Disease Management / Population Health

DM/PHP are designed 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/PHP features include:

• Proactive identification process.
• Programs designed using evidence-based national practice guidelines from recognized sources.
• Collaborative practice models that include the physician and support providers in treatment planning for members.
• Continuous patient self-management education, including primary prevention, coaching related by healthy behaviors modification programs and compliance/monitoring, and case/care management for high-risk members.
• Ongoing planning and communication with 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 the benefits of collaborating with DM/PHP?

• 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 DM.
• Collaborative treatment plans — DM invites your input for patient treatment plans. We provide you with DM 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, the secure provider website (login is required).
• Receive feedback on your patients between appointments — You can access Patient360 via Availity to obtain feedback on your patients regarding their care plans and condition management while enrolled in DM.

How to contact us

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 on how the organization coordinates interventions with care plans for individual members.
• Know how to contact the case manager responsible for managing and communicating with their patients.
• Be supported by the organization when interacting with members to make decisions about their health care.
• Receive courteous and respectful treatment from the organization’s staff.
• Communicate complaints to the organization.

A copy of these rights and responsibilities can also be found in the provider manual.

DM and our programs do not advertise, market or promote specific products or services to members or providers. DM and our programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.

CPGs for the chronic conditions listed above are available on Availity.* , our secure provider website. CPGs can be requested at any time.

* Availity, LLC is an independent company providing administrative support services on behalf of Amerigroup Community Care.