Harvard Pilgrim identifies specific populations (i.e., members with asthma, diabetes, etc.) for enrollment in its Disease and Health Risk Management programs. These programs aim to improve the medical care and self-management of our members with these conditions.
Disease and Health Risk Management programs are population-based, evidence-based systematic approaches to improving care and are available to all members with relevant diagnoses. Members are identified through algorithms based on medical and/or pharmacy claims, and laboratory results, as well as health risk appraisal results, referrals by providers and self-referral.
Program components include:
- Clinical practice guidelines for effective care
- Patient identification and outreach
- Identification of high-risk patients for care management
- Patient education in managing their condition in order to reduce adverse outcomes and maximize quality of life
Current disease and health risk management programs include:
Disease and condition management programs
Health & prevention programs
To refer a patient to a Care or Disease Management Program, call