Anthem Blue Cross

Providers - California

Disease Management


Our Disease Management (DM) programs are based on a system of coordinated care management interventions and communications designed to assist physicians and other health care professionals manage members with chronic conditions. 

Our mission

The mission of the DM program is to improve the health and quality of life for the members served 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 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, fax a completed Disease Management Referral Form to 1-888-762-3199 or access the form via Availity.

Program Objectives

DM 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 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.

Our DM programs feature:

  • Proactive identification process.
  • Evidence-based clinical practice guidelines from recognized sources.
  • Collaborative practice models that include the physician and support providers in treatment
  • Planning.
  • Continuous patient self-management education. 
  • Ongoing communication with providers regarding patient status.
  • NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care.

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

DM invites your input for patient treatment plans. We provide you with DM information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist you in creating an individual plan of care. CPGs are available on Availity (login is required). 

Review feedback on your patients

Providers can also access Patient360 via Availity to obtain feedback regarding their patients’ care plans and condition management while enrolled in DM programs. 

How to contact us


 

Call 1-888-830-4300 Monday through Friday, 8:30 a.m. to 5:30 p.m. local time.

Call:

1-888-830-4300

Confidential voicemail is available 24 hours a day, 7 days a week.

Provider rights and responsibilities

You have the right to information about Anthem Blue Cross (Anthem), including:

  • Provided program and services.
  • Our staff.
  • Our staff’s qualifications.
  • Any contractual relationships.
  • How we coordinate our interventions with your patient’s treatment plans.
  • How to contact the person who manages and communicates with your patients.

You also have the right to:

  • Decline to participate in or work with any of our programs and services for your patients.
  • Be supported by our organization when interacting with patients to make decisions about their health care.
  • Receive courteous and respectful treatment from our staff.
  • Communicate complaints about DM as outlined in the Anthem provider grievances procedures, which can be located in the Anthem Blue Cross provider manuals:

A copy of these rights and responsibilities can also be found in the provider manual.

Our DM programs do not advertise, market or promote specific products or services to members or providers.

Related resources

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.