Clinical Programs - Disease and Condition Management Programs

Disease management programs are available to assist members with chronic conditions to improve self-management skills through education and support from a registered nurse and monitoring with biometric devices, as needed.

Identification and Referral

Eligible members are primarily identified for disease management through medical and pharmacy claims, physician referral or via self-referral. Members can also be identified through their participation in our Complex Care Management program.

Health Management for Chronic Conditions

Condition management is designed for adult members who have one or more of the following chronic conditions:

  • Asthma
  • Diabetes
  • Heart Failure
  • Coronary Artery Disease
  • COPD
  • Chronic Kidney Disease
  • ESRD

Program components include:

  • Personalized care plan promoting self-care, self-reliance and prevention
  • Access to nurses and other members of the health care team
  • Disease-specific educational materials and online self-help tools
  • Education on how to recognize and alleviate warning signs and symptoms of disease
  • Support for complying with physician's plan of care and medications
  • Availability of biometric self-monitoring equipment, as appropriate
  • Education and support regarding diet and/or medication adherence
  • Screening for depression
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