Disease Management

The Disease Management (DM) department provides services for Healthy Blue members. These services are based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

DM services include:

  • A holistic, member-centric approach to DM focused on the needs of the member.
  • Motivational interviewing techniques used in conjunction with member empowerment.
  • Programs for patients with asthma, bipolar disorder, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, HIV/AIDS, hypertension, major depressive disorder (MDD) in adult and child/adolescent, schizophrenia, and substance use disorder (SUD).
  • 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.

Additionally, DM offers the Healthy Families program, which is a six-month program for members ages 7-17 designed to assist families in obtaining a healthier lifestyle. This program provides families with fitness and healthy behavior coaching, written nutrition information, and online and community resources. To receive additional information or enroll in the Healthy Families program, call us at 1-844-421-5661.

Mission

The mission of the DM department is to improve the health and quality of life for members by encouraging self-care efforts, coordinating health care education and providing interventions along the continuum of care.

Programs

Our programs feature:

  • Proactive population identification processes.
  • Chronic disease care gaps identification.
  • 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/surveillance, as well as home visits and care/case management for high-risk members.
  • Process and outcomes measurement, evaluation and management.
  • Ongoing communication with primary and ancillary providers regarding patient status.
  • Nine of our Disease Management programs are National Committee for Quality Assurance accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
Objectives

DM objectives are to:

  • Address gaps in care.
  • Improve the understanding of disease processes.
  • Improve quality of life for our members.
  • Provide opportunities for patient-centered care.
  • Support network provider relationships with members.
  • Increase network provider awareness of DM programs.
  • Reduce acute episodes requiring emergent or inpatient care.
Who is eligible?

Members are eligible if they have been diagnosed with one of the above conditions and are identified through continuous case finding efforts, claims mining and referrals.

The Healthy Blue DM department and programs do not advertise, market or promote specific products or services to members or providers.

The DM department and programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.

How to use DM services

Maximize your time

As a valued provider who could use some help in following up with patients, you can refer your asthma, bipolar disorder, CAD, CHF, COPD, diabetes, HIV/AIDS, hypertension, MDD for adult and child/adolescent, schizophrenia, and SUD. In addition, refer patients who could benefit from additional education or care management.

Get help with treatment plans

To assist in managing patients, DM requests your input for patient treatment plans. DM information and the most up-to-date Clinical Practice Guidelines (CPGs) are provided to assist you in creating an individual plan of care.

Receive feedback on your patients

Providers can access Patient360 to obtain feedback on their patients regarding their care plans and condition management while enrolled in a DM program.

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 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.

These rights and responsibilities are available to you in written format upon request to DM by calling 1-888-830-4300.

The CPGs are available to providers on our secure provider website (login is required). They can also be requested at any time.

How can you contact us?

Hours of operation

DM case managers are registered nurses who are available from 8:30 a.m. to 5:30 p.m. CT, Monday through Friday. Confidential voicemail and the Care on Call line are available 24/7.

Contact information

Please call 1-888-830-4300 to reach a DM case manager. Your patients can also get information about DM programs and services by calling 1-888-830-4300.

How can you contact us?

Hours of operation

DM case managers are licensed nurses and are available from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day. Care on Call is available 24/7 for our members.

Contact information

Please call 1-888-830-4300 to reach a DM case manager. Your patients can also get information about DM program services by calling 1-888-830-4300.