If you (or a covered dependent) are suffering from a chronic health condition, the Disease Management Program can help. Provided through Boon-Chapman, the program provides information and resources you can use to better manage chronic conditions. The program is free of charge to active participants of the PPO medical plans.

What is a chronic condition?

A chronic condition usually requires regular or periodic visits to a provider for treatment, continues over an extended time (usually three months or more), and may cause episodes of incapacity or continued incapacity. The common chronic conditions covered by the Disease Management Program are:

  • Asthma

  • Coronary artery disease

  • Congestive heart failure

  • Diabetes

  • High blood pressure

About the Disease Management Program

The program integrates clinical physician care, assessment information, claims and pharmacy data to identify participants with certain medical conditions and provide some level of case management or intervention, along with incentives for participation and reaching certain milestones. With dual goals of improving your health and helping hold down costs, the program strives to:

  • Achieve consistency in long-term management

  • Improve participant’s understanding of his or her condition

  • Increase provider awareness and participation

  • Initiate earlier collaboration between the medical plan and physician

  • Promote improved compliance with treatment protocols

  • Monitor participant condition, including consideration of other health conditions and lifestyle issues

  • Reduce emergency room/inpatient admissions

The program is founded on clinical practice guidelines from nationally recognized sources such as the American Diabetes Association.

Disease Management Program incentives

If you qualify for the Disease Management Program (based on prior medical claims, prescription drug utilization and/or risk factors identified in the Wellness Program), you may be eligible for certain incentives. Incentives are based on the severity of the condition.

  • $50 incentive when you participate in a baseline assessment (performed by a registered nurse)

  • $25 incentive for each milestone completed (continues as long as you qualify to receive them)

  • Baseline assessment: Comprehensive medical and psychosocial evaluation (30 minutes to one hour)

Milestone assessments:

  • High-intensity assessment (every three months)

  • Moderate-intensity assessment (every six months)

  • Low-intensity assessment (every 12 months)

Disease Management Enhanced Diabetic Incentive

$150 incentive exists for diabetics enrolled in the Disease Management Program. The incentive is payable if the participant meets the following qualifications and is in addition to any other incentives. This incentive, as with all other Disease Management incentives, is authorized by the Disease Management nurse. Requirements include:

  • A 1 C test every 3 to 6 months

  • Yearly lipid panel

  • Yearly micro albumin urine test

  • Yearly comprehensive foot exam

  • Yearly dilated eye exam

  • Monitor glucose at home

If you have any questions regarding the Disease Management Program, please contact Boon-Chapman (Prime Dx) or call at 1-800-477-4625.