Disease Management (DM) is 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 our members by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.
DM services include:
Members diagnosed with one or more of the conditions listed below are eligible for DM services.
Disease Management aims to:
Nine of our Disease Management programs are NCQA accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
Our DM programs do not advertise, market or promote specific products or services to members or providers. They do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
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.
Disease Management invites your 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 for your patient.
Providers can access Patient360 to obtain feedback on their patients regarding their care plans and condition management while enrolled in our program.
Call 1-888-830-4300 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day.
Providers have additional rights and responsibilities such as the right to:
A copy of these rights and responsibilities can also be found in the provider manual.
The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity our secure provider website. CPGs can also be requested at any time.