Products & ProgramsCommercialMay 31, 2023

Expansion of Back Pain Guide Program effective July 1, 2023

Effective July 1, 2023, Anthem Blue Cross and Blue Shield (Anthem) and Carelon Medical Benefits Management, Inc.,* a separate company, will expand the Back Pain Guide Program for Anthem fully insured members to include joint pain. The expanded program will be called Back and Joint Pain Guide. This is a voluntary, no cost program that members can enroll in using Sydney (Anthem’s digital platform). No pre-authorization is required for members to participate.

The expanded program will continue to use predictive analytic models to identify members who are experiencing back or joint pain or are at risk for complications related to these pain conditions. This early identification allows our program to target members who could experience an increase in back or joint pain without the right education and support.

Our targeting management process includes:

  • Predictive models for members likely to be referred for surgery based on several risk factors.
  • Risk stratification to help ensure the appropriate level of support is provided.
  • Targeted outreach to members through our digital engagement platform, email, and phone.
  • Customized education and support of provider treatments based on member’s specific needs.
  • Education and support of services such as behavioral health as appropriate.

Members included in the Back and Joint Pain Guide program

All fully insured members currently participating in programs with Carelon Medical Benefits Management and Anthem, as well as Anthem members of three pilot National Accounts groups, are included.

The following members are excluded: self-funded (ASO) groups, Medicare Advantage,

Medicaid, Medicare, Medicare supplement, MA EGR, and the Federal Employee Program® (FEP®).

The Carelon Medical Benefits Management microsite for Back and Joint Pain Guide provides access to helpful information and tools including program information and FAQ.

We value your participation in our network and look forward to working with you to improve the health of our members.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

MULTI-BCBS-CM-024779-23-CPN24691

PUBLICATIONS: June 2023 Provider Newsletter