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Disease Management

Our patient-centered clinical support means your health and well being is at the heart of everything we do. To support you our nurse case managers:

  • Evaluate your medical situation to find gaps in care
  • Work with you and your doctor to create a personal care plan
  • Support your treatment goals by working with the treating doctor(s)
  • Assess the home environment and support systems
  • Verify that the right medications and/or treatments are in place
  • Help with health plan requirements for precertification, prior authorization, using network providers, and more
  • Educate you about programs and services available to you

This program is designed to meet your specific needs.

Case Management Approach

If you have asthma, diabetes, chronic renal failure, congestive heart failure or other medical conditions, you may choose to join in our voluntary Disease Management Program. We will:

  • Provide you with condition-specific health care information
  • Contact you from time to time to see how you are doing
  • Suggest coping strategies
  • Explain techniques to help you and your doctor effectively monitor your medical condition

Our nurses cannot diagnose, prescribe or give medical advice. Specific questions should be addressed to your doctor.

The Disease Management Program is part of your MHBP benefit package, and your participation is optional. If you register for the program, you may discontinue your participation at any time. To register for participation in the Disease Management Program, click the link below, or call us at 800-410-7778.

Register for the Disease Management Program Now >>

URAC-Accredited Clinical Management Programs

MHBP offers URAC-Accredited Case Management, Health Utilization Management and Disease Management (for six conditions: Congestive Heart Failure, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Asthma, Diabetes and Chronic Kidney Disease).

urac accredited

About URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation. For more information, visit the URAC website.

Case Management Rights and Responsibilities

As a participant in the case management program, members have the right to:

  • Be educated about their rights
  • Be informed of choices regarding services
  • Have input into the case management plan
  • Refuse treatment or services, including case management services and the implications of such refusal relating to benefits eligibility and/or health outcomes
  • Use end of life and advance care directives
  • Obtain information regarding the organization’s criteria for case closure
  • Receive notification and a rationale when case management services are changed or terminated
  • Obtain information on alternative approaches when the consumer, family and/or caregiver is unable to fully participate in the assessment phase
  • File a complaint regarding the case management program by contacting Customer Service by phone at 800-410-7778 or by writing to MHBP, PO Box 981106, El Paso, TX 79998

Members have the responsibility to:

  • Accurately and fully disclose relevant information and notify Aetna of any changes
  • Become involved in individual health care decisions
  • Work with Aetna representatives to set goals and implement interventions to manage their condition
  • Work with health care providers to develop and carry out agreed-upon treatment plans
  • Make a good-faith effort to keep healthy habits, such as exercising, not smoking and eating a healthy diet
  • Follow case management program procedures

Disease Management Rights and Responsibilities

As a participant in Aetna's disease management program, you have the right to:

  • Know about the philosophy and features of the disease management program
  • Have personal health information shared by the disease management program only within with state and federal law
  • Identify the staff member and their job title and to speak with a supervisor of the staff member if requested
  • Receive accurate information from the disease management program
  • Receive administrative information regarding changes in or termination of the disease management program
  • Decline participation, revoke your approval or dis-enroll at any point in time

You have the responsibility to:

  • Submit any forms that are necessary to participate in the program, to the extent required by law
  • Give accurate clinical and contact information and to notify the disease management program of changes in this information
  • Notify your treating provider of your participation in the disease management program (if applicable)