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District of Columbia

Condition care


Our Condition Care program is based on a system of coordinated care management interventions and communications designed to help physicians and other healthcare professionals manage enrollees with chronic conditions.

Mission

The mission of Condition Care program is to improve the health and quality of life for the enrollees we serve. We do this by encouraging self-care efforts, coordinating healthcare education, and providing interventions along the continuum of care.

Condition Care services include:

  • A holistic, enrollee-centric approach to condition care focusing on the needs of the enrollee through telephonic and community-based resources
  • Motivational interviewing techniques used in conjunction with enrollee self-empowerment
  • The ability to manage more than one disease to meet the changing health care needs of our enrollee population
  • Weight management and smoking cessation education

Who is eligible?

Enrollees diagnosed with one or more of the conditions list below are eligible for Condition Care services:

  • Asthma
  • Bipolar disorder
  • Coronary artery disease (CAD)
  • Congestive heart failure (CHF)
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • HIV/AIDS
  • Hypertension
  • Major depressive disorder (MDD) — adults
  • Major depressive disorder (MDD) — children/adolescents
  • Schizophrenia
  • Substance use disorder (SUD)

How can I refer an enrollee to Condition Care?

To refer an enrollee to the Condition Care program, fill out our Condition Care Referral Form and email the completed form to Condition-Care-Provider-Referrals@amerigroup.com.

What are some of the Condition Care features?

  • Proactive population identification processes
  • Program content is based on evidence-based national practice guidelines
  • Collaborative practice models to include physician and support service providers in treatment planning for enrollees
  • Continuous patient self-management education, including primary prevention, coaching related by healthy behaviors modification programs and compliance or monitoring, and case/care management for high-risk enrollees
  • Ongoing communication with primary and ancillary providers regarding patient status
  • NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care

What are Condition Care programs designed to do?

  • Address gaps in care
  • Improve enrollee understanding of disease processes
  • Improve the quality of life for enrollees
  • Support collaboration to develop enrollee-centered goals and interventions
  • Support relationships between the enrollee and provider networks
  • Increase network provider awareness of Condition Care programs
  • Reduce acute episodes requiring emergent or inpatient care
  • Identify social drivers of health and address them by referring enrollees to appropriate community resources

What are the benefits of collaborating with Condition Care?

  • Quality of care — If you have patients with one or more of the conditions listed above who could benefit from additional education or care management, we encourage you to refer them to Condition Care
  • Collaborative treatment plans  — Condition Care invites your input for patient treatment plans. We provide you with Condition Care information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist in creating an individual plan of care for your patient:
    • CPGs are available on Availity Essentials* (login is required)
  • Receive feedback on your patients between appointments — You can access Patient360 via Availity Essentials to obtain feedback on your patients regarding their care plans and condition management while enrolled in Condition Care

Contact Condition Care

Email:

Condition-Care-Provider-Referrals@amerigroup.com

Phone:

888-830-4300
Monday – Friday; 8:30am – 5:30pm local time
Confidential voicemail is available 24 hours a day.

Wellness Program

We offer assistance with weight management, nutrition, and tobacco cessation. The Wellness Program helps enrollees by establishing individual goals and providing support and follow-up over a six-month period. Program is offered to enrollees ages 18 and older. The Wellness Program:

  • Combines coaching, education, and community-based resources to support a healthy lifestyle
  • Assigns a health coach to support the enrollee with motivational interviewing sessions, telephonic coaching, and education-based support measures designed to improve treatment plan compliance and increase healthy choices
  • Allows the health coach to work directly with the m enrollee to set realistic and achievable short-term goals for a healthy lifestyle, thereby optimizing success toward achieving long-term goals

Refer an enrollee to the Wellness Program

To refer an enrollee to the Wellness Program, please fill out our Wellness Program Referral Form and email the completed form to Condition-Care-Provider@amerigroup.com.

Contact the Wellness Program

Email:

Condition-Care-Provider@amerigroup.com

Phone:

844-421-5661
Monday – Friday; 8:30am – 5:30pm local time

Provider rights and responsibilities

You have additional rights and responsibilities including the right to:

  • Obtain information about the organization’s services, staff qualifications, and any contractual relations
  • Decline to participate in or work with the organization’s programs and services on behalf of their patients
  • Be informed how the organization coordinates interventions with care plans for individual enrollees
  • Know how to contact the case manager responsible for managing and communicating with their patients
  • Be supported by the organization when interacting with enrollees to make decisions about their healthcare
  • Receive courteous and respectful treatment from the organization’s staff
  • Communicate complaints to the organization

Our Condition Care program does not advertise, market, or promote specific products or services to enrollees or providers. We do not have financial ownership arrangements with anyone who advertises, markets, or provides the goods and services we offer.

Provider tools & resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality service for our enrollees.