Disease Management Programs
Children’s Medical Services Health Plan has several programs to improve the health of children with chronic conditions. We know this means more than just helping your child see a provider. It means helping you and your child understand and manage health conditions. We do this through our disease management programs. You and your child are provided education and personal help from CMS Health Plan staff. The goal of this service is to add to the quality of care and help to improve your child’s health.
If your child has one of the conditions below, call Member Services at 1-866-799-5321 (TTY 1-800-955-8770) or a care manager for information:
- Asthma Program: Guides those with asthma to learn more about the condition, health risks, how to reduce triggers (like dust, mold, cold air, cigarette smoke) and staying on track with the plan of care and medication schedule
- Cancer Program: Offers education about diagnosis and treatment helps manage symptoms and side effects, helps with finding healthcare services and emotional support for members and their families during this difficult time
- Diabetes Program: Helps people with diabetes learn more about diabetes and health risks, healthy lifestyle choices (like diet, smoking, exercise and controlling blood sugar levels), staying on track with the plan of care and medication schedule
- High Blood Pressure (Hypertension) Program: Helps those with high blood pressure to address and improve lifestyle habits like smoking, exercise, low fat diet, following the medication schedule, new ways to manage stress and learning the early signs of a heart attack
- Substance Abuse Disorder Program: Offers guidance on health, wellness, and positive support systems, referrals to Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), encouragement and support for the treatment plan and self-care
- Behavioral Health Program: Helps members find a provider, counselor or other care, offers guidance on health, wellness and healthy support systems, following the plan of care and medication schedule, changing unhealthy behaviors and learning healthy coping skills
Healthy Rewards
Earn cash rewards when your child completes healthy activities to manage their disease or condition. The My Health Pays Program offers:
Activity | Criteria | Value |
|---|---|---|
| Comprehensive Diabetes Care | Ages 13-20 years. Complete HbA1c test and dilated eye exam once in the calendar year. | $25 |
| Tobacco Cessation Health Coaching Sessions* | Ages 10 years and up. Must submit a consent form, verbally pledge to stop tobacco use and complete all four sessions within six months of the first session. $5 reward after each completed session. | $20 |
| Weight Loss Health Coaching Sessions* | Ages 10 years and up. Must submit a consent form, verbally pledge to lose weight within 30 days and complete six sessions within six months. | $20 |
| Substance Use Health Coaching* | Ages 12 years and up. Complete three coaching sessions with a Care Manager in three months. Enrollment in Care Management and signed consent form are required. | $10 |
| Post Behavioral Health Admission Follow up Visit | Complete outpatient follow up appointment with a behavioral health provider within seven days after discharge from an inpatient facility. | $20 |
* What is a Health Coaching Session?
The above Healthy Activities are eligible for rewards. These include participating in Health Coaching Sessions. The sessions are completed over the phone to fit your schedule. During these sessions, our Health Coaches can help answer questions about how to improve health. They can also provide education and support to help our members set goals and make better lifestyle choices.