On a cool fall day, a Blue Cross member had the rare chance to meet face-to-face with the Blue Cross health coach he worked with for more than a year.

Based on the nature of the care management program, members generally work with nurses over the phone. But Antonio was given a special opportunity to meet Marcy, a registered nurse working in the High Complexity Case Unit (HCCU) at Blue Cross and Blue Shield of Minnesota. Nurses in the HCCU work directly with members who have the most complex medical conditions, helping them to navigate their care.

The bond between members and their health coaches can be quite strong. In fact, Antonio refers to Marcy as "his angel" and credits her for being a major part of his journey to a healthier life.

“She was my angel. Her medicine was talking.”

Stepping in immediately

Antonio suffered a stroke during the summer of 2017. The stroke led to many complications—including limited vision. One major obstacle that came from this was his inability to read his medication bottles to make sure he took the correct medication and dose at the correct time. Upon Antonio’s release from the hospital, Marcy quickly stepped in.

“The home health care agency he had assigned to him for skilled nurse visits was planning to get out there in a day or two,” Marcy says. “I let them know that he really needs somebody out there today to get things set up for him and they got out there that evening.”

Ongoing support

Beyond that, Antonio was concerned about his ability to complete simple tasks like cooking himself a meal. Over the course of their work together, Marcy worked with Antonio to make sure he had the assistance he needed to get back on his feet. As he explains it more than a year later, Antonio says he’d frequently tell her, “Miss Marcy, I need your help.”

Marcy and Antonio touched base weekly, discussing healthy habits and the importance of making long-term lifestyle changes, in addition to the ongoing logistics of navigating a complex health care system. Marcy also helped Antonio find a nurse to provide diabetic foot care and secured a talking glucose monitor, so he didn’t need to manually read his blood sugar tests each time. In addition, she helped him create personal health goals that have led to a significant change in diet, exercise and health monitoring practices.

HCCU addresses members’ complex health needs

Individuals with complex health needs, like Antonio, often require both medical and social services from a wide variety of providers and caregivers. To better address the serious challenges and high costs associated with caring for these patients, Blue Cross launched the HCCU program in September 2016. The program has been growing ever since, helping to make health care more sustainable one case at a time.

“The goal of the HCCU program is to provide patient-centric care management that works to deliver better outcomes and experiences for our members at a lower overall cost,” says Dana Erickson, president and CEO of Blue Cross.

Through the analysis of a member’s medical history, previous claims and ongoing treatment plans, the HCCU team can identify opportunities to streamline care and improve a member’s health holistically. Typically, members engaged in HCCU are dealing with multiple diagnoses and complications, creating a very confusing and expensive scenario.  By taking a step back to address the situation and work with health care providers across various specialties, HCCU helps to ensure that the appropriate coordination of care plan is in place for each member.

“Even on a good day, the health care system can be very difficult to navigate,” Erickson says. “HCCU was designed to identify the most complex situations and provide one-on-one coordination across all aspects of care for that individual.”

Deep relationship leads to better outcomes

The one-on-one approach is proving to work. Members with complex health conditions are getting the best possible care through their trusted coaching relationship they develop with their health coach.

“We work with members on a deeper level,” explains Marcy. “The most rewarding part of the job is the relationships I build with members.”

In fact, her relationship with Antonio was so positive that she says, “Sometimes, I would save my weekly call to Antonio until Friday afternoon, so I’d know my week would end with a pleasant conversation.”

The feeling was mutual. “She was my angel,” said Antonio. “Her medicine was talking.”