Provider Support Helping Members

Disease Management Centralized Care Unit

Anthem Blue Cross (Anthem) Disease Management Centralized Care Unit (DMCCU) is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

DMCCU services include:

  • A holistic, member-centric approach to disease management, focusing on the needs of the member
  • Motivational interviewing techniques used in conjunction with member self-empowerment
  • Disease management programs for asthma, bipolar disorder, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, HIV/AIDS, hypertension, major depressive disorder (MDD), schizophrenia and substance use disorder
  • The ability to manage more than one disease to meet the changing health care needs of our member population

DMCCU also offers weight management services.

Our Mission

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

About Anthem Disease Management Programs

Our programs feature the following:

  • 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, behavior modification programs and compliance/surveillance, as well as home visits and case management for high-risk members
  • Process and outcomes measurement, evaluation and management
  • Ongoing communication with providers regarding patient status

Objectives

DMCCU objectives are to:

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

Who Is Eligible?

All Anthem members diagnosed with above conditions are eligible for these services. Members are identified through continuous case finding efforts including, but not limited to, continuous case finding, welcome calls, claims mining and referrals.

How Can You Use DMCCU Services?

Maximize Your Time

As a valued provider who could use some help in following up with patients, you can refer your asthmatic, bipolar, CAD, CHF, COPD, diabetic, HIV/AIDS, hypertensive, MDD, schizophrenia, and substance use disorder patients who could benefit from education or care management to DMCCU.

Get Help with Treatment Plans

In order to assist in managing patients, DMCCU requests your input for patient treatment plans. Disease management information and the most up-to-date clinical practice guidelines are provided to assist you in creating an individualized plan of care.

Receive Feedback on Your Patients

Providers receive feedback on members enrolled in disease management programs in member status letters, care plans and telephonic communications. Feedback includes: assessment of how well the condition is being managed, adherence to treatment plans, patient goals, and psychosocial and safety issues while enrolled in a disease management program. Feedback is provided weekly, monthly, quarterly, annually or as needed based on the severity of the member’s condition.

Provider Rights and Responsibilities

As a participating provider with members enrolled in a disease management program, you have additional rights and responsibilities. You have the right to:

  • Have information about DMCCU, including programs and services, our staff and their qualifications, and any contractual relationships.
  • Decline to participate in or work with DMCCU programs and services for our members if contractually possible.
  • Be informed of how DMCCU coordinates our disease management-related interventions with treatment plans for individual patients.
  • Know how to contact the person responsible for managing and communicating with your patients.
  • Be supported by DMCCU to make decisions interactively with patients regarding their health care.
  • Receive courteous and respectful treatment from DMCCU staff.
  • Communicate complaints to DMCCU regarding disease management as outlined in the Provider Complaint and Grievance Procedure.

These rights and responsibilities are available to you in written format upon request to DMCCU. The clinical practice guidelines (CPGs) for the following chronic conditions are available in the resource area of the secure provider home page. Login is required. CPGs are also faxed to providers upon member enrollment in a disease management program and can be requested at any time.

Disease Management Programs for Our Members

Pulmonary

DMCCU offers asthma and COPD disease management programs for our members. These programs identify and stratify members into risk groups. Based on these risk groups, the program provides specific interventions, such as printed information, durable medical equipment (DME) as needed, home health instruction and/or community asthma and COPD programs and self-management education. In addition, follow-up calls are made to the member/guardian/primary care provider (PCP) on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Cardiac

DMCCU offers a CHF, CAD and hypertension disease management program for our members. These programs identify and stratify members into risk groups. Based on the identified needs, these programs provide specific interventions, such as printed information, one-on-one education from a nurse and DME as needed. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Behavioral Health

DMCCU offers a disease management program for our members diagnosed with major depressive disorder, bipolar disorder, schizophrenia or substance use disorder. The overall goal of the program is to help our members get the most benefit from their health care. This can be accomplished by allocating appropriate health plan resources to the care and treatment of members with behavioral health needs and to enhance the capabilities of the network physicians to manage their patients with these disorders. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

Diabetes

DMCCU offers a diabetes disease management program for our members. The program identifies and stratifies members into risk groups. Based on the identified needs, the program provides specific interventions such as printed information, one-on-one education from a nurse certified as a diabetes educator, home health instruction, and community-based diabetes classes. The diabetes program also facilitates endocrinology referrals for members as needed. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

HIV/AIDS

DMCCU offers an HIV/AIDS disease management program for our members. The program identifies and stratifies members into risk groups. Based on the identified needs, the program provides specific interventions, such as printed information, one-on-one education from a nurse and coordination of care. Follow-up calls are made to the member/PCP on a routine basis to determine the need for further intervention. If you would like a complete program description, please contact us.

The Anthem DMCCU and our disease management programs do not advertise, market or promote specific products or services to members or providers.

The Anthem DMCCU and our disease management programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.