Providers | Blue Shield of California Promise Health Plan

Transitional Care Management

It is clearly established that hospital readmissions contribute significantly to the health care costs. Blue Shield of California Promise Health Plan's Transitional Care Management Program has been developed to meet all regulatory requirements and deliver high quality care to our most vulnerable members during transition of care episodes. A Transitional Care Management is defined as any time a member moves from one care setting to another. Anytime a member is admitted from home to the hospital or discharged from the hospital to the Skilled Nursing Facility and eventually back home they are experiencing a Transitional Care Management.

Blue Shield of California Promise Health Plan's Transitional Care Management Team is comprised of Case Managers, Social Workers, Pharmacists, Physicians and Transitional Care Management Coordinators. This team works closely with the member and/or caregivers to assist them through each Transitional Care Management concurrently. Every time a Transitional Care Management occurs, the PCP will be notified in writing. Once the member transitions to their home, the Transitional Care Management Case Manager (TCM CM), who is a nurse will call the member and performs a comprehensive hospital discharge assessment and medication reconciliation. The TCM CM will also assist the member with making an appointment to see the PCP and or any specialists needed. The Case Manager will share information with providers in order to properly coordinate care for the member.

We are confident that this program will be successful in lowering our readmission rates and improving the quality of care our members receive. For more information call (877) 702-5566.

Blue Shield Promise Programs

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