About Disease Management
The mission of the DM department is to improve the health and quality of life for the members
served by encouraging member self-care efforts, coordinating health care education and
providing interventions along the continuum of care.
DM services include:
- A holistic, member-centric approach to disease management that focuses on providing the tools and educational support necessary for members to effectively manage their health care needs
- Motivational interviewing techniques used in conjunction with member self-empowerment strategies
- The management of each member’s co-existing diseases to meet the changing healthcare needs of our member population
- Management programs are available for the following disease states:
- A holistic, member-centric approach to DM focusing on the needs of the member.
- Motivational interviewing techniques used in conjunction with member self-empowerment.
- Programs for patients with 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 (SUD).
- 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.
Who is eligible?
Members who have been diagnosed with the above conditions and are identified through
continuous case finding efforts, claims mining and referrals are eligible for DM services.
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, coaching
related to healthy behaviors and compliance/surveillance, and case/care management for
- Process and outcomes measurement, evaluation, and management.
- Ongoing communication with primary and ancillary providers regarding patient status.
Nine of our DM programs are accredited by the National Committee for Quality Assurance and
incorporate outreach, education, care coordination and follow-up to improve treatment
compliance and enhance self-care.
DM programs are designed to:
Disease Management Referral Form
- Address gaps in care.
- Improve member understanding of disease processes.
- Improve quality of life for our members.
- Collaborate with providers to develop member-centered goals and interventions.
- Support relationships between member and network providers.
- Increase network provider awareness of DM programs.
- Reduce acute episodes requiring emergent or inpatient care.