According to Department of Health Care Services (DHCS) contractual requirements, disease care management for Medi-Cal is provided for two chronic disease states: diabetes and asthma. These are not refer-in programs. Members are identified for inclusion in these programs twice per year, using Healthcare Effectiveness Data and Information Set (HEDIS®) definitions of asthma and diabetes. Stratification into two risk categories occurs, identifying "red" or high-risk members for outbound telephonic case management, and "green" or low-risk members who have not sought care through an emergency department or inpatient setting in the previous 12 months. The low-risk members receive annual mailings, including instructional booklets and other tools to make encourage monitoring and initiation of a care plan with their primary care physician (PCP). McKesson Health Solutions provides case management functions by telephone for these two programs, and completely controls identification, stratification, mailings, and telephonic intervention with the asthma cohort.

Episodic care management involves treating a specific episode of a member's care that occurs following a specific set of events or diagnoses. Episodic care management usually involves the use of specialists, discharge planners and concurrent review nurses, in addition to the primary care physician (PCP) . Episodic care management is performed by the Health Net Health Services Department, the responsible affiliated health plan's UM department or a participating physician group (PPG) with delegated utilization management functions.