About Disease Management
Our Disease Management (DM) department offers programs that are based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions
The mission of the DM department is to improve the health and quality of life for the members served by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.
DM services include:
- A holistic, member-centric approach to DM focusing on the needs of the member.
- Motivational interviewing techniques used in conjunction with member self-empowerment.
- Programs for patients with asthma, bipolar disorder, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, HIV/AIDS, hypertension, major depressive disorder (MDD) in adult and child/adolescent, schizophrenia, and substance use disorder (SUD)
- The ability to manage more than one condition to meet the changing health care needs of our member population.
- Weight management and smoking cessation education.
Our programs feature:
- Proactive population identification processes.
- Evidence-based national practice guidelines
- Collaborative practice models to include physician and support-service providers in treatment planning for members
- Continuous patient self-management education, including primary prevention, coaching related to healthy behaviors and compliance/surveillance, and case/care management for high-risk members.
- Continuous patient self-management education, including primary prevention, coaching related to healthy behaviors and compliance/surveillance, and case/care management for high-risk members
Nine of our DM programs are accredited by the National Committee for Quality Assurance and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
DM programs are designed to:
- Address gaps in care.
- Improve memberunderstanding of disease processes.
- Improve quality of life for our members.
- Collaboratewith providersto develop member-centered goals and interventions.
- Support relationships between member and network providers.
- Increase network provider awareness of DM programs.
- Reduce acute episodes requiring emergent or inpatient care.
Who is eligible?
Members who have been diagnosed with the above conditions and are identified through continuous case finding efforts, claims mining and referrals are eligible for DM services.
How can you use DM services?
- Maximize your time.
As a valued provider, we encourage you to refer your patients with the following conditions to Disease Management: asthma, bipolar disorder, CAD, CHF, COPD,diabetes, HIV/AIDS, hypertension, MDD in adult and child/adolescent, schizophrenia and SUD. In addition, refer patient who could benefit from additional education or care management
The DM department and our DM programs do not:
- Advertise, market or promote specific products or services to members or providers.
- Have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.