Disease Management (DM) PATH

Our disease management (DM) PATH program complements the care you provide for our members with chronic conditions such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes, coronary artery disease (CAD) and asthma, by offering them outbound calls and ongoing education. Members who benefit from the program are identified monthly via health risk surveys and laboratory results, as well as utilization management, claims or encounter and pharmacy data. We also identify potential program members from health records, coaching programs and, the care and case management process as well as through self-referral and referrals from you, their doctors and practitioners.

Practitioners are informed of their high risk members enrolled in the DM program. We will work with you to help reinforce adherence to your plan of care by using evidence-based clinical practice guidelines to emphasize how members can prevent complications and flare-ups of chronic conditions.

The DM PATH program provides interventions based on assessments. Services include:

• One-on-one telephonic health coaching and monitoring based on a care plan created by a registered nurse and other health care staff. The plan is tailored to address the members’ physical, behavioral and emotional health and take into account lifestyle and cultural needs.
• Information to make sure your patients understand how to best manage their 
  condition(s). This includes periodically evaluating their health status and sharing that information with you. You are also welcome to contact us to discuss your patient’s current progress.
• EmblemHealth’s quarterly newsletter with the latest information based on current clinical guidelines.
• Educational tools to help patients understand their disease(s), including guidance about:
  

  — Symptom-management
  — Diet and nutrition needs
  — Treatment options
  — Planning for doctor visits

• Coordination of care between members and their practitioners, caregivers and the health plan administrators.
• Access to culturally and language-appropriate community-based support services.
• Evaluation of members’ satisfaction with the program.

Members identified as high risk are enrolled in the program, but can opt out at any time by calling our toll-free line. Members who choose to opt out are also welcome to opt back into the program. Information about the program is available on the EmblemHealth website. It is also available to members in their primary language.

If you have any questions or would like to refer patients to our DM PATH program, please call us at 1-888-881-3112, Monday through Friday, from 9 am to 5 pm.