Provider Support Helping Members

Disease Management

Our Disease Management (DM) programs 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 disease management, focusing on the needs of the member.
  • Motivational interviewing techniques used in conjunction with member self-empowerment.
  • DM 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) in adult and child/adolescent, schizophrenia, and substance use disorder.
  • The ability to manage more than one condition to meet the changing health care needs of our member population.
  • Weight management and smoking cessation education.
Our mission

The mission of the DM 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 DM 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, coaching related to healthy behaviors and compliance/surveillance, and case/care 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 aims to:

  • Address gaps in care.
  • Improve the understanding of disease processes.
  • Improve the quality of life for our members.
  • Collaborate 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.

Who is eligible?

Members diagnosed with the conditions listed above and are identified through continuous case finding efforts, claims mining and referrals are eligible for DM services.

How can you use DM services?

Maximize your time

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

Get help with treatment plans

In order to assist in managing patients, DM requests your input for patient treatment plans. Disease management information and the most up-to-date Clinical Practice Guidelines (CPGs) are provided to assist you in creating an individualized 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 DM programs.

Provider rights and responsibilities

As a participating provider with patients enrolled in a DM program, you have additional rights and responsibilities. You have 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.

CPGs are available to our providers on our secure provider website (login is required).

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

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