Disease Management/Population Health Program and Clinical Health Promotion
The Disease Management/Population Health Program (DM/PHP) is 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 team is to improve the health and quality of life for members by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.
DM/PHP services include:
- A holistic, member-centered approach to condition management focusing member needs 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.
Members diagnosed with one or more of the conditions listed below 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) in adult and child/adolescent
- Substance use disorder (SUD)
How can I refer a member to this program?
To refer a member to the DM/PHP, fill out the DM/PHP Referral Form and email the completed form to DM/PHP-Provider_Referrals@healthybluene.com.
- 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 related by healthy behaviors and compliance/monitoring, and care management for high-risk members.
- Ongoing communication with primary and ancillary providers regarding patient status.
These programs are National Committee for Quality Assurance (NCQA) accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
DM/PHP programs are designed to:
- Address gaps in care.
- Improve the understanding of disease processes.
- Improve the quality of life for members.
- Support collaboration to develop member-centered goals and interventions.
- Support relationships between the member and network providers.
- Increase network provider awareness of Disease Management and Population Health Programs.
- Reduce acute episodes requiring emergent or inpatient care.
- Identify social determinants of health and address by referring members to appropriate community resources.
Benefits of collaboration
- 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/PHP.
- Collaborative treatment plans – DM/PHP 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 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 to obtain feedback on your patients regarding their care plans and condition management while enrolled in our program.
How to contact us
Email us at DM-PHP-Provider-Referrals@healthybluene.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
We offer assistance with weight management, nutrition, and tobacco cessation. The Wellness Program helps members by establishing individual goals and providing support and follow-up over a six-month period. Program offered to members ages 18 and older.
The Wellness Program:
- Combines care management, education and community-based resources to support a healthy lifestyle.
- Assigns a case manager to support the member with motivational interviewing sessions, telephonic coaching, and education-based support measures designed to improve treatment plan compliance and increase healthy choices.
- Allows the case manager to work directly with the member to set realistic and achievable short-term goals for a healthy lifestyle – optimizing success toward long-term goals.
How can I refer a member to the Wellness Program?
To refer a member, fill out our Clinical Health Promotion Program Referral Form and email the completed form to DM-PHP-Provider-Referrals@healthybluene.com.
Contacting The Wellness Program
Call 1-844-421-5661, Monday to Friday, from 8:30 a.m. to 5:30 p.m. CT.
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 your patients.
- Be informed how the organization coordinates interventions with care plans for individual members.
- Know how to contact the care 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.
A copy of these rights and responsibilities can also be found in the provider manual . Our disease management programs do not advertise, market or promote specific products or services to members or providers.
Our disease management programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
Provider Tools & Resources
- Roster Automation Standard Template
- 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
- Policies, Guidelines & Manuals
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
- Quality of Care Form