Healthy Outcomes: Integrated Health Management Solution

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers a suite of health management programs for our commercial members with select health conditions called Healthy Outcomes. This confidential program is available to eligible members at no cost. Members can visit for more information on the program and take advantage of many helpful online tools, trackers, modules and articles to help them manage their health.

Members are identified for the Healthy Outcomes program that best meets their specific health care needs. Eligible members are actively identified via claims data, biometric data, health assessment results, or through case manager/provider/nurse line referrals. In addition, Blue Cross NC offers value-based benefits to eligible members such as nutritional counseling, a deductible waiver for diabetic supplies, and a copayment reduction for some asthma medications.

We are working with our health and wellness vendor, Optum, to administer these integrated and flexible health and wellness solutions, including:

Healthy Outcomes Case Management - personal outreach for high-risk members with complex conditions or health care needs

Healthy Outcomes Condition Care - disease management support and education for members with moderate health issues and one of five chronic conditions (CAD, COPD, congestive heart failure, asthma, or diabetes). Some members also have access to optional programs for depression and musculoskeletal pain management, depending on what their employer makes available. Healthy Outcomes Condition Care is an integrated program that supports your treatment plan, helps your patients to better understand their conditions and provides support by offering:

  • Educational materials to the member that discuss disease basics, medications, necessary tests and the impact of lifestyle behaviors and co-morbidities on health
  • Support through one-on-one telephonic health coaching that may offer insight into disease self-management, answer general health questions, support communication with the patient and provider and more
  • Tools that enhance patient-provider communication

Healthy Outcomes Maternity - program to support expectant and new mothers throughout their pregnancy and beyond

Healthy Outcomes Wellness - range of programs to engage, educate and guide members on the path toward better health

If you have Blue Cross NC patients who participate in a Healthy Outcomes program, you’ll receive individual patient reports from Optum, including these condition care reports:

  • Pre-Visit Report - faxed one to two days prior to appointment; provides between-visit summary of relevant clinical data
  • Alert Report - faxed when urgent problems are noted and need to be brought to your immediate attention
  • Medication Gap Report - faxed when medication gaps are identified to help support patient’s overall plan of care and includes all known prescriptions for patient

As an in-network physician, you also have access to the Patient Care Summary via Blue eSM.  This report provides an essential snapshot of your patient’s health such as any overdue screenings or tests, a three-year medical history including any specialist visits, a 12-month record of the patient’s prescription drug history, as well as whether or not Blue Cross NC Case Management is trying to reach the patient.

If you have a Blue Cross NC patient who may benefit from a Healthy Outcomes program, please encourage him or her to contact us at the toll-free number listed on their Blue Cross NC ID card. Please note that this program is not available to State Health Plan, Federal Employee Program, Blue MedicareSM members, or to members whose ASO employer groups do not offer disease management services.

If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.