Population Health Management (PHM) is a more holistic approach that prioritizes prevention and management of disease conditions. Anthem is committed to maintaining or improving the physical and psychosocial well-being of our members by delivering the highest quality care and providing tailored health solutions. The programs include:
Future Moms
As part of Anthem’s health and wellness strategy, we offer Future Moms, our maternity program for routine to high-risk maternity cases. The Future Moms program offers care and treatment leading to overall healthier outcomes for mothers and newborns. The program helps expectant mothers to focus on early prenatal interventions, risk assessments and education. The clinical structure consists of nurse care managers who are supported by pharmacists, registered dietitians, social workers, and medical directors. The participant’s unique situation determines the frequency of contact. Participation in the program is voluntary and thus considered an opt-out program.
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. BHF leads to overall healthier outcomes for mothers and newborns. In addition to proving education content, tools, and resources from pre-conceptions through parenthood, the program helps expectant mothers to focus on early prenatal interventions, risk assessments and education. The clinical structure consists of nurse care managers who are supported by pharmacists, registered dietitians, social workers, and medical directors. The participant’s unique situation determines the frequency of contact. The program for maternity uses a voluntary opt-in model.
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.
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 4-6 weeks after delivery. The list also includes the recommended schedule for prenatal, postpartum, and well infant checkups.
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. Participation in the program is voluntary and thus considered an opt-out program.
Preventing Hospital Readmissions with the 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. Participation in the program is voluntary and thus considered an opt-out program.
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. Participation in the program is voluntary and thus considered an opt-out program.
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 member with accessing appropriate levels of care, and improving 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 member. Program involvement is voluntary, and a member can opt out at any time.
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 percent 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. Participation in the program is voluntary and thus considered an opt-out program.
Informing Members
Members receive information regarding the PHM programs offered by the Plan through a variety of methods. These include health plan website, phone calls, and mailings. General information regarding programs is available for our members through member newsletters, which are distributed annually. Further descriptions of care management programs are also available on the Anthem websites.
Supporting Providers through Tools and Education
Anthem is addressing health disparities through evidence-based research, robust analytics and program design, innovative strategies, and caring solutions. We have also created programs that help medical practices address the special needs of diverse audiences.