Disease Management

The Disease Management (DM) department provides services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) 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 mission

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

DM services include:

  • A holistic, member-centric approach to DM 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) for 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.

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 behavior and compliance/surveillance as well as case/care management for high-risk members.
  • Process and outcomes measurement as well as evaluation and management.
  • Ongoing communication with primary and ancillary providers regarding patient status.

DM programs are designed 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 relationships between members and network providers.
  • Increase network provider awareness of DM programs.
  • Reduce acute episodes requiring emergent or inpatient care.

DM does 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 provide the goods and services we offer.

Who is eligible?

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

How can you use DM services?

  • Maximize your time
    As a valued provider, we encourage you to refer your patients with the following conditions to DM: asthma, bipolar disorder, CAD, CHF, COPD, diabetes, HIV/AIDS, hypertension, adult and child/adolescent MDD, schizophrenia, or SUD. In addition, refer patients who could benefit from additional education or care management.
  • Get help with treatment plans
    In order to assist in managing patients, DM requests your input for patient care 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 they are 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 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). CPGs can be requested at any time.

How can you contact us?

DM case managers are registered nurses and are available from 8:30 a.m. to 5:30 p.m., local time, Monday through Friday. Confidential voicemail and the 24/7 NurseLine are always available.