Disease Management
Each month, Community Health Plan of Washington runs a special computer program that looks at patient records (claims, provider visits, and pharmacy) to find people who qualify for disease management. The program looks for patients at high risk for diabetes, asthma, and hypertension. The members who are at the highest risk are enrolled in disease management to find out if they need extra help with their health care.
There are some other ways we find high-risk patients who might qualify for disease management:
- We look at the results of the health risk appraisals (HRAs) that all Medicare Advantage members take. If a member of another program (such as Basic Health or Healthy Options) gets a diagnosis related to diabetes, asthma, or hypertension, we send the member an HRA and look at the results.
- We look at data collected by utilization management and case management.
- At daily rounds of hospital patients, Community Health Plan refers patients to disease management if their conditions are related to diabetes, asthma, or hypertension. At daily rounds, case managers tell us if they see such patients.
- Members may refer themselves and providers may refer patients directly to disease management.
For more information about Disease Management, see:
- Disease Management Guidelines
- How Disease Management Works With Your Patients
- How to Use Disease Management Services
- Disease Management Referral Form
Diabetes Management
Asthma Management
Hypertension Management
Community Health Plan Basic Health and Washington Health Program members get free access to the health risk assessment tools and rich health information of WorldDoc 24/7 Personal Health Management System. You are welcome to log on and use these resources if you are a member.