the situation. Members can be assured that they will be referred to the care program that best suits their specific needs.”

Ultimately, Chris is glad she was able to assist Loren through this difficult process. “She is a joy to work with and her positive attitude is an inspiration to me.”

Have a story to tell us about a positive experience you had with BCBSF? Email us at socialmedia@bcbsfl.com. For more information on the Care Consultant Team, refer to www.bcbsfl.com.

HopeBlue Palliative Care: Filling a Gap

“Don’t worry - help is on the way.” This simple sentence must have sounded like a life preserver being thrown to a drowning person. Indeed, Dr. Frank Santamaria, administering to the needs of a patient suffering from severe difficulties with breathing, was able to provide the patient his first night’s rest in months.  The next morning, not only was the patient feeling better, his wife was ecstatic with relief:  “You don’t know what you’ve done! I can’t tell you the difference you made for him.” No doubt she had her first night of rest in a long time, too.

Dr. Santamaria came to Blue Cross and Blue Shield of Florida on a mission: he wants to make palliative care services available to more patients in Florida than he was able to do as a medical director at a local hospice organization.  Palliative care, in its simplest form, is treatment which may alleviate pain and symptoms of a serious illness and works to improve a patient’s quality of life. Symptoms may include severe pain; constant nausea or vomiting; inability to breathe without tremendous effort; anxiety; depression or others.  People who want to receive palliative care do not have to be end-stage in their illness, nor do they have to forgo additional curative care – two requirements for admission to a hospice program. Rather, palliative care can be given along with therapies such as chemotherapy as a way to manage debilitating symptoms.  It helps a person live better with his condition, and gives the family more quality time with their loved one.

Dr. Santamaria explained it this way:  our current health care system does a good job addressing the medical needs of people suffering from acute or chronic diseases (think a urinary tract infection or diabetes). It also has evolved in serving the needs of those towards end-of-life (think hospice programs). What is lacking in the continuum of care are services for patients in the middle:  those whose quality of life is poor, and getting worse as their condition worsens, yet are not at a point where hospice is appropriate.  Palliative care is meant to fill that gap.

Blue Cross and Blue Shield of Florida is now piloting HopeBlue, a comprehensive palliative care program for members offered through Chapters Health Palliative Care. HopeBlue is available first in Hillsborough County. It will extend into Hardee, Highlands and Polk counties over successive months. Eventually, the intent is to make it available to our members statewide.  BCBSF nurse case managers assisting members in those counties will help identify patients who are eligible to participate and who might benefit from the program.  Members can then voluntarily elect to join the pilot – at no additional cost to them.

Why participate?  Dr. Santamaria gives another compelling example:  he was able to assist a man living with chronic obstructive pulmonary disease (COPD) who found it daunting even to talk on the phone or walk to his mailbox because of his severe shortness of breath.  “His quality of life was very poor. [After palliative treatment,] the man can now walk to the mailbox, and can speak more than just a few words at a time on the phone. He’s no longer quite as impaired [by his symptoms.] The man says his quality of life is three times what it was.”

Want to know more about HopeBlue?  Call our nurse case managers at 1-800-955-5692, option 4. November is also National Hospice and Palliative Care Month. Read more about how palliative care can make a difference when it’s needed the most.

We’d like to know what you think.  If you have questions about palliative care in general, or the HopeBlue program, write them here and we’ll be sure to respond back with information from our medical team.