Disease Management / Population Health and Clinical Health Promotion
The Disease Management/Population Health Program (DM/PHP) 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.
The mission of the DM/PHP 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.
DM/PHP services include:
- A holistic, member-centric approach to DM 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 DM/PHP services:
- Bipolar disorder
- Coronary artery disease (CAD)
- Congestive heart failure (CHF)
- Chronic obstructive pulmonary disease (COPD)
- Major depressive disorder (MDD) — adults
- Major depressive disorder (MDD) — children/adolescents
- Substance use disorder (SUD)
How can I refer a member to this program?
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 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.
DM/PHP 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 DM 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 DM/PHP?
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 DM.
Collaborative treatment plans
- CPGs are available on Availity (login is required).
Receive feedback on your patients between appointments
How to contact us
Email us at DM-PHP-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 DM/PHP staff member. Confidential voicemail is available 24 hours a day.
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?
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.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)