Condition Care

Our program

 

Our Condition Care (CNDC) program is based on a system of coordinated care management interventions and communications designed to support physicians and other healthcare professionals in managing members with chronic conditions.

 

 

 

Our mission

 

The mission of the program is to encourage member self-management through member education, motivational interviewing to encourage behavior change, collaboration, and providing interventions within a holistic care management model. The program supports short- and long-term behavioral, social, and physical healthcare needs by screening, assessing, and developing tailored interventions while working collaboratively with the member and others involved in their care to help improve access to healthcare.

 

 

 

CNDC services:

 

• A holistic, member-centric approach to condition care 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 healthcare needs of our member population
• Weight management and smoking cessation education

 

 

Eligibility

 

Members diagnosed with one or more of the conditions listed in this section are eligible for CNDC services:

 

• Asthma
• Bipolar disorder
• Coronary artery disease
• Congestive heart failure
• Chronic obstructive pulmonary disease
• Diabetes
• HIV/AIDS
• Hypertension
• Major depressive disorder — adults
• Major depressive disorder — children/adolescents
• Schizophrenia
• Substance use disorder

 

 

Quality of care

 

If you have patients with one or more of the conditions listed, who could benefit from additional education or care management, we encourage you to refer them to CNDC.

 

 

Member referrals

 

Coming soon!

 

 

 

Program features:

 

• Proactive population identification processes
• Evidence-based national practice guidelines
• Collaborative practice models to include physicians and support service providers in treatment planning for members
• Continuous patient self-management education, including primary prevention, coaching related to healthy behavior 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

 

 

CNDC programs are designed to:

 

• Identify members who meet the enrollment criteria for specific programs
• Improve the member's understanding of the disease or condition process
• Promote member self-management through personalized interventions
• Promote collaboration with members and care providers to develop person-centered goals based on the member's level of need
• Address gaps in care
• Reinforce adherence with evidence-based clinical practice guidelines to promote member informed decision making
• Improve a member’s quality of life
• Support relationships between the members and their practitioners and providers
• Increase network practitioner and provider awareness of CNDC programs
• Reduce potentially avoidable acute episodes requiring emergent or inpatient care
• Measure and analyze program effectiveness through various reporting metrics including member and provider satisfaction, participation rates, and use

 

 

 

Collaborative treatment plans

 

CNDC invites your input for patient treatment plans. We provide you with CNDC 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 in Availity Essentials (login is required).

 

 

Contact CNDC

 

Our CNDC case managers are available 8:30 a.m. to 5:30 p.m. local time.  Confidential voicemail is available 24 hours a day.

 

Call:    888-830-4300

 

Email:    Condition-Care-Provider-Referrals@wellpoint.com

 

 

 

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

 

 

 

Disclaimer 

 

Our CNDC programs do not advertise, market, or promote specific products or services to members or providers. We do not have financial ownership arrangements with anyone who advertises, markets, or provides the goods and services we offer.

 

 

The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined on this page are available on Availity Essentials. CPGs can be requested at any time.

 

 

 

Related information

 

Coming Soon!

 

 

Related pages

 

Forms 

 

Case management 

 

Policies, guidelines, and manuals