Case and Disease Management Programs

We offer case and disease management programs that support your treatment plans and help members manage their conditions. Using medical, pharmacy and behavioral health claims data, our predictive model systems help us identify members who are at high risk for certain health issues. With this information we’re able to direct them to our programs.

Patients can also be identified at the time of hospital discharge through one of the following:

• Health risk assessment
• Readmission predictive model
• NurseLine referral
• Member or caregiver referral

Please help us identify members

A critical part of these programs is identifying high-cost, complex and at-risk members who can benefit from these services. If you have patients, who are UnitedHealthcare members, that would benefit from case or disease management, you can refer them to the appropriate program by calling the number on the back of the member’s health insurance ID card.

More about case management

Some examples of these programs include transplant and neonatal resource services. We collaborate with members and their health care providers to facilitate health care access and decisions that can have a dramatic impact on the quality and affordability of their health care.

Specifically, our programs are designed to assist in helping ensure that members:

• Receive evidenced-based care
• Have necessary self-care skills and/or caregiver resources
• Have the right equipment and supplies to perform self-care
• Have requisite access to the health care delivery system
• Are compliant with medications and the physician’s treatment plan

Our case managers are registered nurses who engage the appropriate internal, external or community-based resources needed to address members’ health care needs. When appropriate, we provide referrals to other internal programs such as disease management, complex condition management, behavioral health, employee assistance and disability.

Upon referral, each member is assessed for the appropriate level of care for his or her individual needs. Programs vary depending on the member’s benefit plan. Case management services are voluntary and a member can opt out at any time. 

More about disease management programs

We offer disease management programs that are designed to provide members with specific conditions and the appropriate level of intervention.

Depending on the member’s health plan and benefit plan design, the management required for these conditions varies and may include:

• Acute myocardial infarction
• Asthma
• Cancer
• Chronic obstructive pulmonary disease
• Congenital heart disease
• Coronary artery disease
• Diabetes
• Heart failure
• Hemophilia 
• High-risk pregnancy
• Kidney disease

Our disease management programs include:

• Screening for depression and helping members access the appropriate resources
• Addressing lifestyle-related health issues and referring to programs for weight management, nutrition, smoking cessation, exercise and stress management
• Helping members understand and manage their condition and its implications (e.g., diabetes care)
• Educating on how to reduce risk factors, maintain a healthy lifestyle and adhere to treatment plans and medication regimens

For some programs, members may receive:

• A comprehensive assessment by specialty-trained registered nurses to determine the appropriate level and frequency of interventions
• Educational mailings, newsletters and tools, such as a HealthLog, to assist them in tracking their physician visits, health status, self-measurements, laboratory results and recommended targets or screenings
• Information on gaps in care and encouragement to discuss treatment plans, goals and results with the physician
• Transitional case management when discharged from a hospital, if they are high risk
• Outbound calls to address particular gaps in care – for the highest-risk individuals. Care providers will be notified when patients are identified for the high-risk program.

Physicians with patients in moderate-intensity programs also may receive information on their patient’s care opportunities.

These programs complement the physician’s treatment plan, reinforce instructions you may have provided and offer support for healthy lifestyle choices.