Disease Management Centralized Care Unit

Disease Management Centralized Care Unit (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, CAD, CHF, 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 healthcare needs of our member population

DMCCU also offers Weight Management services.

In addition, Anthem assists with management of prenatal cases in high-risk populations.

The mission of the Disease Management Centralized Care Unit is to improve the health and quality of life for our members by encouraging self-care efforts, coordinating health care education and providing interventions along the Continuum of Care.

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, 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

DMCCU objectives include:

• Addressing gaps in care
• Improving the understanding of disease processes
• Improving the quality of life for our members
• Providing opportunities for patient-centered care
• Supporting network providers' relationships with members
• Increasing network provider awareness of DMCCU programs
• Reducing acute episodes requiring emergent or inpatient care

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

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, schizophrenic, and substance use disorder patients who could benefit from education or care management to DMCCU.

Get help with treatment plans

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 patents

Providers receive feedback on members enrolled in disease management programs through 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
• Psychosocial and safety issues

Feedback is provided weekly, monthly, quarterly, annually, or as needed while enrolled in a disease management program based on the severity of the member's condition.

Hours of Operation

DMCCU Case Managers are licensed nurses/social workers, and are available from 8:30am to 5:30pm local time, Monday through Friday. Confidential voicemail is available 24 hours a day. Care on Call is available 24 hours a day/7 days a week for our members.

Contact Information

Please call 1-888-830-4300 to reach a DMCCU Case Manager. Your patients can get information about DMCCU program services by visiting www.anthem.com or calling 1-888-830-4300.

• Disease Management Referral Form

As a participating provider with patients enrolled in a disease management program you have additional rights and responsibilities.

You have the right to:

• 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 healthcare
• Receive courteous and respectful treatment from DMCCU staff
• Communicate complaints to DMCCU regarding disease management as outlined in Provider Complaint and Grievance Procedure

These rights and responsibilities are available to you in written format upon request to Disease Management Centralized Care Unit.

The Clinical Practice Guidelines (CPGs) for the following chronic conditions are available in the resource area of the secure provider home page. Log in is required. CPGs are also faxed to providers upon member enrollment in a disease management program and can be requested at any time.

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, 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/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, schizophrenia, and substance use disorder. The overall goal of the program is to help our members get the most benefit from their health care 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-on 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.