Disease Management (DM) is a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. Our DM program proactively targets patients with chronic conditions or high cost illnesses who will benefit from effective self-management and evidence-based treatment, leading to improved health status and lower rates of hospitalization.

The patient’s physician providers are an integral part of the case management process. Provider interaction is collaborative and non-confrontational; in most cases the member’s physician providers are encouraged by our involvement. Our nurses utilize their own many years of experience in conjunction with industry leading clinical resources such as Milliman when discussing any possible alternate courses of treatment.

Disease Management Objectives

The core objectives of the BMS CareConnex™ DM module are:

• Encouragement of the patient, and their physician, to take responsibility for managing the chronic illness;
• Reduction of long term healthcare costs by averting or reducing the number of ER visits and hospitalizations;
• Enhancement of the patient’s quality of life;
• Enable patient to experience fewer absences from school or work.

Technical ability.

One clear advantage of BMS CareConnex™ is the technical and multi-faceted DM candidate identification process that is designed for maximum clinical agility, and improved implementation and penetration of the DM program. Following are some highlights:

• BMS AutoTrigger™ is a proprietary software application that filters the entire claims data set on a daily basis and automatically refers appropriate members to a DM nurse. Daily claims data review permits rapid intervention when appropriate.
• The patient may self-refer to BMS CareConnex™ via a secure, web based interface.
• The patient may also self-refer to BMS CareConnex™ via a dedicated, confidential toll-free phone number.

Targeted efforts yield long term results

Individuals with chronic, manageable diseases account for about 20% of the population, yet those individuals incur 80% of the claims. DM is a proactive system, targeting members in the “20%” and focusing on prevention of complications from the disease, thereby maintaining the patient’s good state of health. We offer DM programs for the following chronic illnesses:

• Congestive Heart Failure (CHF);
• Hypertension;
• Chronic Obstructive Pulmonary Disease (COPD);
• Diabetes;
• Asthma;