Our Disease Management (DM)/Population Health Program (PHP) is based on a system of coordinated care management interventions and communications designed to help physicians and other health care professionals manage members with chronic conditions.
The mission of Disease Management/Population Health is to improve the health and quality of life for the members we serve. We do this by encouraging self-care efforts, coordinating health care education and providing interventions along the continuum of care.
DM/PHP services include:
DM/PHP programs include:
Members diagnosed with the above conditions as identified through continuous case finding efforts, claims data and referrals are eligible for Disease Management/Population Health Program services.
To refer a member, fax a completed Disease Management/Population Health referral form to 1-888-762-3199
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/PHP.
DM/PHP invites your input for patient treatment plans. We provide you with DM/PHP information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist in creating an individual plan of care for your patient.
You can access Patient360 to obtain feedback on your patients regarding their care plans and condition management while enrolled in DM.
Call 1-888-830-4300 to reach a case manager between 8:30 a.m. and 5:30 p.m. local time, Monday to Friday. Confidential voicemail is available.
Members can get information about DM services by calling the number above or visiting our member website.
The Nurse Helpline is available to members 24/7 at 1-866-864-2544.
You have additional rights and responsibilities, such as the right to:
The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity, our secure provider website. CPGs can be requested at any time.
Our disease management/population health programs do not advertise, market or promote specific products or services to members or providers. We do not have financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.