Disease Management/Population Health
Our Disease Management (DM) team 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 department is to improve the health and quality of life for Anthem Blue Cross and Blue Shield Medicaid (Anthem) members by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.
DM 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.
Who is eligible?
Members diagnosed with one or more of the conditions listed below are eligible for DM services:
- Bipolar disorder
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure (CHF)
- Coronary artery disease (CAD)
- Major depressive disorder (MDD) for children, adolescents and adults
- Substance use disorder (SUD)
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.
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 processes.
- Evidence-based clinical practice guidelines from recognized sources.
- Collaborative practice models that include the physician and support providers in treatment:
- DM invites provider 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.
- Continuous patient self-management education.
- Ongoing planning and communication with providers regarding patient status:
- Providers can access Patient360 via Availity to obtain feedback on their patients regarding their care plans and condition management while enrolled in DM programs.
- NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
Please call 1-888-830-4300 to reach a DM case manager. Our DM case managers are registered nurses.
Your patients can get information about DM program services by visiting our member website or by calling 1-888-830-4300.
- After hours, call the 24/7 NurseLine at 1-866-864-2544.
Hours of operation:
- DM case managers are available from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday.
- Confidential voicemail and the 24/7 NurseLine are always available 24 hours a day.
Provider rights and responsibilities
You have the right to information about 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 healthcare.
- 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 provider manual.
Our DM programs do not advertise, market or promote specific products or services to members or providers.
The Clinical Practice Guidelines (CPGs) for the chronic conditions listed above are available on Availity, our secure provider website. CPGs can be requested at any time.
Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid.