Disease Management

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 other healthcare professionals manage chronic conditions.

Our mission

The mission of the DM/PHP is to improve the health and quality of life for the 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 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/PHP services:

• Asthma
• Bipolar disorder
• Chronic obstructive pulmonary disease (COPD)
• Congestive health failure (CHF)
• Coronary artery disease (CAD)
• Diabetes
• HIV/AIDS
• Hypertension
• Major depressive disorder (MDD) for children, adolescents, and adults
• Substance use disorder (SUD)
• Schizophrenia

How can I refer a member to DM?

To refer a member, complete a Disease Management/Population Health Referral Form and email the completed form to DM-PHP-Provider-Referal@anthem.com.

DM/PHP is 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 relationships between the members and network providers.
• 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.

Programs feature include:

• Proactive identification process.
• Evidence-based clinical practice guidelines from recognized sources.
• Collaborative practice models that include the physician and support-service providers in treatment planning for members.
• Continuous patient self-management education, including primary prevention, coaching related by healthy behaviors modification programs and compliance/monitoring, and case/care management for high-risk members.
• Ongoing communication with primary and ancillary providers regarding patient status.
• Nine National Committee for Quality Assurance (NCQA) programs, which incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care.