Disease Management

Disease Management

Health Gauge’s condition/disease management program is a holistic approach in assessment of needs, collaboration with the treatment team, care planning and education. The program goals are; to educate and promote members’ self-management skills, coordinate healthcare treatments and engage providers on evidence-based practices and their member’s progress.

Using advanced data analytics, we identify and stratify the highest-cost and highest-risk members who have the greatest probability of being positively impacted by program interventions.

  • Covered Conditions
  • Asthma
  • Diabetes
  • Coronary Artery Disease
  • Congestive Heart Failure
  • Sleep Apnea
  • COPD
  • Opiate Abuse
  • Behavioral Health
  • Chronic (multiple high-cost co morbid conditions)
  • Depression & Obesity (interwoven into all programs as applicable)

Our consultative approach to designing the long-term well-being strategy for CMHA employees and dependents includes three steps:

Step 1: Data analysis of medical claims, DM, RX, HRA, productivity/presenteeism, culture (norms, values, attitudes, peer support and organizational support) needs & interest, and satisfaction surveys.

Step 2: Use the data analysis to draft a strategic and operating plan. The strategic plan includes the overall program mix and goals. The comprehensive evaluation plan is also included in the strategic plan. The operating plan contains measurable objectives as well as clear role delineation and timelines.

Step 3: Use a stratification technique to ensure we provide the right amount of resources to employees at all risk levels – low, moderate and high.

How It Works

  • Referral is received from the member, provider, data analytics and utilization and case management programs
  • Member engagement
  • Assessment of the member's needs
  • Action steps planning
  • Collaboration with the member's provider (this is an ongoing step throughout the program)
  • Ongoing education and support of the member; referral to community services
  • Continue health coaching until goals are met
  • Documentation of outcomes