We provide a wide range of medical management programs designed to support our members at any stage of health. These programs are targeted to specific conditions or are designed to improve or maintain overall health.
The goals of our medical management programs are to:
- Ensure our members receive appropriate care
- Assist our members with managing a limited benefit
Enable us to be responsible stewards of the cost of health care
We apply appropriate dental care management procedures to ensure that treatment provided:
- Is consistent with widely accepted standards of practice
- Could not have been omitted without adversely affecting the patient's condition or quality of care
- Is not primarily for the convenience of the patient, the participating dental provider or any other person
- Is the least costly appropriate treatment and location that can be used safely to treat the patient's condition
Is the appropriate type, level, amount and frequency of care necessary to treat a dental condition or injury that is harmful to the health of a patient
Hypertension, also known as high blood pressure, is a pervasive and costly health condition affecting nearly 47% of U.S. adults. Hypertension can be directly tied to other conditions, such as stroke, heart failure, chronic kidney disease and heart attack.
Three in four adults with hypertension do not have their condition under control, largely due to difficulties in managing blood pressure and adhering to medication regimens. When left uncontrolled, high blood pressure increases the risk of heart disease and stroke by three to four times.
Omada for Hypertension is designed to help members by providing a comprehensive and supportive environment for members to manage their condition. This program offers:
- Personalized care plans: Clinically relevant information and targeted outcomes specific to each member
- Proactive coaching: Focusing on changing behaviors and addressing unmet behavioral health needs associated with lifestyle changes
- Dedicated care team: Assigned health coaches and hypertension specialists who provide guidance and support
- Peer support groups: Virtual groups where members can connect with others facing similar challenges
- Connected devices and tools: Tracking blood pressure and weight (for members with an elevated body mass index BMI) to monitor progress
Omada for Hypertension is part of our cardiometabolic care continuum, suitable for members with both Stage 1 and Stage 2 hypertension. Members are paired with a dedicated health coach and hypertension specialist who focus on leading behavior change through proactive coaching and data-driven insights.
This program is available to ASO groups as a buy-up.
Strive Health is the approved vendor for our kidney health management program, which improves care and outcomes for eligible members with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The program focuses on early detection, proper care and treatment as the most effective approaches to delay the disease’s progression, enabling patients to live better, longer lives. Strive will routinely engage participating members to support their overall health and well-being. Participating members will receive information about dialysis center treatments, in-home dialysis and kidney transplant options.
Note: To ensure best practice and compliance with HIPAA, we have entered into a Business Associate Agreement with Strive. Strive may contact your office to request or share protected health information (PHI) about patients to facilitate these care coordination services and close care gaps. We have authorized Strive to do this, and these requests are permissible without patient authorization under HIPAA.