Disease Management/Population Health program
Who is eligible?
Disease Management/Population Health program case managers must, at a minimum, provide case management to members with the following conditions or statuses. This priority list is not exhaustive, and case management should be offered to members whose health conditions warrant case management services:
- Congestive heart failure (CHF)
- Coronary arterial disease (CAD)
- Hypertension (excluding mild hypertension)
- Chronic obstructive pulmonary disease (COPD)
- High-risk or high-cost substance use disorders (SUD), including opioid use disorders
- Members with co-morbid (PH and BH) conditions
- Children with severe emotional disturbance (SED) and adults with serious mental illness (SMI)
- Children with special healthcare needs
- High-risk pregnancy including members who are pregnant and have a SUD or history of a SUD
- Severe cognitive and/or developmental limitation
- Members with complex conditions such as cystic fibrosis, cerebral palsy, sickle cell anemia, etc.
- Justice involved populations
- Members in supportive housing
- Members with homeless/transient status
The Disease Management/Population Health program includes and addresses the following for each condition:
- Condition monitoring (including self-monitoring and medical testing)
- Adherence to treatment plans (including medication adherence, as appropriate)
- Medical and behavioral health co-morbidities and other health conditions (for example, cognitive deficits, physical limitations)
- Health behaviors
- Psychosocial issues including depression and substance use screening
- Providing information about the patient’s condition to caregivers who have the patient’s consent
- Encouraging patients to communicate with their practitioners about their health conditions and treatment
- Additional resources external to the organization, as appropriate
Our case managers use member-centric motivational interviewing to identify and address health risks, such as tobacco use and obesity, to improve condition-specific outcomes. Interventions are rooted in evidence-based Clinical Practice Guidelines from recognized sources. We implement continuous improvement strategies to increase evaluation, management, and health outcomes.
For more information on our program and how to refer an Anthem member, please visit https://providers.anthem.com/kentucky-provider/patient-care/disease-management.
Your input and partnership are valued. Once your patient is enrolled in the Disease Management/Population Health program, you will be notified by the clinical associate assigned.
We look forward to working with you.
April 2022 Anthem Provider News - Kentucky