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.