| Providers - West Virginia

Disease Management


Our Disease Management (DM) program is based on a system of coordinated care management interventions and communications designed to assist physicians and other health care professionals manage members with chronic conditions. 

Our mission

The mission of the DM program is to improve the health and quality of life for the members served by encouraging member self-care efforts, coordinating health care education and providing interventions along the continuum of care.  

Objectives

Disease Management aims to:

  • Address gaps in care
  • Improve the understanding of disease processes
  • Improve the quality of life for members
  • Support network provider relationships with members
  • Increase network provider awareness of Disease Management programs
  • Reduce acute episodes requiring emergent or inpatient care

Our programs feature:

  • Proactive identification process
  • Evidence-based clinical practice guidelines from recognized sources
  • Collaborative practice models that include the physician and support providers in treatment planning
  • Continuous self-management education
  • Ongoing process and outcomes measurement, evaluation and management
  • Ongoing communication with providers regarding patient status

Disease Management services include:

  • A holistic, member centered approach to disease management focusing on the needs of the member
  • Motivational interviewing techniques used in conjunction with member self-empowerment
  • DM programs for 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, and substance use disorder 
  • The ability to manage more than one disease to meet the changing health care needs of our member population
  • Weight management and smoking cessation education

Our disease management programs do not advertise, market or promote specific products or services to members or providers.

Who is eligible?

Members diagnosed with the above conditions are eligible for Disease Management services.

What are the benefits of collaboration with Disease Management services

Collaborative treatment plans

Disease management invites your input for patient treatment plans. We provide you with DM information and the most up to date Clinical Practice Guidelines (CPG) to assist you in creating an individual plan of care. CPGs are available on the secure provider website (log in required). CPGs can be requested at any time. 

The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are also available on Availity*. CPGs can be requested at any time.

Review feedback on your patients

Providers can access Patient360 via Availity to obtain feedback regarding their patients’ care plans and condition management while enrolled in DM programs. 

How can I refer a member to DM?

To refer a member, fax a completed Disease Management Referral Form to 1-888-762-3199 or send via Availity.

Hours of operation

Our DM case managers are available 8:30 a.m. to 5:30 p.m. local time.
Confidential voicemail is available 24 hours a day. The Nurse Helpline is also available for our members 24 hours a day, 7 days a week.

Provider rights and responsibilities

You have the right to information about UniCare, including:

  • Provided program and services
  • Our staff
  • Our staff’s qualifications
  • Any contractual relationships
  • How we coordinate our interventions with your patient’s treatment plans
  • How to contact the person who manages and communicates with your patients

You also have the right to:

  • Decline to participate in or work with any of our programs and services for your patients
  • Be supported by our organization when interacting with patients to make decisions about their health care
  • Receive courteous and respectful treatment from our staff
  • Communicate complaints about DMCCU as outlined in the UniCare provider complaint and grievance procedures, which can be located in the Provider Manual

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

Related resources

* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.

Provider tools & resources

Interested in becoming a provider in the UniCare network?

We look forward to working with you to provide quality services to our members.