About Disease Management

The Disease Management (DM) department offers services for Anthem Blue Cross and Blue Shield Medicaid (Anthem) members. These services are based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

DM Services

DM services include:

• A holistic, member-centric approach to DM focusing on the needs of the member.
• Motivational interviewing techniques used in conjunction with member self-empowerment.
DM 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, and 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

Our mission

The mission of the DM department is to improve the health and quality of life for Anthem members by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.

About Anthem DM programs

Our programs feature the following:

• 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, coaching healthy behaviors and compliance/surveillance, and case/care 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

Objectives

DM aims to:

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

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.

How can you use DM services?

Maximize your time
As a valued provider who could use some help in following up with patients, you can refer your 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 could benefit from additional education or care management.

Get help with treatment plans
In order to assist in managing patients, DM requests your input for patient treatment plans. DM information and the most up-to-date Clinical Practice Guidelines (CPGs) are provided to assist you in creating an individualized 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 DM programs.

Hours of operation
DM case managers are registered nurses who are available from 8:30 a.m. to 5:30 p.m., local time, Monday through Friday. Confidential voicemail and the member Care on Call line are always available.

Contact information
Please call 1-888-830-4300 to reach a DM case manager. Your patients can get information about DM program services by visiting https://mss.anthem.com/ky/home.html or calling 1-888-830-4300.

Provider rights and responsibilities

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

• Obtain information about the organization’s services, staff qualifications and any contractual relations.
• Decline to participate in or work with the organization’s programs and services on behalf of their patients.
• Be informed how the organization coordinates interventions with care plans for individual members.
• Know how to contact the Case Manager responsible for managing and communicating with their patients.
• Be supported by the organization when interacting with members to make decisions about their healthcare.
• Receive courteous and respectful treatment from the organization’s staff.
• Communicate complaints to the organization.

These rights and responsibilities are available to you in written format upon request to DM by calling 1-888-830-4300.

The CPGs for the above-outlined chronic conditions are available on our secure provider website (login is required). CPGs can also be requested at any time.

DM forms

• Disease Management Referral Form
• Clinical Health Promotion Program Referral Form