Health Net's Disease Management - Be In Charge! program follows the NCQA best practice four step model of population identification, stratification, education, and intensive coaching for high-risk members. Services are excluded for members with certain conditions and diagnosis and conditions such as:

• Gestational Diabetes
• High Risk Pregnancy
• Hospice and/or no longer receiving curative care

Data from multiple sources is integrated to identify members who may benefit from disease management. The report used to identify members for disease management includes, but is not limited to:

• Member prioritization report - member screening information and other existing data is included in the Disease Management Prioritization Report, which leverages seven core Disease Management Conditions in combination with the CM implacability model.
• These seven conditions include diabetes, asthma, COPD, heart failure, coronary artery disease (including hypertension and ischemic heart disease), lifestyle (obesity and tobacco use).
• Screening for Depression is part of the Disease Management/Health Coaching initial assessment, and the member is referred to a specialist if an intervention is indicated.

*Adult programs only

Materials are tailored to the diverse clinical, cultural and linguistic needs of Medi-Cal members.

Health Net mails educational materials, an action plan, information about the program, and contact numbers for the Health Net Nurse Advice Line and disease management program to members enrolled in the Disease Management - Be In Charge! program. Health Net conducts outbound telephonic interventions and referrals to complex case management for members identified as being at high risk for hospitalizations or poor outcomes. Members also have access to the Health Net Health Education Department. Providers can also refer a member for complex case management by using the Care Management Referral Fax Form – Medi-Cal (PDF), Care Management Referral Fax Form – Community Health Plan of Imperial Valley (PDF) or Care Management Referral Fax Form – CalViva Health (PDF) members.

Twice a year, Health Net sends primary care physicians (PCPs) lists of their Health Net, Community Health Plan of Imperial Valley or CalViva Health members enrolled in the disease management program and each member's risk category following identification and stratification activities.

Providers should contact the Health Net Health Education Department when referring members who have asthma, diabetes or heart failure, and are not currently in the program. Members may also self-refer into the program or may opt out of this program at any time by contacting the Health Education Department.

For Medi-Cal members with diabetes under age 21, all related diabetes care, including medications and case management services, is arranged by California Children's Services (CCS). Health Net's health assessment coordinators and utilization management nursing staff work with providers and members to make sure that appropriate CCS referrals are made for all type 1 and type 2 diabetic members. CCS has its own network of providers. To access case management services and obtain authorization for services, providers must submit a Service Authorization Request (SAR) to the county CCS program. Diabetic members under age 21 are not included in Health Net's disease management program.

Medi-Cal members under age 21 with a chronic pulmonary condition that causes significant reduction of lung volume or anatomical morphology, such as bilateral pulmonary dysplasia, receive care arranged by CCS. The care includes medications and case management services through CCS' network of providers. Members with asthma under age five are not included in the Disease Management - Be In Charge! program.