Disease Management/Population Health
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.
Our mission
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:
- 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 disorder (COPD)
- Congestive heart failure (CHF)
- Coronary artery disease (CAD)
- Diabetes
- HIV/AIDS
- Hypertension
- Major depressive disorder — adult
- Major depressive disorder – child/adolescent
- Schizophrenia
- Substance use disorder
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 at www.availity.com.
Fax:
1-888-762-3199
Objectives
Disease Management 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 network provider relationships with members.
- 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 programs feature:
- Proactive population identification processes.
- Evidence-based national practice guidelines.
- Collaborative practice models to include physician and support service providers in treatment planning for members.
- Continuous patient self-management education, including primary prevention, coaching related to healthy behaviors and compliance or monitoring, and care management for high-risk members.
- Ongoing communication with primary and ancillary providers regarding patient status.
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.
What are the benefits of collaborating with DM?
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
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.
Receive feedback on your patients
Providers can access Patient360 to obtain feedback on their patients regarding their care plans and condition management while enrolled in our program.
How to contact us
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.
Call:
1-888-830-4300
Provider rights and responsibilities
Providers have additional rights and responsibilities such as 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 members.
- Know how to contact the care 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.
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.