Disease Management/Population Health
Our Disease Management (DM) team is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions. DM services include a holistic, member-centric care management approach that allows case managers to focus on multiple needs of members. Our disease management programs include:
- Bipolar disorder
- Chronic Obstructive Pulmonary Disorder (COPD)
- Congestive Heart Failure (CHF)
- Coronary Artery Disease (CAD)
- Major depressive disorder–adult and child/adolescent
- Substance Abuse disorder
In addition to our 12 condition-specific disease management programs, our approach also allows us to assist members with smoking cessation and weight management education.
The mission of the DM department is to improve the health and quality of life for our members served by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.
DM aims to:
- Address gaps in care.
- Improve the understanding of disease processes.
- Improve the quality of life for members.
- Support network provider relationships with members.
- Increase network provider awareness of Disease Management programs.
- Reduce acute episodes requiring emergent or inpatient care.
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/monitoring, and case/care management for high-risk members
- Ongoing communication with primary and ancillary providers regarding patient status
Nine of our DM programs are National Committee for Quality Assurance-accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
Who is eligible?
Members diagnosed with the above conditions are eligible for DM services.
Our DM programs do not advertise, market or promote specific products or services to members or providers.
Our DM programs 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 Disease Management?
Maximize your time
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 Disease Management.
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 are provided to assist you in creating an individual plan of care.
Receive feedback on your patients
Providers can access Patient360 via Availity to obtain feedback on their patients regarding their care plans and condition management while enrolled in DM programs.
Please call 1-888-830-4300 to reach a case manager. Your patients can get information about DM program services by visiting our
member website or by calling 1-888-830-4300.
Hours of operation
DM case managers are available by calling 1-888-830-4300 from 8:30 a.m. to 5:30 p.m. Pacific time, Monday through Friday. Confidential voicemail and the Nurse Helpline are always 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 their patients.
- Be informed 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 healthcare.
- Receive courteous and respectful treatment from the organization’s staff.
- Communicate complaints to the organization.
These rights and responsibilities are available to you in written format upon request to DM by calling 1-888-830-4300.
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.