Condition Care/Clinical Health Promotion

The Condition Care (CNDC) provides services for Healthy Blue 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.

Our mission

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

CNDC services include:

  • A holistic, member-centric approach to CNDC 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 health care needs of our member population.
  • Weight management and smoking cessation education.

Who is eligible?

Members diagnosed with one or more of the conditions listed are eligible for CNDC 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) — adults
  • Major depressive disorder (MDD) — children/adolescents
  • Schizophrenia
  • Substance use disorder (SUD)

How can I refer a member to this program?

To refer a member to the CNDC/PHP, fill out our CNDC Referral Form and email the completed form to CNDC-Provider-Referrals@healthybluela.com.

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 and compliance/ monitoring, care/case management for high-risk members.
  • Ongoing communication with primary and ancillary providers regarding patient status.
  • Nine of our Condition Care 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.

CNDC is designed to:

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

What are the benefits of collaborating with CNDC?

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 CNDC.

 

Collaborative treatment plans

CNDC invites your input for patient treatment plans. We provide you with CNDC 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  via Availity to obtain feedback on your patients regarding their care plans and condition management while enrolled in CNDC.

How to contact us

Email us at CNDC-Provider-Referrals@healthybluela.com anytime or call 1-888-830-4300 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday, to reach a CNDC staff member. Confidential voicemail is available 24 hours a day.

Email us:

CNDC-Provider-Referrals@healthybluela.com.

Clinical Health Promotion Program

Healthy Families Program

This is a program offering families assistance with leading a healthy lifestyle and improving childhood obesity in our members. The Healthy Families Program helps members by providing education, community resources, and individualized plans of care over a six month period. Program offered to members ages 7 to 17.

How can I refer a member to the Healthy Families Program?

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

The Healthy Blue DM department and programs do not advertise, market or promote specific products or services to members or providers.

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

Provider rights and responsibilities

You have additional rights and responsibilities, including 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 your 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 your 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.

A copy of these rights and responsibilities can also be found in the provider manual.

Documents

Provider tools & resources

Interested in becoming a provider in our network?

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