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
Refer a member to DM/PHP
Fill out and email the completed DM/PHP Referral Form.
- Proactive population identification processes
- Program content is 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
- National Committee for Quality Assurance (NCQA) accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care
- Address gaps in care.
- Improve member understanding of disease processes.
- Improve the quality of life for members.
- Support collaboration to develop member-centered goals and interventions.
- Support relationships between the member and provider networks.
- Increasing 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.
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/PHP.
Collaborative treatment plans
DM/PHP invites your input for patient treatment plans. We provide you with DM/PHP 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 in Availity (login is required).
Receive patient feedback
You can access Patient360 to obtain feedback on your patients regarding their care plans and condition management while enrolled in our program.
Confidential voicemail is available.
Provider rights and responsibilities
You have additional rights and responsibilities, such as 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 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 to the organization.
Clinical practice guidelines
Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity, our secure provider website. CPGs can be requested at any time.
Our DM/PH programs do not advertise, market, or promote specific products or services to members or providers. We do not have financial ownership arrangements with anyone who advertises, markets, or provides the goods and services we offer.