Blue Cross & Blue Shield of Rhode Island Expands In-Home Case Management Program


Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced that they have expanded their In-Home Case Management (IHCM) program specifically targeted toward Medicare Advantage members with high-risk, complex medical needs. The patient-centered program, which launched this fall, allows community-based case managers to work collaboratively with members and their healthcare providers to help the members better manage their own health and wellness, ultimately improving their long-term health outcomes.

The IHCM program builds on a successful partnership launched in early 2014 that deployed nurses into the homes of nearly 400 members to complete home assessments and communicate recommendations for care to the primary care team.  The pilot results demonstrated a need for community-based case management as an extension of the member’s primary care team. Participating members’ needs included home safety modifications, physical therapy, coordination with social services, long-term planning, and pharmacist or physician intervention.

The expanded program, which includes a broader scope of services and Patient Centered Medical Home (PCMH) partners, will be offered initially to more than 1,500 Medicare Advantage members. Care for these patients will be coordinated with six PCMH practices across the state, representing 34 individual PCMH practices, and will be provided by CareLink, a Rhode-Island-based long-term care provider. A PCMH practice takes a team-based approach to primary care, providing a more coordinated, holistic experience for patients by improving communication between the physicians, nurse practitioners and specialists who interact with each patient.

“At Blue Cross, we are committed to looking for ways to improve the care our members receive and their overall health,” said Mark Waggoner, Senior Vice President of Care Integration & Management at BCBSRI. “This is the second pilot-tested program we’ve announced recently that we believe will yield better outcomes for members – the first being our on-site pharmacist program. We’re excited to expand both of these programs to provide a higher level of care to those patients who need it most.”

Under the IHCM program, case managers will support patients in navigating our complex healthcare system by improving coordination between members and their care team and by helping patients identify their own personal health goals. An IHCM team will consist of at least one Rhode Island licensed Registered Nurse and one Licensed Clinical Social Worker, who will work in coordination with the patients’ PCMH practice.

 “We’re excited to partner with Blue Cross to expand this initiative, which we’ve already seen improve patients’ outcomes,” said Joan Kwiatkowski, Chief Executive Officer at CareLink. “Just in the short time the program has been in operation, we have identified a number of individuals who need support that under the traditional healthcare system that they would not have accessed. These services resulted in better use of the healthcare system and reduced risk factors facing these individuals.  Patients have been very grateful for this added support.”

To be eligible for this IHCM program, members must require an intensive level of management or require extensive support, education and resources to improve their health. While this program currently focuses on high-risk, complex Medicare Advantage members, BCBSRI will continue to evaluate and explore expansions to include other patient populations.


About Blue Cross Blue Shield of Rhode Island

Blue Cross & Blue Shield of Rhode Island is the state’s leading health insurer and covers more than 550,000 members. The company is an independent licensee of the Blue Cross and Blue Shield Association. For more information, visit, follow us on Twitter @BCBSRI, and like us on Facebook at



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