About DM

The Disease Management (DM) department provides services on behalf of Empire BlueCross BlueShield HealthPlus (Empire) members. These services are based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

About DM services

DM services include:

  • A holistic, member-centric approach to DM focusing on the needs of the member.
  • Motivational interviewing techniques used in conjunction with member self-empowerment
  • Disease management programs for:
    • Behavioral health conditions.
    • Substance use disorder.
    • Heart conditions.
    • Diabetes.
    • HIV/AIDS.
    • Pulmonary conditions.
    • Weight management and smoking cessation education.

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 healthy behaviors and compliance/surveillance, and case/care management for high-risk members.
  • Process and outcomes measurement, evaluation and management.
  • Ongoing communication with primary and ancillary providers regarding patient status.
  • Nine of our DM programs are National Committee for Quality Assurance accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.
How can you use DM services?

Maximize your time

As a valued provider who could use some help in following up with patients, you can refer patients with asthma, bipolar disorder, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, HIV/AIDS, hypertension, major depressive disorder in adult and child/adolescent, schizophrenia or SUD. In addition, refer patients who could benefit from additional education or care management.

Get help with treatment plans

In order to assist in managing patients, DM requests your input for patient care plans. Disease management information and the most up-to-date Clinical Practice Guidelines (CPGs) are provided to assist you in creating an individual plan of care.

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 a DM program.

Provider rights and responsibilities

You have additional rights and responsibilities, such as 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.

These rights and responsibilities are available to you in written format upon request to DM by calling 1-888-830-4300.

CPGs on our secure provider website (login is required). They can also be requested at any time.

The Empire DM department and our DM programs do not advertise, market or promote specific products or services to members or providers.

The Empire DM department and our DM programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.