Disease Management

Improve Quality and Cost-Efficiency with Health Plus Disease Management

Health Plus Disease Management programs are a useful adjunct to physician care and treatment, and can help members become more self-reliant in the management of their health. Designed to help members improve self-care  and thereby reduce their need for frequent medical intervention, Disease Management involves broad-based educational and public health interventions.

Members Targeted

Those with the following chronic conditions:

• Asthma
• Coronary Artery Disease
• Diabetes
• Depression

Members who participate in Health Plus Disease Management programs are eligible for a variety of plan sponsored interventions. These may include home assessments, educational visits by registered nurses, disease-specific educational materials, and referrals to weight management and smoking cessation programs.

Program Components

Potential participants are identified through various mechanisms, including claims and pharmacy data, new member health risk assessment questionnaires, and provider referrals. When a member is enrolled in a Disease Management program, Health Plus clinical staff will complete additional health risk assessments, based on the severity of the member's condition. In addition, the member will receive individually tailored verbal and written education. Follow-up services can also include educational mailings, DME, home visits, and specialist referrals. Disease Management recommendations are based on established clinical guidelines.

Contact with Provider

The Nurse/Disease Manager periodically sends letters to the PCP with updates on the member’s status, level of compliance, and current health education needs. Recommendations for follow-up intervention are made depending on acuity level. As always, members are encouraged to visit their PCP for care as needed.

How to Refer Members

Providers can refer members for these important services by calling our Provider Care Center at 1-800-450-8753 and pressing 6. Alternatively, the Disease Management referral form can be downloaded here. Once completed, the form should be faxed to 718-360-1314 for medical referrals or to 718-504-7112 for depression referrals.