Disease management
We offer disease management programs that can help you better manage your health. These programs educate you on your disease and give you tips on how to stay healthy. If you have one of the illnesses listed below, we can help you:
- Asthma
- Congestive Heart Failure (CHF)
- Chronic Obstructive Pulmonary Disease (COPD)
- Diabetes
- HIV
- HEP C
Through the disease management programs, you can:
- Learn more about your diagnosis
- Talk to a nurse or Social Worker as appropriate
- Be given appropriate community resources
We'll work with your doctor to come up with a care plan just right for you. The care plan will help you meet your goals and manage your illness.
It's your choice to participate in a disease management program. You can join by calling Member Services. Your PCP, specialist or other health care providers may also suggest that you join the program. Because it's an opt-in program, you can choose to join or leave the program at any time.
Members Services is available at:
- 1-866-638-1232, TTY PA Relay 7-1-1 (Medical Assistance)
- 1-800-822-2447, TTY 1-800-628-3323 (CHIP)
- 1-855-346-5635, TTY PA Relay 7-1-1 (Private Coverage Option)
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Asthma
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Aetna Better Health can help you get care if you have asthma. Some people have bad asthma problems and a lot of trouble breathing. Some people have fewer asthma problems and less trouble breathing. Everyone with asthma needs care from a doctor.
We have a disease management program for members with asthma. If you have asthma, tell us and your doctor. If you learn you have asthma from your doctor, tell us. We will work with you to see if you are low risk or high risk for problems.
If you are low risk, we will give you information to help you take care of yourself.
If you are high risk, a case manager will call you to talk about your care. Here are some things the case manager will talk about with you:
- Taking care of your asthma at home
- Why taking your medicine is important
- What causes asthma attacks
- Why you need to do what your doctor tells you
- Ways to change your habits so you feel better
- Help you create a plan for what to do when you have an asthma attack
It is important to know as much as you can about your asthma.
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Diabetes
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Your Aetna Better Health disease management team can help you get the right care if you have diabetes. People with diabetes have too much sugar in their blood. If they do not get treatment or care, they could have major health problems such as heart disease, and blindness.
Some people have mild diabetes. They take care of it by exercising and eating healthy foods. Other people have more serious diabetes. They have to take shots of a hormone called insulin. Insulin helps your body's cells use food the right way. Everyone with diabetes needs care from a doctor.
We have a disease management program for members with diabetes. Call us if your doctor tells you that you have diabetes. We will work with you to see if you are low risk or high risk for problems.
- If you are low risk, we will give you information to help you care for yourself. Also, we will work with your doctor to get you the right care.
- If you are high risk, a case manager will call you to see if you need more help.
We will teach you about diabetes and help you take care of yourself. You will learn:
- How to take care of your diabetes
- How to watch your blood sugar
- Why you need to take your medicine
- How to take good care of your feet
- How to get the right eye exams (there is a special exam for diabetics)
- Why you need to do what your doctor tells you
- How to learn healthy habits so you feel better
- It is important to learn as much as you can about your diabetes.
Here are resources that can help you learn more about Diabetes and how to manage it.
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Chronic Obstructive Pulmonary Disease (COPD)
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Aetna Better Health can help you get care if you have COPD. COPD stands for chronic obstructive pulmonary disease, which is a lung disease. A lot of people can live well with COPD. We can help you live well too.
COPD happens slowly over time. People often will not know there is a problem. COPD makes people’s lungs not work as well as they used to. Some people have worse COPD than others. That is why everyone gets different kinds of treatment. We will work with you and your doctor to find the best treatment for you.
We have a disease management program for members with COPD. Tell us and your doctor if you have lung disease. Call us if your doctor tells you that you have lung disease. We will see if you are low risk or high risk for problems with COPD.
If you are high risk, a case manager will call you to see if you need more help. The case manager will talk to you about not smoking and your treatment. Some people need oxygen, medicines or other care.
It is important to learn as much as you can about your COPD.
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Congestive Heart Failure (CHF)
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Aetna Better Health can help you get care if you have Congestive Heart Failure (CHF). CHF is not a disease. It is a condition that happens when the heart cannot pump enough blood for your body. We have a disease management program for members with CHF.
Everyone with CHF needs care from a doctor. If you do not get care, your heart could get weaker and you will feel very sick. You may even have to go to the hospital.
Many people live very well with CHF. To live well, you must see a doctor regularly and do what the doctor tells you. We will work with you and your doctor to get you the right treatment.
Most people with CHF fit in one of four groups:
- Group One: A person may not have signs of CHF or heart damage. He or she may have other problems such as high blood pressure, diabetes or blocked blood vessels in the heart. We will teach you ways to live healthier if you are part of this group. This will help you be less likely to get CHF.
- Group Two: A person's heart has been damaged. The heart is not as healthy as it could be. But the person does not show symptoms of heart failure. Maybe the person has had a heart attack or an infection in the heart. Maybe the heart valves are not working correctly. Your doctor may give you medicine called ACE inhibitors or beta blockers if you are part of this group.
- Group Three: A person's heart may be damaged, like in group two. The person shows signs of heart failure. We will teach you about having healthier habits if you are part of this group. You will learn about exercise and eating healthy food. Also, your doctor may give you medicine for your CHF.
- Group Four: This is the most serious group. A person's heart may be getting weaker. It may not be able to pump blood to the body very well. Your doctor may refer you to a heart doctor, or you may have to go to the hospital if you are part of group four.
It is important to learn as much as you can about your CHF.
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HIV
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CHIP disease management programs
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CHIP members are eligible to participate in any of the following disease management programs:
- Asthma
- Diabetes
- Obesity
- Tobacco Cessation
The diabetes management program is staffed by physicians, nurses and other health care professionals who understand diabetes. They will work with you and keep your doctor informed of your condition and the services we are providing you. Program members are entitled to:
- Support from our nurses and other health care staff to make sure you understand the best ways to manage your condition and periodically evaluate your health status.
- Periodic newsletters to keep you informed of the latest information on diabetes and diabetes management.
- Educational materials that can help you understand and manage your medications and plan visits to your doctor. These materials also give you information on upcoming events such as health fairs.
Call Member Services at 1-800-822-2447 to find out more about the disease management programs available to your child.
Enroll your child in a disease management program
Aetna Better Health Kids may automatically enroll your child in a disease management program if your child has certain diagnoses. Your child’s PCP may also enroll your child in one of Aetna Better Health Kids’ disease management programs.
Contact Member Services at 1-800-822-2447 if your child is not currently enrolled in a program and you think that he or she would benefit from disease management services.