CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT

Transcription

1 CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT HEALTH SERVICES AND PROGRAMS The Plan s Health Promotion and Disease Management Department seeks to improve the health and overall well-being of our members by offering health education and health management programs to educate, inform and encourage self-care. Our services are customer-focused and customer-driven, with the goal of increasing awareness and care for the early detection and treatment of disease. We offer health education materials and services to all eligible Anthem members, as appropriate. Promoting Good Health One way to help promote good health is to prevent illness whenever possible. That s why Anthem covers routine health screenings and immunizations. Additionally, our health promotion programs provide members with guidelines, reminders, information and encouragement to stay well and healthy. They may receive: Information about health issues Flu Shot Reminders Health screening reminders, such as breast and cervical cancer screenings Chapter 17: Page 1

2 Helping Optimize Health Anthem offers health promotion and disease management programs to help members who have asthma, Congestive Heart Failure, Diabetes and other chronic illnesses. Through these programs, we: Educate members about adopting healthy lifestyles Encourage members to follow recommended health guidelines Remind members to work closely with their physicians Provide Doctors with national medical guidelines which can help them design patient treatment plans We first introduce new members to our health services and programs through a new member packet, with information presented in an easy-to-read format. We include preventive health guidelines and a Member Services Guide that includes information on how to access health education services by calling our Member Customer Service at We then use a variety of methods to communicate health services information to members, including: PCPs who refer members to available and applicable programs Telephone calls (outbound and inbound) Written materials Direct mailings Participation in health fairs and community events Our website For a detailed description of any of our programs and member materials, refer to our website at Chapter 17: Page 2

3 How to Get Health Education Materials for Your Office We supply providers with health education materials developed to meet our members cultural and linguistic needs. To request health education materials, contact the Chronic Disease Management Program Department at Chapter 17: Page 3

4 24-HOUR NURSE ASSIST LINE How the Nurse Information Line Assists Members The 24-Hour Nurse Assist Line, a 24-hour health information line staffed by registered nurses, is available to all members 24 hours a day, 7 days a week, to help with health-related questions. The 24-Hour Nurse Assist Line phone number is Members can contact this area for: Assistance with self-care information (symptoms, medications and side effects, reliable self-care home treatment information) After-hours access to telephone and emergency sign language interpreters The nurses at MedCall have access to a telephone interpreter service for callers who do not speak English. All calls are confidential. How the 24-Hour Nurse Assist Line can help Providers After regular business hours, providers can call 24-Hour Nurse Assist Line, to request telephone interpreters. Chapter 17: Page 4

5 PREVENTIVE CARE PROGRAMS The Plan developed preventive care programs to help promote and maintain good health for members, and to remind members about the importance of regular checkups. Providers are an integral part of these programs. Although the programs target different needs, they all share the same goal helping members to live healthier lives. An ounce of prevention is worth a pound of cure. At Anthem, we take this old adage seriously. We understand that prevention, in the form of preventative medical practices, may help our members maintain optimal health. That's why Anthem supports preventive health services based on guidelines recognized by organization such as the U.S. Preventive Services Task Force. These include physician guidelines for: Well Visits Health Screenings Immunizations Disease Management Counseling Interventions Why do we care about preventative health services? Because, at Anthem, our mission is to improve the health of the people we serve. Chapter 17: Page 5

6 Provider Responsibilities The following are the responsibilities of providers that help members maintain healthy lifestyles: Document all health care screenings, immunizations, procedures, health education and counseling in the member s medical record Schedule appropriate Preventative Health Services, including exams, immunizations and tests according to the Preventative Health Guidelines listed on our website at While the services are considered non-covered by the Plan, Providers should still encourage their patients to visit a dentist and optometrist regularly. Well Woman Program Our Well Woman Program encourages women to have regular cervical and breast cancer screenings. The program reminds and encourages women to call their PCP to make an appointment for scheduled screenings. Physician Care for Women PCP responsibilities for the care of female members include: Informing and referring members for cervical and breast cancer screenings Educating members on the Preventive Care Guidelines for women Scheduling screening exams for members Providers can access the Preventive Health Care Guidelines chapter in this manual. These guidelines are also on our website at Chapter 17: Page 6

7 HEALTH EDUCATION PROGRAMS To assist you in helping members improve and manage their health, the Plan developed several health management programs to address the member s health status and condition. Weight Management Program- Healthy Lifestyles Healthy Weight is a comprehensive weight management program which engages, educates, motivates and supports people in achieving a healthy weight. Healthy Lifestyles Healthy Weight helps each individual member develop a personalized weight management plan tailored to their unique needs, based on their current state of health and risk factors, behaviors and lifestyle, and psychological and preference factors associated with the change process. Healthy Lifestyles Healthy Weight then provides each individual with the support, resources and motivation to successfully reach their healthy weight. Assisting Providers in Addressing the Obesity Pandemic The Plan is committed to addressing the obesity pandemic by assisting providers in screening members for obesity, addressing preventive efforts and instituting appropriate management. Providers should encourage Anthem members to contact their Customer Service area at for information regarding the Healthy Lifestyles Healthy Weight program. For provider tools, visit Chapter 17: Page 7

8 Tobacco Treatment Program Healthy Lifestyles Tobacco Free helps each individual member develop a personalized quit plan tailored to their unique needs, based on their current state of health and risk factors, behaviors and lifestyle, and psychological and preference factors associated with the change process. Healthy Lifestyles Tobacco Free then provides each individual with the support, resources and motivation to successfully achieve their goal to quit. Tobacco Cessation Program The Plan s tobacco cessation program, Healthy Lifestyles Tobacco Free, offers numerous resources and tools to help members who want to quit smoking. This program helps members in any stage of cessation readiness and includes several resources. The Plan offers smoking cessation classes to members at no cost; call the Member Customer Service for more information Smoking cessation clinical practice guidelines are posted online at Provider Assessment of Tobacco Use The following are guidelines for providers to help members quit smoking: Assess members smoking status and offer quick advice about quitting Offer members resources to stop smoking, including our Healthy Lifestyles Tobacco Free program information Providers should encourage Anthem members to contact their Customer Service area at for information regarding the Healthy Lifestyles Tobacco Free program. Chapter 17: Page 8

9 CHRONIC DISEASE MANAGEMENT PROGRAMS The Plan seeks to improve the health and overall well-being of members by offering health management programs that educate, inform and encourage self-care. The Plan designed the following programs to help members learn and follow self-care regimens and treatment therapies for existing medical conditions, chronic diseases or health conditions. Anthem s Asthma Care Program The Asthma Care Program assists Anthem in the identification of members with asthma, ensures the members receive appropriate treatment and assists in the development of an Asthma Action plan for each Member which improves their self-management skills. The program is based on the National Institutes of Health (NIH) and National Heart Lung and Blood Institute (NHLBI) guidelines for the Diagnosis and Management of Asthma ( Plan works collaboratively with providers in the identification, management and treatment of members with asthma. Provider Care for Asthmatic Members Primary Care Physicians (PCPs) are to provide each asthmatic member with ongoing treatment and prescribe medication following the NIH/NHLBI Guidelines for the Diagnosis and Management of Asthma. PCPs should: Assess members for asthma using the NIH risk categories Chapter 17: Page 9

10 Provide each member diagnosed with asthma with a written Asthma Action Plan that describes medication dosage and level of care needed based on peakflow readings Coordinate care with care management, pharmacy, and specialists as needed Document all referrals and treatments related to asthma in the member s medical record Order asthma educational materials by calling our Chronic Disease Management Program Department at or visiting our website at Keep a supply of the information in your office for future patients suffering with the illness/disease. Anthem s Diabetes Care Program We designed our Diabetes Care Program for adults to enhance the care of our members with diabetes. We adopted the clinical practice guidelines from the American Diabetes Association, available on our website, Providers who do not have internet access can request hardcopy of these clinical practice guidelines by calling our Chronic Disease Management Program Department at Provider Care for Diabetic Members PCPs are to provide each diabetic member with ongoing treatment and perform the appropriate physical and laboratory examinations following the Diabetes Care Guidelines from the American Diabetes Association. Providers are required to: Assess and treat members according to the Diabetes Care Guidelines Refer members for appropriate laboratory and screening tests Refer adult members to the Diabetic Care Program, classes and local community agencies, if available. Chapter 17: Page 10

11 Coordinate care management, pharmacy, and specialty care services, as needed. Document all referrals and treatments related to diabetes in the member s medical record Order diabetes educational materials by calling our Chronic Disease Management Program Department at or visiting our website at Keep a supply of the information in your office for future patients suffering with the illness/disease. Anthem s Cardiac Care Program Having a heart condition like coronary artery disease or congestive heart failure doesn't mean members have to stop enjoying life. By following doctor's orders, taking medicine properly, eating right and keeping track of weight, members can optimize their health. Anthem has created the Cardiac Care Program to help them learn how to optimize their health. Cardiovascular Disease: American Heart Association (AHA) Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: ( Congestive Heart Failure: Diagnosis and Management of Chronic Heart Failure in the Adult AHA: ( Provider Care for Members with Cardiovascular Conditions PCPs are encouraged to provide each member with a cardiovascular condition ongoing treatment and perform the appropriate physical and laboratory examinations following the guidelines from the American Heart Association (AHA), the National Institutes of Health (NIH) and National Heart Lung and Blood Institute (NHLBI). Chapter 17: Page 11

12 Providers are encouraged to: Improve quality of care in accordance with the AHA clinical practice guidelines for congestive heart failure and coronary artery disease Promote a patient-physician interactive approach toward cardiovascular care by using action/goal plans, facilitating patient-physician communication and encouraging members to take a more active role in managing their condition Encourage member adherence to physician-prescribed treatment plans Increase member self-management and knowledge of cardiovascular disease, including early detection and management of symptoms Reduce exacerbation of the conditions and secondary complications Refer members to the Cardiac Care Program, classes and local community agencies, when available. Order cardiovascular educational materials by calling our Chronic Disease Management Program Department at or visiting our website at Keep a supply of the information in your office for future patients suffering with the illness/disease. Chapter 17: Page 12