Chronic Care Management
Some members have special health care needs and medical conditions. Our Care Management Unit will help you get the services and the care that you need. They can help you learn more about your condition. They will work with you and your provider to make a care plan that is right for you.
Our care management unit has nurses and social workers that can help you:
- Get services and care including information on how to get a referral to special care facilities for highly specialized care
- Work with health care providers, agencies and organizations
- Learn more about your condition
- Make a care plan that is right for you
- Access services after hours for crisis situations
- Arrange services for children with special health care needs such as well-child care, health promotion, disease prevention and specialty care services
- Coordinating services with other agencies such as:
- California Children’s Services
- Regional Centers
- Sacramento and San Diego Behavioral Health County Mental Health Departments
- Transplant services
We contact every member after they enroll in our health plan. We ask about your health care needs and your past health care. We will complete an Initial Health Screen (IHS). Together, the IHS and your health history let us know if you have special health care needs. A care management staff member may call you to see if you’d like to join the program.
You may also call us if you are interested in the Care Management Program. Just call Aetna Better Health of California at 1-855-772-9076, TTY 711. Ask to speak to care management. Our Care Management Program is voluntary. You can stop taking part in the program anytime.
We have a disease management program to help if you have certain conditions.
Asthma affects people in different ways. In some people it’s worse, and they have a lot of trouble breathing. Others don’t have as many problems. If you have asthma, the important thing is to discuss your case with your doctor. We’re here to help.
If you’re low risk, we’ll give you information to help you take care of yourself.
If you’re high risk, a care 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
It’s important to learn as much as you can about your asthma.
If you want to learn more about Aetna Better Health of California’s asthma management program, call Member Services toll-free at 1-855-772-9076, TTY 711. Ask to talk to an asthma care manager.
Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a lung disease. We can help you get care if you have COPD. Many people live active lives with COPD. We can help you live well too.
COPD happens slowly over time. At first, people may not know there’s a problem. With COPD, people’s lungs don’t work as well as they used to. Some people have worse COPD than others. That’s why everyone’s treatment is different. We’ll work with you and your doctor to find the best treatment for you.
We have a Chronic Care Management Program for our members who have COPD. Tell your doctor and us if you have lung disease. We’ll find out if you are at low risk or high risk for problems with COPD.
If you are at high risk, a care manager (CM) will call you to see if you need more help. The CM will talk to you about your treatment. Some people need oxygen therapy or more medicines. If you are a smoker, the CM will also talk to you about how to stop smoking.
It is important to learn as much as you can about your COPD. If you want to learn more about Aetna Better Health of California’s COPD management program, call Member Services toll-free at 1-855-772-9076, TTY 711. Ask to talk to a COPD care manager.
Coronary artery disease (CAD)
Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the U.S. in both men and women.
CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. As the buildup grows, less blood can flow through the arteries. The heart muscle can't get the blood or oxygen it needs. This can lead to chest pain or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the heart's blood supply, causing permanent heart damage.
Over time, CAD can also weaken the heart muscle and contribute to heart failure. Heart failure means the heart can't pump blood well to the rest of the body.
If you want to learn more about Aetna Better Health of California’s CAD management program, call Member Services toll-free at 1-855-772-9076, TTY 711. Ask to talk to a CAD care manager.
People with diabetes have too much sugar in their blood. If you have diabetes, we can help you manage it better. Without treatment, you could develop major health problems like heart disease. Diabetes also can severely affect your eyesight.
Some people have mild diabetes. They take care of it by exercising and eating healthy foods. Other people have diabetes that is more serious. 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 Chronic Care Management Program for members with diabetes. Tell your doctor and us if you have diabetes. Call us if your doctor tells you that you have diabetes. We’ll work with you to see if you are at low risk or high risk for problems.
If you’re at low risk, we’ll give you information to help you care for yourself. Also, we’ll work with your doctor to get you the right care.
If you’re at high risk, a care manager will call you to see if you need more help.
We can teach you about diabetes and help you take care of yourself. You’ll 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
- Why you need to do what your doctor tells you
- How to learn healthy habits so you feel better
It’s important to learn as much as you can about your diabetes.
If you want to learn more about Aetna Better Health of California’s diabetes management program, call Member Services toll-free at 1-855-772-9076, TTY 711. Ask to talk to a diabetes care manager.
Resources: American Diabetes Association
Heart failure (HF)
Your heart is a wonderful machine that pumps blood to every cell in your body. Your blood carries oxygen and important nutrients your body needs. When your cells are fed properly, your body can function normally.
If you have heart failure (HF), your heart is weaker. It can't always supply the cells with enough oxygen. That’s why you may often feel tired or short of breath. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.
We can help you. We have a Chronic Care Management Program for members with HF. We can help you get care from a doctor. It’s important to get good care. Otherwise, you may get much worse and need to go to the hospital.
Many people live very well with HF. You can too. To live well, however, you must see a doctor regularly and do what the doctor tells you. We’ll work with you and your doctor to get you the right treatment.
Most people with HF fit in one of four groups:
Group One: A person may not have signs of HF or heart damage. He or she may have other problems such as high blood pressure, diabetes or blocked blood vessels in the heart. We’ll teach you ways to live healthier if you are part of this group. Then it will be less likely that your HF will quickly get worse.
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’re part of this group.
Group Three: A person's heart may be damaged, as in Group Two. The person shows signs of heart failure. We’ll teach you healthier habits to adopt if you’re part of this group. You’ll learn about exercise and eating healthy food. Also, your doctor may give you more medicines to treat your HF. Your doctor may send you to a heart specialist.
Group Four: This is the most serious group. In this group, the heart is weaker. It may not be able to pump blood to the body very well. Your doctor will work with a heart doctor to treat you. It’s likely you may need to go to the hospital for treatment if you are part of Group Four.
It’s important to learn as much as you can about your HF. If you want to learn more about Aetna Better Health of California's Chronic Care Management Program for HF, call Member Services toll free at 1-855-772-9076, TTY 711. Ask to talk to a HF Care Manager.