Our Disease Management (DM) programs are based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.
The mission of the DM department is to improve the health and quality of life for the members served. We do this by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.
Our programs feature the following:
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 aims to:
Members diagnosed with the conditions listed above and who are identified through continuous case-finding efforts, claims mining and referrals are eligible for DM services.
As a valued provider who could use some help in following up with patients, you can refer your patients with the following conditions: asthma, bipolar disorder, CAD, CHF, COPD, diabetes, HIV/AIDS, hypertension, MDD in adult and child/adolescent, schizophrenia, SUD, ADHD, autism/PDD, or CKD.
In order to assist in managing patients, we request your input for patient treatment plans. We provide disease management information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist you in creating an individualized plan of care.
Providers can access Patient360 to obtain feedback on their patients regarding their care plans and condition management while enrolled in DM programs.
As a participating provider with patients enrolled in a DM program, you have additional rights and responsibilities. You have the right to:
These rights and responsibilities are available to you 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).
The Anthem DM department and our DM programs do not advertise, market or promote specific products or services to members or providers.
The Anthem DM department and our DM programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
Page Last Updated: 02/24/2021
DM case managers are registered nurses who are available from 8:30 a.m. to 5:30 p.m., PT, Monday through Friday. Confidential voicemail and the 24/7 NurseLine are always available.
Please call 1-888-830-4300 to reach a DM case manager. Your patients can get information about DM services by visiting www.anthem.com or by calling 1-888-830-4300.