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Medicaid Providers

Disease Management

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.

Objectives

Disease management aims to:

  • Address gaps in care.
  • Improve the understanding of disease processes.
  • Improve the quality of life for members.
  • Support network provider relationships with members.
  • Increase network provider awareness of disease management programs.
  • Reduce acute episodes requiring emergent or inpatient 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, and case 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.

Disease management services include:

  • A holistic, member-centered 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
    • 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).
  • 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.

Who is eligible?

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

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

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

Note: Programs offered are subject to change.

How to use disease management services

Refer your patients to the diseases management program

You can refer patients with asthma, bipolar disorder, CAD, CHF, COPD, diabetes, HIV/AIDS, hypertension, MDD in adult and child/adolescent, schizophrenia, or SUD. In addition, refer patients who may benefit from additional education or care management.

Get help with treatment plans

As we work with patients, we would like 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 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 enrolled in disease management programs.

Contacting us

Please call 1-888-830-4300 to reach a care manager. Your patients can get information about disease management program services by visiting our member website or by calling 1-888-830-4300.

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 are available to you in written format upon request to disease management by calling 1-888-830-4300.

The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity our secure provider website. CPGs can also be requested at any time.

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.