We are dedicated to providing safe, responsible, and quality health care. We coordinate care through our disease management program to improve results.
The program looks for patients at risk for diabetes, asthma, congestive heart failure (CHF), chronic pulmonary disease (COPD) and depression. The members who are at the highest risk are enrolled in disease management to find out if they need extra help with their health care.
There are some other ways we find high-risk patients who might qualify for disease management:
- We look at the results of the health risk appraisals (HRAs) that all Medicare Advantage members take. If a member of another program (such as Apple Health or Community HealthEssentials Plus) gets a diagnosis related to diabetes, asthma, or hypertension, we send the member an HRA and look at the results.
- We look at data collected by utilization management and case management.
- At daily rounds of hospital patients, we refer patients to disease management if their conditions are related to diabetes, asthma, or hypertension. Case managers tell us if they see such patients.
- Members may refer themselves and providers may refer patients directly to disease management.
If you have questions about Disease Management, please contact our Customer Service at 1-800-440-1561 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m. (PST) Monday through Friday.