Disease management (DM) is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing patients with chronic conditions.
The mission of the Disease Management program is to improve the health and quality of life for the members served by encouraging self-care efforts, coordinating health care education and providing interventions along the continuum of care.
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.
- The ability to manage more than one disease to meet the changing healthcare needs of our member population.
- Weight management and smoking cessation education.
About DM programs under Anthem Blue Cross and Blue Shield (Anthem)
We have programs for:
- Bipolar disorder.
- Coronary artery disease (CAD).
- Congestive heart failure (CHF).
- Chronic obstructive pulmonary disease (COPD).
- Major depressive disorder (MDD) in adults.
- Major depressive disorder (MDD) in children and adolescents.
- Substance use disorder (SUD).
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 healthy behaviors and compliance/monitoring) and case/care management for high-risk members.
- Ongoing communication with primary and ancillary providers regarding patient status.
- NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
DM objectives include:
- Addressing gaps in care.
- Improving the understanding of disease processes.
- Improving the quality of life for our members.
- Providing opportunities for patient-centered care.
- Supporting network provider relationships with members.
- Increasing network provider awareness of DM programs.
- Reducing acute episodes requiring emergent or inpatient care.
- Identifying barriers to health care and addressing them by referring members to appropriate community resources.
All Anthem members with the above conditions/diagnoses are eligible for DM services.
What are the benefits of collaborating with DM?
Maximize your time
- 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.
Collaborative treatment plans
- DM 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 you in creating an individual plan of care.
- CPGs are available on the secure provider website (login is required). CPGs can also be requested at any time.
Receive feedback on your patents between appointments
- You can access Patient360 to obtain feedback on your members regarding their care plans and condition management while enrolled in DM.
How can I refer a member to DM
To refer a member, fax a completed Disease Management Referral Form to 1-888-762-3199 or send via Availity.
How to contact us if you have questions
Hours of Operation
DM case managers are registered nurses and are available from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day. The 24/7 NurseLine is available 24 hours a day, 7 days a week for our members.
Please call 1-888-830-4300 to reach a DM Case Manager. Your patients can get information about DM program services by visiting our Anthem provider website or calling 1-888-830-4300.
Provider rights and responsibilities
As a participating provider with patients enrolled in a DM program, you have additional rights and responsibilities.
You have the right to:
- Obtain information about DM, including programs and services, our staff and their qualifications, and any contractual relationships.
- Decline to participate in or work with DM programs and services for our members, if contractually possible.
- Be informed on how DM coordinates our disease management-related interventions with treatment plans for individual patients.
- Know how to contact the person responsible for managing and communicating with your patients.
- Be supported by DM when interacting with patients to make decisions regarding their healthcare.
- Receive courteous and respectful treatment from DM staff.
- Communicate complaints to DM regarding disease management as outlined in the Provider Complaint and Grievance Procedure.
The rights and responsibilities are available in the provider manual and on the provider web portal.
The Clinical Practice Guidelines (CPGs) for the following chronic conditions are available in the Resource area of the secure provider home page. Login is required. CPGs can be requested at any time.
Disclaimer: Our DM department and disease management programs do not advertise, market or promote specific products or services to members or providers, nor do they have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.