Condition Care (CNDC) is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.
The mission of the CNDC Department is to improve the health and quality of life for our members by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.
CNDC 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 listed below are eligible for CNDC services.
- Bipolar disorder
- Chronic obstructive pulmonary disorder (COPD)
- Congestive heart failure (CHF)
- Coronary artery disease (CAD)
- Major depressive disorder — adult
- Major depressive disorder – child/adolescent
- Substance use disorder
Resources for working with diverse patients
Wellpoint offers resources to support your diverse patient panel on the provider website.
Condition Care aims to:
- Address gaps in care
- Improve the understanding of disease processes
- Improve the quality of life for members
- Support collaboration to develop member-centered goals and interventions
- Support network provider relationships with members
- Increase network provider awareness of CNDC programs
- Reduce acute episodes requiring emergent or inpatient care
- Identify social determinants of health and address by referring members to appropriate community resources
Our programs feature:
- Proactive population identification processes
- 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 to healthy behaviors and compliance or monitoring, and care management for high-risk members
- Ongoing communication with primary and ancillary providers regarding patient status
Nine of our Condition Care programs are NCQA accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
Our CNDC programs do not advertise, market or promote specific products or services to members or providers. They do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
What are the benefits of collaborating with CNDC?
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 CNDC.
Collaborative treatment plans
Condition Care invites your input for patient treatment plans. We provide you with CNDC information and the most up-to-date Clinical Practice Guidelines to assist you in creating an individual plan of care for your patient.
Receive feedback on your patients
Providers can access Patient360 to obtain feedback on their patients regarding their care plans and condition management while enrolled in our program.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Prior Authorization lookup tool
- Prior Authorization requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)