Anthem Blue Cross

Providers - California

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.
 

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 (CPGs) to assist you in creating an individual plan of care for your patient. CPGs are available on Availity.* (Login is required.)
  • Review feedback on your patients between appointments — You can also access Patient360 via Availity to obtain feedback regarding their patients’ care plans and condition management while enrolled in DM.

How to contact us


Email us at DM-PHP-Provider-Referral@anthem.com anytime or call 1-888-830-4300 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, including 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 on how the organization coordinates interventions with care plans for individual members.
  • Know how to contact the case 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 about DM as outlined in the Anthem Blue Cross (Anthem) provider grievances procedures, which can be located in the Anthem provider manuals:

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

DM and our programs do not advertise, market or promote specific products or services to members or providers. DM and our programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.

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.