Disease Management / Population Health
Our Disease Management/Population Health Program (DM/PHP) is based on a system of coordinated care management interventions and communications designed to support physicians and other healthcare professionals in managing members with chronic conditions.
The DM/PHP mission is to improve the health and quality of life for the members we serve. We do this by encouraging self-care efforts, coordinating healthcare education and providing interventions along the continuum of care. Our 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 healthcare needs of our member population.
- Weight management and smoking cessation education.
Who is eligible?
Members diagnosed with one or more of these conditions are eligible for DM/PHP services:
- Bipolar disorder
- Coronary artery disease
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Major depressive disorder — adults
- Major depressive disorder — children/adolescents
- Substance use disorder
Program features include:
- Proactive population identification processes.
- Programs based on 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 by healthy behaviors modification programs and compliance or monitoring, and case management for high-risk members.
- Ongoing communication with primary and ancillary 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.
DM/PHP programs are designed to:
- Address gaps in care.
- Improve member understanding of the disease processes.
- Improve the quality of life for members.
- Collaborate with providers to develop member-centered goals and interventions.
- Support relationships between the member and provider networks.
- Increase network provider awareness of DM/PHP.
- Reduce acute episodes requiring emergent or inpatient care.
- Identify social determinants of health and address them by referring members to appropriate community resources.