Coronary Heart Disease (CHD)

According to the American Heart Association (AHA), over 70 million Americans have some form of cardiovascular disease. Our CHD program emphasizes educating members about their health conditions and working with them to take a more active role in their health care. With the help of a nurse care manager, enrolled members will receive education to promote:

  • Improved understanding of their heart disease
  • Encouragement of healthy lifestyle choices
  • Improved health care team relationships
  • Empowerment to make informed health decisions

With these changes, members will have a good foundation to start down the road to good health and enjoy a better quality of life.

Blue Cross’ multidisciplinary team of healthcare professionals collaborate to ensure each enrollee receives a “whole-person” approach to their disease management by addressing clinical functional, financial, psychosocial, environmental and support system needs.

Our heart care management programs are designed to assist members in effective management of heart disease. This management includes nutrition, exercise, weight management, smoking avoidance and education about heart disease.

Eligible Members

The program is available to Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc. and Federal Employee Program (FEP) primary members 18 to 80 years of age.

The selection process for our CHD program is based on hospital claims, encounters, and pharmacy and laboratory data. We analyze claims data to assess relative health risk, identify medical conditions and build a member-centric clinical profile.

The program is not available to members who have other insurance as primary, are being actively treated for cancer, a transplant recipient, have ESRD, HIV/AIDs, are a hospice care recipient or nursing home resident. This is a voluntary program and members may “opt out” of the program at any time.

Re-Enrollment into Program

CHD program members are re-enrolled based on nurse assessment for any of the following reasons:

  • Member requests re-enrollment
  • Physician refers member again
  • Member experiences a CHD-related admission
  • If the member has any of the following:
      1. Increased relative risk scores
      2. More than two hospitalizations in 12 months
      3. Emergency room visits for CHD-related complications
      4. Medication non-adherence (45-day-or-less gap in medication refills)

Our Care Management team includes physician advisors, registered nurses, pharmacists and behavioral health specialists.

Physicians receive the following when their patient enrolls:

  • Written or telephonic notification if their patient is receiving ongoing nurse calls along with the nurse's contact information.
  • Notification of their patients who may be in need of healthcare services via a care coordination nurse call.
  • Patient referral by Blue Cross nurses when member does not have an established patient-physician relationship.
  • Access to claims-based Blue Health Records with up to three years of claims history (through iLinkBLUE)

Clinical Guidelines

AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update

Resources

American Heart Association

How can I contact a nurse?

If you wish to contact a nurse to inquire about our programs, please call the Case and Disease Management Unit at 1.800.317.2299.

To refer a member for a care management program:

Complete the CMDM Referral Form and fax it to 225.298.3184.