The Anthem Condition Care Program, also known as the Population Health Program, is a structured system designed to provide coordinated care management and communication. It’s specifically created to help doctors and other healthcare professionals in managing patients with chronic conditions more effectively.
What is the Anthem Condition Care Program?
The core mission of the Anthem Condition Care/Population Health Program (CNDC/PHP) is to enhance the health and overall quality of life for its members. This is achieved by actively encouraging members to engage in self-care practices, facilitating access to vital healthcare education, and delivering targeted interventions throughout their care journey. The program takes a holistic, member-centered approach, prioritizing individual needs through both telephone-based support and readily available community resources.
Key services offered by the Anthem Condition Care Program include:
- Member-Centric Care: A comprehensive approach that puts the member at the heart of the care process, utilizing both telephonic support and community-based resources to address their unique needs.
- Motivational Interviewing: Employing proven motivational interviewing techniques to empower members in taking an active role in their own health management and self-care.
- Multi-Disease Management: Providing the capability to manage multiple health conditions simultaneously, recognizing the complex and evolving healthcare needs of our diverse member population.
- Education and Support: Offering vital education on weight management and smoking cessation, equipping members with the knowledge and tools for healthier lifestyles.
Who Can Benefit from the Program?
The Anthem Condition Care Program is available to members who have been diagnosed with one or more of the following health conditions:
- Asthma
- Bipolar disorder
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF)
- Coronary Artery Disease (CAD)
- Diabetes
- HIV/AIDS
- Hypertension
- Major Depressive Disorder (MDD) for children, adolescents, and adults
- Substance Use Disorder (SUD)
- Schizophrenia
How to Access Anthem Condition Care?
Referring a member to the Condition Care program is a straightforward process. To initiate a referral, simply complete the Condition Care/Population Health Referral Form and send the completed form via email to [email protected].
Key Benefits of Anthem Condition Care Program
The Anthem CNDC/PHP is thoughtfully designed to deliver significant improvements in member care and health outcomes. The program aims to:
- Close Care Gaps: Proactively identify and address any gaps in the care members are receiving, ensuring comprehensive support.
- Enhance Disease Understanding: Improve members’ understanding of their specific disease processes, empowering them to make informed decisions about their health.
- Improve Quality of Life: Ultimately enhance the overall quality of life for members living with chronic conditions through tailored support and resources.
- Foster Collaborative Care: Support strong collaboration between members and their healthcare providers to establish shared goals and effective intervention strategies.
- Strengthen Provider-Member Relationships: Build stronger relationships between members and their network of healthcare providers for more coordinated and patient-centered care.
- Increase Program Awareness: Enhance awareness among network providers about the valuable resources and support offered through CNDC programs.
- Reduce Acute Episodes: Minimize the occurrence of acute health episodes that may necessitate emergency or inpatient care through proactive management.
- Address Social Determinants of Health: Identify and address social factors that impact health by connecting members with appropriate community resources and support systems.
Program Features Designed for Your Well-being
The Anthem Condition Care Program incorporates several key features to ensure effective and patient-centered care:
- Proactive Identification: Utilizes a proactive process to identify eligible members who could benefit from program services.
- Evidence-Based Guidelines: Employs evidence-based clinical practice guidelines from trusted sources to ensure the delivery of high-quality, effective care.
- Collaborative Practice Models: Implements collaborative practice models that involve physicians and support-service providers in developing comprehensive treatment plans tailored to each member’s needs.
- Continuous Self-Management Education: Provides ongoing patient self-management education, including primary prevention strategies, health behavior modification coaching, compliance support, monitoring, and dedicated case/care management for high-risk individuals.
- Ongoing Provider Communication: Maintains consistent communication with primary and specialist providers regarding member status, ensuring a coordinated care approach.
- NCQA Accredited Programs: Features nine National Committee for Quality Assurance (NCQA) accredited programs, which integrate outreach, education, care coordination, and follow-up to improve treatment adherence and enhance self-care capabilities.
