Population Health Management Programs

Building Healthy Families*

As part of Anthem’s health and wellness strategy, we offer Building Healthy Families (BHF), our end-to-end, digital solution that offers helpful resources from preconception through early parenthood. The BHF program offers 24/7 access to BHF through Sydney web or mobile, to help them connect to useful resources for every stage of their unique journey. Pregnant members receive in-app support from Family Care Coaches.

General Health and Wellness

There are general health and wellness programs offered to members. Below are checklists that may be mailed to members who qualify.

Maternity Checklist

This checklist is for members who are identified as pregnant via claims data. The mailer includes a checklist of key items to keep in mind, such as getting a car seat, enrolling baby into the health plan, returning to work and getting the postpartum check-up within 3-6 weeks after delivery. The list also includes the recommended schedule for prenatal, postpartum, and well infant checkups.

Personal Health Checklist

This checklist provides members with a personalized list of preventive and chronic care screenings that the member needs to complete during the year, as well as medication management tips when appropriate. Members will be encouraged to see a doctor for a yearly check-up, in addition to being provided general preventive care and vaccine reminders.

Complex Case Management*

Case management focuses on the timely, proactive, collaborative, and member centric coordination of services for individuals identified with complex medical conditions. To facilitate linking members with services that meet their needs and achieve their goals, members are identified for the Complex Case Management program via medical and behavioral diagnosis or condition.

Preventing Hospital Readmissions with Post Discharge Management (PDM) and Care Transitions Intervention (CTI) Programs*

These programs provide focused care management services to members who are identified as high risk for readmission. The evidence-based Care Transitions Intervention (CTI) model launched in March 2022 for Commercial/Exchange members over the age of 18. Similar to the PDM program, the CTI model is a post-discharge program with the strategic goal to reduce preventable 30-day hospital readmissions. The CTI program involves coaching members to empower them to better self-manage their health conditions within a 30-calendar day intervention timeframe.

Disease Management*

The Disease Management (Condition Care) Program is designed to help maximize health status, improve health outcomes for members diagnosed with Asthma (Pediatric and Adult), Diabetes (Type 1 and Type 2, Pediatric and Adult), coronary artery disease (CAD), Heart Failure (HF), and Chronic Obstructive Pulmonary Disease (COPD). This DM program was created and developed based on recent versions of nationally accepted evidence-based Clinical Practice Guidelines.

Behavioral Health Case Management (BHCM) Program*

One of the goals of the Behavioral Health Case Management (BHCM) Program is to provide members who have chronic medical conditions with a comprehensive behavioral health case management program to address overall needs, support members to access appropriate levels of care and improve treatment compliance.

Behavioral Health Case Management addresses the needs of members in a medical case management and disease management program who are also struggling with depression or other behavioral health concerns. Medical and behavioral case managers work jointly to support the members. If a member is engaged, then communication is sent to the primary care provider and/or behavioral health provider to support coordination of care.

Behavioral Health Post Discharge Management*

Individuals that see an outpatient Behavioral Health provider promptly after discharge have better continuity of care, fewer readmissions, and better treatment compliance. One of the goals of the BH Post Discharge Management (BH PDM) program is to improve the percentage of members that have a follow up visit with a BH provider within 7 days of discharge from an inpatient psychiatric setting. Follow up visits can be in traditional behavioral health outpatient provider offices, Intensive Outpatient Program settings, Partial Hospital or Residential Treatment Center (RTC) Programs. If a member is engaged, then communication is sent to the primary care provider and/or behavioral health provider to support coordination of care.

Cancer Care Navigator*

This is a member-focused initiative designed to provide specialized member support across the care continuum in alignment with oncology providers. The program aims to simplify the complexities of cancer care, align with care teams, and connect members to the right resources, at the right time. Once members are identified, oncology trained Cancer Care Navigators (CCN) outreach to engage members into the program and to build individualized care plans aimed at helping members adhere to their current treatment plans. Cancer Care Navigators also collaborate with the oncology practice to identify how they can best support the members to help improve patient outcomes and experiences.

Informing Members

Members receive information regarding the PHM programs offered by the Plan through a variety of methods. These include health plan websites, phone calls, and mailings. General information regarding programs is available for our members through member newsletters, which are distributed annually.

*Participation in the program is voluntary and thus considered an opt-out program.