Disease Management / Population Health
The Disease Management/Population Health Program (DM/PHP) 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/PHP program is to improve the health and quality of life for our members served by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.
DM/PHP 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 healthcare needs of our member population.
- Weight management and smoking cessation education.
Who is eligible?
Members diagnosed with one or more of the conditions listed are eligible for DM/PHP services:
- Bipolar disorder
- Chronic obstructive pulmonary disorder (COPD)
- Congestive heart failure (CHF)
- Coronary artery disease (CAD)
- Major depressive disorder — adult
- Major depressive disorder – child/adolescent
- Substance use disorder
How can I refer a member to this program?
To refer a member to the Disease Management/Population Health Program, fill out our DM/PHP, Referral Form and email the completed form to DM-PHP-Provider-Referrals@amerigroup.com.
DM/PHPs 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 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.
Program features include:
- Proactive population identification processes.
- Programs are based on 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 programs are National Committee for Quality Assurance (NCQA) accredited and 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 to assist you in creating an individual plan of care for your patient.
Receive feedback on your patients
Providers can access Patient360 through Availity to obtain feedback on their patients regarding their care plans and condition management while patients are enrolled in our program.
Hours of operation
From 8:30 a.m. to 5:30 p.m. local time, Monday through Friday to reach a DM/PHP staff member. Confidential voicemail is available 24 hours a day.
Provider rights and responsibilities
You 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 your 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 your patients.
- Be supported by the organization when interacting with members to make decisions about their healthcare.
- 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.
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.