Introduction | Prevention | Utilization Management | Disease Management | Case Management | Health Education Resources

Disease Management
Smart choices for healthy living.

Employees with chronic diseases make up about 10% of your population but can account for 70% of your total health care costs.* And half of these employees do not comply with their treatment plans. Because so many health problems related to chronic diseases are preventable if caught early, one of the most effective ways to keep costs down is to encourage your employees to make healthier lifestyle choices and follow their doctor’s treatment plan. Our Disease Management programs teach employees how to self-manage:

• Asthma
• Diabetes
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Coronary artery disease.

In addition, self-insured employer groups have the opportunity to purchase additional Disease Management programs that meet their workforce's specific needs. Contact your account representative for more information.

Identification

Disease Management participants are identified through claims and pharmacy data, physician referrals, case management nurse referrals, self referrals, as well as our MyHealthProfile risk assessment and Healthy Lifestyle Coaching programs.

How Does Disease Management Work?

Once enrolled,** predictive modeling and risk stratification are used to identify and provide employees with the right level of individualized intervention based on their risk factors.

Supported by a state of the art information technology system, our nurses are able to help employees with chronic diseases follow recommended testing and exams, understand medication regimens and improve the employee’s ability to care for themselves. Our disease management programs can refer employees with serious conditions to our case management program.

Components of the disease management program include:

• Welcome packet and call
• Regular phone calls that provide assessments and coaching
• Care reminders
• Action plans
• Targeted educational materials
• Disease newsletters
• Opportunities for employees to call nurses if they have questions.

For more information on CareEssentials, please contact your CareFirst BlueCross BlueShield representative.

*Berk, Marc L. and Alan Monheit, “The concentration of Health Expenditures Revisited”, Health Affairs, Vol. 20. No. 2 (March/April 2001)
** Disease Management programs are available for additional fees if the account is self-insured.