Population Health's Disease Management

Members can access quarterly newsletters online to learn about their health plan benefits, special programs they may qualify for, medical news and more.

Eligible members receive:

• Education materials emphasizing self-management strategies for healthy behaviors like accessing health care services, maintaining collaborative relationships with providers, maintaining a healthy weight, being tobacco-free and self-monitoring
• Introductory packages upon enrollment in the program that provide information about availability of nurse coaching

This program:

• Offers a continuum of targeted intervention — education and enhanced access to services intended to encourage member self-management
• Supports members through screenings, assessments and tailored interventions
• Sends eligible members condition-specific education materials addressing:
  • Information about their primary diagnoses
  • Self-management strategies
  • Medication adherence
  • Coordination of services

By using these tools and working with a case manager, the member’s behavioral, social and physical health care needs are addressed.

Once identified from enrollment as pregnant, members are stratified as low-, medium-, high- or urgent-risk OB based on responses to screeners and are provided varying levels of support based on clinical risk factors.

All identified pregnant members, regardless of stratification level, have access to prenatal and postpartum educational materials, as well as information about incentives, to encourage mothers to make and keep prenatal and postpartum appointments. All pregnant members have access to Wellpoint on Call, our 24/7 Nurse HelpLine. We track and report Taking Care of Baby and Me® mailings, as well as members’ utilization of incentives.

Members enrolled in any Population Health Disease Management program are also eligible at any time for care coordination. Members may benefit from care coordination services when they have short-term, immediate, targeted needs and do not require complex case management services. Additionally, members with more intensive needs appropriate for complex case management who refuse those services may be appropriate for care coordination services.

Members may receive various interventions, including:

• Assistance with resources like transportation and pharmacy benefits
• Arranging PCP appointments
• Telephonic contact for coaching
• Mailings of disease-specific education materials
• Information regarding Wellpoint-on-Call (physicians available 24 hours a day, 7 days a week for consultation and advice)

We administer an initial health risk assessment to members identified for the Complex Case Management program. The case manager assesses the member’s total health care needs in a holistic manner, including physical, behavioral, functional, cognitive and social factors — This includes a gap analysis to determine health care needs and prioritize goals. Once needs are identified, the case manager works with the member and health care provider(s), family and caregiver(s) to develop interventions to achieve identified goals.

Examples of interventions include:

• Health education
• Interpretation of benefits
• Community resource referrals
• Post-discharge service authorizations and member outreach (for example, DME, home health services and coordination of physician appointments)
• Service coordination
• Medication reconciliation review
• Assistance to develop a self-management plan
• Community-based services (for example, home or hospital visits)
• Provider-based intensive case management (behavioral health)
• Special needs program interventions
• Ongoing assessment of barriers to meeting goals or complying with the care plan and interventions to address those barriers