Disease Management/Population Health
The mission of the DM department is to improve the health and quality of life for Healthy Blue members by encouraging member self-care efforts, coordinating health care education, and providing interventions along the continuum of care.
DM services include:
- A holistic, member-centered approach to disease management focusing on the needs of the member.
- Motivational interviewing techniques used in conjunction with member self-empowerment.
- 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.
Benefits of collaborating with DM:
- Quality of care: You can refer patients who have multiple conditions; we can provide additional education and care management.
- Collaborative 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. Together, we can create patient treatment plans.
- CPGs are available on Availity* (login is required).
- Receive feedback on your patients between appointments: Get feedback on your patients’ care plans and condition management through Patient360 in Availity.
Who is eligible?
Disease management services are available for members diagnosed with one or more of the following conditions:
- 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 (SUD)
Our programs* feature:
- 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, healthy behaviors coaching, compliance/monitoring, and care management for high-risk members.
- Ongoing communication with primary and ancillary providers regarding patient status.
- Nine National Committee for Quality Assurance (NCQA) accredited programs that incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care.
- 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 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 refer members to appropriate community resources
Please call 888-830-4300, Monday to Friday, 8:30 a.m. to 5:30 p.m. Local time. Confidential voicemail is available 24 hours a day.
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 care manager responsible for managing and communicating with their patients.
- Be supported by the organization when interacting with members to make decisions about their health care.
- Receive courteous and respectful treatment from the organization’s staff.
- Communicate complaints to the organization.
Note: Our DM programs do not advertise, market, or promote specific products or services to members or providers. We do not have any financial ownership arrangements with anyone who advertises, markets, or provides the goods and services we offer.