Disease Management / Population Health / Clinical Health Promotion
Our Disease Management/Population Health Program (DM/PHP) is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.
The mission of the DM/PHP program 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 DM, 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 healthcare needs of our member population.
- Weight management and smoking cessation education.
- The New Baby, New LifeSM program to all pregnant members during the prenatal and postpartum period and for newborn members (through the first 90 days of life). For more information, visit the Maternal Services page.
Who is eligible?
Members diagnosed with one or more of the conditions listed below are eligible for DM/PHP services:
- Bipolar disorder
- Coronary artery disease (CAD)
- Congestive heart failure (CHF)
- Chronic obstructive pulmonary disease (COPD)
- Major depressive disorder (MDD) in adult and child/adolescent
- Substance use disorder
- Attention deficit hyperactivity disorder (ADHD)
- Autism/pervasive development disorder and chronic kidney disease (CKD)
How can I refer a member to this program?
To refer a member to the Disease Management/Population Health Program, fill out our DM/PHP Referral Form and email the completed form to DM-PHP-Provider-Referrals@anthem.com.
- 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 accredited by the National Committee for Quality Assurance and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
DM/PHP programs are designed to:
- Address gaps in care.
- Improve the understanding of disease processes.
- Improve the quality of life for our members.
- Support collaboration to develop member-centered goals and interventions.
- Support network provider relationships with members.
- Increase network provider awareness of DM programs.
- Reduce acute episodes requiring emergent or inpatient care.
- Identify social determinants of health and address them by referring members to appropriate community resources.
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 in creating an individual plan of care for your patient.
CPGs are available on Availity.* (Login is required.)
Receive feedback on your patients between appointments
You can access Patient360 via Availity to obtain feedback on their patients regarding their care plans and condition management while enrolled in DM.
How can you contact us?
Email us at DM-PHP-Provider-Referrals@anthem.com 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.
Clinical Health Promotion Program
Healthy Families Program
The Healthy Families program offers families assistance with leading a healthy lifestyle and improving childhood obesity in our members. The Healthy Families Program helps members by providing education, community resources and individualized plans of care over a six-month period. Program offered to members ages 7 to 17.
How can I refer a member to the Healthy Families Program?
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 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.
A copy of these rights and responsibilities can also be found in the provider manual. CPGs are available to our providers on our secure provider website (login is required).
The Anthem Blue Cross and Blue Shield (Anthem) DM department and our DM programs do not advertise, market or promote specific products or services to members or providers.
The Anthem DM department and our DM programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
Page Last Updated: 07/16/2021