Capital Blue Cross Employs Medical Professionals: What They Do and Why It Matters

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Dr. Jeremy Wigginton started his career caring for patients in rural Louisiana and Mississippi. He loved making a difference in people’s health, but he wanted to do more.

So Dr. Wigginton left full-time practice for a job in the health insurance industry.

“It’s about being able to make an impact on a larger scale,” said Dr. Wigginton, who’s the Chief Medical Officer at Capital Blue Cross. “I have a passion for helping people find high quality and affordable healthcare. When you’re a physician in practice, you can only impact those people who you see in clinic. By moving to the insurance industry, I can have a potential impact on hundreds of thousands of people.”

Dr. Wigginton is one of many healthcare professionals at Capital Blue Cross – from doctors to nurses to pharmacists – who use their training to help members access affordable, quality care.

How Capital’s medical professionals advocate for your health

Capital’s medical professionals make an impact in many ways, including:

• Supporting the best treatment options: Capital’s medical professionals work with your doctor to help ensure the care you receive from your own doctor is safe, effective, and aligned with your unique health needs. By working together, they can review treatment plans with your healthcare provider to prioritize your well-being and help avoid unnecessary or potentially harmful procedures.
• Promoting high-quality care: Capital’s professionals develop and implement programs that seek to help support your healthcare provider to provide safe and effective care.
• Keeping medications affordable: Capital’s staff of pharmacists help determine which medications prescribed by your doctor are the most affordable, such as generics versus brand-name drugs, and help avoid wasteful spending on drugs.
• Helping make care more affordable: By having medical professionals on staff, Capital strives to make sure you receive high-quality care at a fair cost. By thoughtfully reviewing care plans and working with providers, we can better manage healthcare costs and keep your out-of-pocket costs more predictable and manageable.
• Encouraging healthy habits that last: Capital’s health coaches, care managers, and dietitians provide personalized support to help you make meaningful lifestyle changes – like eating better, staying active, and managing chronic conditions. These small steps can lead to a better quality of life today and help prevent more serious health issues down the road.

What medical professionals do at insurance companies

While Capital’s team of medical professionals doesn’t provide hands-on care, they work to address how medically necessary treatments, procedures, and medications are covered – focusing on both quality and affordability.

These experienced clinicians also help design programs and services that help members proactively improve their health and remove barriers to care, making it easier for members to get the help they need.

A key part of their role is understanding which treatments are the most effective and safest, based upon clinical research and best practices.

When care is unnecessary or ineffective, it can cost you valuable time and money. That’s why Capital Blue Cross is committed to help ensure you receive care that truly makes a difference. Its current staff includes about a dozen doctors and pharmacists as well as nearly 150 nurses who are licensed and credentialed by the state in which they reside.

Visit the THINKLink website to meet some of the medical professionals at Capital Blue Cross.