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Disease Management Program Information and Nomination

The philosophy of the Health Net Federal Services, LLC (HNFS) Chronic Care/Disease Management (DM) program is to empower eligible TRICARE beneficiaries to become active partners in their health care to achieve improved health outcomes.

The DM program focuses on improving the management of seven chronic conditions: anxiety, asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, depression and heart failure. Educating eligible TRICARE beneficiaries on disease management and the importance of partnering with the health care team are key parts of the DM program.

The program may include mailings of condition-specific and preventive health education materials, as well as telephone sessions with a Disease Management (DM) specialist.

Beneficiaries likely to benefit from the DM program include those:

  • Interested in gaining knowledge to improve one's health and better manage their DM program-related health condition.
  • Newly diagnosed with one or more of the seven DM program conditions.
  • Recently hospitalized for a DM program-related health condition. 
  • Seen at an emergency department (one or more visits) for a DM program-related health condition.

Why did HNFS contact me about participating in a program?

HNFS delivers the Military Health System DM program in partnership with the Defense Health Agency (DHA). We may have contacted you regarding a disease management program based upon your claims and treatment history. This includes emergency department visits, inpatient hospitalizations, outpatient visits, and medication usage.

In some cases, you may have been referred directly to the DM program through a family member, hospital discharge planner, treating physician, case management staff, HNFS staff, or military hospital or clinic.

Do I have to participate?

While there are numerous benefits to participating in this program, if you were pre-selected or referred by another, you are not obligated to participate. The DM program is an opt-out program, which means eligible beneficiaries identified or referred for participation are considered enrolled unless they decline participation or lose TRICARE eligibility.

Will any of my existing TRICARE benefits change if I participate in this program?

Participation in this program will not affect any of your TRICARE benefits.

What is the cost of this program?

This program is provided at no cost to you.

What are the advantages of a DM program?

There are many, including:

  • Convenience. You do not have to drive anywhere or sit in a waiting room. You can talk with one of our state licensed, condition-specific specialists at home or wherever you decide is convenient for you.
  • Cost. This program is provided at no cost.
  • Anonymity/privacy. You can participate in this program in the privacy of your own home.
  • Homebound/limited access. There is no travel required so your physical ability or location will not limit your access to the help you need.
  • Flexibility. Our office hours are from 8:00 a.m. to 6:00 p.m. in the beneficiary’s local time zone.

What is a DM specialist?

A DM specialist is a licensed mental health, nursing or other health professional who specializes in the management and treatment of certain health conditions. DM specialists may include:  

  • registered nurses (RN)
  • licensed clinical social workers (LCSW)
  • licensed marriage and family therapists (LMFT)
  • respiratory therapists (RT) for asthma and chronic obstructive pulmonary disease (COPD)
  • certified diabetes educators (CDE)
  • registered dietitian nutritionists (RDN)
  • exercise physiologists (EP)

Our programs cover the following conditions: anxiety disorders, asthma, chronic obstructive pulmonary disease, depression, diabetes, and heart disease, which includes coronary artery disease and heart failure.

I see a specialist for my condition. Will this program interfere with my care from my specialist or primary care manager?

This program will not interfere with the care you receive from your specialist or primary care manager (PCM). This program is not meant to replace any treatment you already receive. It is meant to provide you with clinical education, information, support, and guidance. As part of the program, we will obtain your permission to communicate with your PCM (and also your specialist if you would like) through an online portal, mail or telephone to keep him or her updated on your goals and progress in this program.

How do I know this will work for me?

Our DM specialists have years of experience in applying the principles of our program to meet your specific needs. If you are willing to make changes, learn new skills and start taking a more active role in your health, it is likely you will find our program helpful.

What can I expect from this program?

This is typically a six month program. You can expect to spend between 30–45 minutes once a month with your DM specialist discussing your condition. Your DM specialist will assess your needs and teach you the skills needed to help you better manage your condition. Your DM specialist can also:

  • Educate and empower you, so you can better monitor your condition and live a healthier lifestyle.
  • Identify roadblocks and obstacles to treatment.
  • Improve your understanding of your condition.
  • Assist you in understanding your medication and the importance of taking it as prescribed.
  • Discuss what to expect from treatment.
  • Coach you on how to communicate effectively with your health care providers.
  • Provide resources and recommendations to address unmet needs.
  • Initiate collaboration with your health care providers to better meet your needs.
  • Provide you with patient-friendly education materials.
  • Help you identify local or national resources available to assist you with the management of your condition.

Is this program confidential?

Absolutely. We value your trust and handle your personal information according to the strictest industry standards and in accordance with federal HIPAA regulations. We will never discuss your information without your permission unless allowed or required by law.

Is this program available in other languages?

Yes. We contract with an interpreter service to offer our program in various languages as well as providing relay services to the deaf and hard of hearing.

How can I participate in a DM program?

If you were not already pre-selected to participate in a DM program, there are two ways to submit a nomination for participation. Choose which works best for you.

  1. Log in with your DoD Self-Service Logon to complete the "Nominate a Beneficiary for Chronic Care/Disease Management" online form

    or

  2. Complete our Medical Management Referral form and fax it to HNFS at 1-888-965-8823.

HNFS will review the information submitted on the nomination and make a determination regarding program eligibility based on factors such as which TRICARE program you are enrolled, the presence of other health insurance and clinical status/needs. HNFS may request an evaluation for case management services in the event more complex clinical needs are identified.

Questions? Contact HNFS' Chronic Care/Disease Management department.