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Medicaid Providers

Disease Management/Population Health Program (PHP) and Clinical Health Promotion

Our Disease Management team is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing the chronic conditions of Healthy Blue members.

Our mission

The mission of the Disease Management team is to improve the health and quality of life for Healthy Blue members by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.

Our DM/PHP programs are designed to:

  • Address gaps in care.
  • Improve the understanding of disease processes.
  • Improve the quality of life for members.
  • Support collaboration to develop member-centered goals and interventions.
  • Support relationships between member and network providers.
  • Increase network provider awareness of disease management programs.
  • Reduce acute episodes requiring emergent or inpatient care.
  • Identify social determinants of health and address by referring members to appropriate community resources.

What are the benefits of collaborating with DM/PHP?

  • Quality of care — If you have patients with one or more of the conditions listed above who could benefit from additional education or care management, we encourage you to refer them to DM/PHP.
  • Collaborative treatment plans — DM/PHP invites your input for patient treatment plans. We provide you with DM information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist in creating an individual plan of care for your patient:
    • CPGs are available on Availity (login is required).
  • Receive feedback on your patients between appointments — You can access Patient360 to obtain feedback on your patients regarding their care plans and condition management while enrolled in our program.

Program features include:

  • Proactive population identification processes.
  • Program content is based on 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 modification programs and compliance/monitoring, and case/care management for high-risk members.
  • Ongoing communication with primary and ancillary providers regarding patient status.
  • Nine DM programs that are National Committee for Quality Assurance accredited and incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care.

Disease management services include:

  • A holistic, member-centered approach to DM focusing on the needs of the member through telephonic and community-based resources.
  • Motivational interviewing techniques used in conjunction with member self-empowerment.
  • The ability to manage more than one disease to meet the changing healthcare needs of our member population.
  • Weight management and smoking cessation education.

Who is eligible?

Members diagnosed with one or more of the conditions listed below are eligible for DM/PHP services:

  • 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
  • Substance use disorder (SUD).

How can I refer a member to this program?

To refer a member to the Disease Management/Population Health Program, fill out our DM/PHP Referral Form and email the completed form to DM-PHP-Provider-Referrals@healthybluenc.com.

How to contact us

Email us at DM-PHP-Provider-Referrals@healthybluenc.com or call 888-830-4300 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day.

Clinical Health Promotion Program

Wellness Program

We offer assistance with weight management, nutrition, and tobacco cessation. The Wellness Program helps members by establishing individual goals and providing support and follow-up over a six-month period. Program offered to members ages 18 and older.

The Wellness Program:

  • Combines coaching, education, and community-based resources to support a healthy lifestyle.
  • Assigns a health coach to support the member with motivational interviewing sessions, telephonic coaching, and education-based support measures designed to improve treatment plan compliance and increase healthy choices.
  • Allows the health coach to work directly with the member to set realistic and achievable short-term goals for a healthy lifestyle, thereby optimizing success toward achieving long-term goals.
  • How can I refer a member to the Wellness Program?

    To refer a member, fill out our Clinical Health Promotion Program Referral Form and email the completed form to DM-PHP-Provider-Referrals@healthybluenc.com.

    Contacting the Wellness Program

    Call 844-421-5661, Monday to Friday from 8:30 a.m. to 5:30 p.m.

Provider rights and responsibilities

You have additional rights and responsibilities such as the right to:

  • Obtain information about our services, staff qualifications and any contractual relations.
  • Decline to participate in or work with our programs and services on behalf of your patients.
  • Be informed how we coordinate interventions with care plans for individual members.
  • Know how to contact the care manager responsible for managing and communicating with your patients.
  • Be supported by Healthy Blue staff when interacting with members to make decisions about their health care.
  • Receive courteous and respectful treatment from Healthy Blue staff.
  • Communicate complaints to Healthy Blue staff.

These rights and responsibilities can also be found in the provider manual.

Our DM programs do not advertise, market, or promote specific products or services to members or providers.

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

Provider tools & resources

Interested in becoming a provider in the Healthy Blue network?

We look forward to working with you to provide quality services to our members.