Amerigroup of Georgia

Providers - Georgia

Disease Management / Population Health


Our Disease Management (DM) team is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

Our mission 

The mission of the DM department is to improve the health and quality of life for Amerigroup Community Care members 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 disease management focusing on the needs of the member through telephonic and community-based resources.
  • Motivational interviewing techniques used in conjunction with member self-empowerment.
  • The ability to manage more than one disease to meet the changing health care needs of our member population.
  • Weight management and smoking cessation education.
     

Who is eligible?

Members diagnosed with one or more of the conditions listed below are eligible for DM services:

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

How can I refer a member to DM?


To refer a member, fax a completed Disease Management Referral Form to 1-888-762-3199 or access the form via Availity.

Fax:

1-888-762-3199

Program Objectives

DM aims to:

  • Address gaps in care.
  • Improve the understanding of disease processes.
  • Improve the quality of life for members.
  • Support collaboration to develop member-centered goals and interventions.
  • Support relationships between the members and network providers.
  • Increase network provider awareness of DM programs.
  • Reduce acute episodes requiring emergent or inpatient care.
  • Identify social determinants of health and address by referring members to appropriate community resources.

Our DM programs feature:

  • Proactive identification process.
  • Evidence-based Clinical Practice Guidelines from recognized sources.
  • Collaborative practice models that include the physician and support providers in treatment:
    • DM invites provider input for patient treatment plans. We provide you with DM information and the most up-to-date Clinical Practice Guidelines to assist you in creating an individual plan of care.
  • Continuous patient self-management education.
  • Ongoing planning and communication with providers regarding patient status:
    • Providers can access Patient360 via Availity to obtain feedback on their patients regarding their care plans and condition management while enrolled in DM programs.
  • NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care.

Contact us


  • Please call 1-888-830-4300 to reach a Disease Management case manager. 
  • Your patients can get information about DM program services by visiting our member website or by calling 1-888-830-4300.

Call:

1-888-830-4300

Hours of operation

DM case managers are available from 8:30 a.m. to 5:30 p.m. local time, Monday to Friday. Confidential voicemail and the 24-hour Nurse HelpLine are always available 24/7.

Provider rights and responsibilities

You have the right to information about Amerigroup including:

  • Provided program and services.
  • Our staff.
  • Our staff’s qualifications.
  • Any contractual relationships.
  • How we coordinate our interventions with your patient’s treatment plans.
  • How to contact the person who manages and communicates with your patients.

You also have the right to:

  • Decline to participate in or work with any of our programs and services for your patients.
  • Be supported by our organization when interacting with patients to make decisions about their health care.
  • Receive courteous and respectful treatment from our staff.
  • Communicate complaints about DM as outlined in the Amerigroup provider grievances procedures, which can be located in the Amerigroup provider manual.

Our DM programs do not advertise, market or promote specific products or services to members or providers.

The Clinical Practice Guidelines (CPGs) for the chronic conditions listed above are available on Availity, our secure provider website. CPGs can be requested at any time.

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.