Condition Care
Our Condition Care program is based on a system of coordinated care management interventions and communications designed to help physicians and other healthcare professionals manage members with chronic conditions.
Mission
The mission of Condition Care program is to improve the health and quality of life for the members we serve. We do this by encouraging self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.
Condition Care services include:
- A holistic, member-centric approach to disease management focusing on the needs of the member through telephonic and community-based resources
- Motivational interviewing techniques used in conjunction with member self-empowerment
- The ability to manage more than one disease to meet the changing health care needs of our member population
- Weight management and smoking cessation education
Who is eligible?
Members diagnosed with one or more of the conditions list below are eligible for Condition Care 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) — adults
- Major depressive disorder (MDD) — children/adolescents
- Schizophrenia
- Substance use disorder (SUD)
How can I refer a member to Condition Care?
To refer a member to the Condition Care, fill out our Condition Care Referral Form and email the completed form to Condition-Care-Provider-Referrals@wellpoint.com.
What are some of the Condition Care features?
- Proactive population identification processes
- Program content is based on evidence-based national practice guidelines
- Collaborative practice models to include physician and support service providers in treatment planning for members
- Continuous patient self-management education, including primary prevention, coaching related by healthy behaviors modification programs and compliance or monitoring, and case management for high-risk members
- Ongoing communication with primary and ancillary providers regarding patient status
- NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care
What are Condition Care programs designed to do?
- Address gaps in care
- Improve member understanding of disease processes
- Improve the quality of life for members
- Collaborate with providers to develop member-centered goals and interventions
- Support relationships between the member and provider networks
- Increase network provider awareness of Condition Care
- Reduce acute episodes requiring emergent or inpatient care
- Identify social determinants of health and address them by referring members to appropriate community resources
What are the benefits of collaborating with Condition Care?
- Quality of care - If you have patients with one or more of the conditions listed above who could benefit from additional education or care management, we encourage you to refer them to Condition Care
- Collaborative treatment plans - Condition Care invites your input for patient treatment plans. We provide you with Condition Care information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist in creating an individual plan of care for your patient.
- CPGs are available on Availity (login is required)
- Receive feedback on your patients between appointments - You can access Patient360 via Availity to obtain feedback on your patients regarding their care plans and condition management while enrolled in Condition Care
How to contact Condition Care
Email us at Condition-Care-Provider-Referrals@wellpoint.com anytime or call 1-888-830-4300, from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday, to reach a Condition Care staff member. Confidential voicemail is available 24 hours a day.
Provider rights and responsibilities
You have additional rights and responsibilities including the right to:
- Obtain information about the organization’s services, staff qualifications and any contractual relations
- Decline to participate in or work with the organization’s programs and services on behalf of their patients
- Be informed how the organization coordinates interventions with care plans for individual members
- Know how to contact the case manager responsible for managing and communicating with their patients
- Be supported by the organization when interacting with members to make decisions about their healthcare
- Receive courteous and respectful treatment from the organization’s staff
- Communicate complaints to the organization