Blue Choice

South Carolina Healthy Connections

DM Programs and Usage Tips

Program Features:

  • Proactive population identification processes.
  • Chronic disease care gap identification.
  • Evidence-based national practice guidelines.
  • Collaborative practice models, including physicians 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.

Who is Eligible?

All BlueChoice HealthPlan Medicaid members with these diagnoses are eligible for disease management services:

  • Asthma
  • Bipolar disorder
  • Coronary artery disease (CAD)
  • Congestive Heart Failure (CHF)
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • HIV/AIDS
  • Hypertension
  • Major depressive disorder (MDD)
  • Schizophrenia
  • Substance use disorder

We identify members through continuous case finding efforts, including, but not limited to, welcome calls, claims mining and referrals.

Pulmonary

Our asthma and COPD disease management (DM) programs identify and place members into risk groups. Based on these risk groups, the program provides specific interventions. This includes printed information, durable medical equipment (DME) as needed, home health instruction, and/or community asthma and COPD programs and self-management education. We also make follow-up calls to the member/guardian/PCP on a routine basis to determine the need for further intervention.

Cardiac

Our CHF, CAD and hypertension DM programs identify and place members into risk groups. These programs provide specific interventions, such as printed information, one-on-one education from a nurse and DME as needed. We make follow-up calls to the member/PCP on a routine basis to determine the need for further intervention.

Behavioral Health

Our DM program for members diagnosed with MDD, bipolar disorder, schizophrenia and substance use disorder helps them get the most benefit from their health care. We allocate appropriate health plan resources to the care and treatment of members with behavioral health issues. We also enhance the capabilities of the network physicians to manage their patients with these disorders. We make follow-up calls to the member/PCP on a routine basis to determine the need for further intervention.

Diabetes

Our diabetes DM program identifies and places members into risk groups. The program provides specific interventions, such as printed information, one-on-one education from a nurse certified as a diabetes educator, home health instruction and community-based diabetes classes. The diabetes program also coordinates endocrinology referrals for members, as needed. We make follow-up calls to the member/PCP on a routine basis to determine the need for further intervention.

HIV/AIDS

Our HIV/AIDS DM program identifies and places members into risk groups. The program provides specific interventions, such as printed information, one-on-one education from a nurse and coordination of care. We make follow-up calls to the member/PCP on a routine basis to determine the need for further intervention. 

If you would like further information on any of our programs, please contact us.

Maximize Your Time

As a valued provider, you can refer your patients who could benefit from education or care management.

Get Help with Treatment Plans

In order to assist in managing patients, we request your input for patient treatment plans. We provide disease management information and the most up-to-date clinical practice guidelines (CPGs) to help you create an individualized plan of care.

Receive Feedback on Patients

You’ll receive feedback on patients enrolled in disease management (DM) programs in member status letters, care plans and telephone communications. Feedback includes assessments of how well the condition is being managed, adherence to treatment plans, patient goals, and psychosocial and safety issues. We provide feedback weekly, monthly, quarterly, annually or as needed, based on the severity of the member’s condition.