Condition Care
Our Condition Care team is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.
Condition Care services include:
- A holistic, member-centric approach to condition care* focusing on the needs of the member.
- Motivational interviewing techniques used in conjunction with member self-empowerment.
- Condition Care programs for:
- Behavioral health conditions.
- Substance use disorder.
- Heart conditions.
- Diabetes.
- HIV/AIDS.
- Pulmonary conditions.
In addition, we assist with the management of prenatal cases in high-risk populations.
Our programs feature:
- 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, behavior modification programs and compliance/surveillance, as well as home visits and case management for high-risk members.
- Process and outcomes measurement, evaluation and management.
- Ongoing communication with providers regarding patient status.
Our condition care programs do not advertise, market or promote specific products or services to members or providers.
Our condition care programs do not have any financial ownership arrangements with anyone who advertises, markets, or provides the goods and services we offer.
*Programs offered are subject to change.
How to use Condition Care services
Maximize your time
As a valued provider who could use some help in following up with patients, you can refer patients with asthma, bipolar disorder, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, HIV/AIDS, hypertension, major depressive disorder or schizophrenia who could benefit from education and care management.
Get help with treatment plans
In order to assist in managing patients, we request your input for patient treatment plans. Condition care information and the most up-to-date Clinical Practice Guidelines are provided to assist you in creating an individualized plan of care.
Receive feedback on your patients
Providers receive feedback on members enrolled in condition care programs via member status letters, care plans and telephonic communications. Feedback includes assessment of how well the condition is being managed, adherence to treatment plans, patient goals, and psychosocial and safety issues while enrolled in a condition care program. Feedback is provided weekly, monthly, quarterly, annually or as needed based on the severity of the member’s condition.
Contacting us
Hours of operation
Our case managers — who are licensed nurses and social workers — are available from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day. The Nurse HelpLine is available 24/7 for our members.
Contact information
Please call 1-888-830-4300 to reach one of our case managers. Your patients can get information about Condition Care program services by calling 1-888-830-4300.