Central California Alliance For Health

 

Health Education and Disease Management Programs


The Alliance is committed to improving access to affordable health care for our members. We offer innovative programs to help members achieve healthier outcomes. These programs are managed by experienced health education professionals. They assist members with techniques to stay healthy and understand and manage chronic conditions, including enrollment in Health Education and Disease Management Programs. Members can receive incentives for their participation in some of these programs through the Alliance’s Member Incentive Program. Only Alliance Medi-Cal members who do not have other health insurance are eligible to participate in the Member Incentive programs.


For more information about our Health Education and Disease Management programs, please click the links below:

•  Care Management Services
•  Clinical Health Education Benefits
•  Quick Reference Guide

Health Education

Alliance Nurse Advice Line

The Alliance Nurse Advice Line is the first step to improve member access to care, help avoid inappropriate use of the emergency department, improve member satisfaction, and redirect members to primary care where appropriate by offering immediate medical professional advice using best-practice care guidelines.


When Alliance members have health questions, the Nurse Advice Line is a good place to start. It’s free, fast, and easy, and members can call 24 hours a day, 7 days a week. A registered nurse will answer their health questions and quickly give members advice on their care options. Additionally, the Nurse Advice Line staff can schedule appointments directly with the member’s PCP, as needed, for followup.


Members who call the Alliance Nurse Advice Line will be entered into a monthly raffle for a chance to win a $50 gift card.


Members or providers can also request a free copy of the book “What to do When Your Child Gets Sick,” which is an easy-to-read guide for parents and caregivers of children from birth to eight years of age.


Breastfeeding Support and Breast Pump Benefit

The Alliance gives new moms access to breastfeeding education, support, and referrals. New moms are eligible for a free breast pump if either mom or baby has medical issues that prevent nursing at the breast, or if the mother is returning to work or school and wants to continue breastfeeding.


• Click here for the Breastfeeding Support and Breast Pump Benefit Description.

• Click here for the Breast Pump Vendor List.

Member Wellness Resources

The Alliance offers a wide variety of health education resources for our members which can be accessed by calling the Health Education Line at (800) 700-3874 ext. 5580.


The Alliance Health and Wellness Calendar includes a list of various community resources, including behavioral health, nutrition and fitness, pain management and alternative treatment, social support services for domestic violence, and substance use and tobacco cessation. Classes or programs are offered at no cost, low cost, or on a sliding scale to help members and their families live a healthier life.

Living Healthy, our quarterly trilingual (English, Spanish, and Hmong) member newsletter, provides information on Alliance services and benefits, personal health, and local health education resources.

Ask Me 3 is a patient education program designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes.

Patient brochures are available in English and Spanish.

• The Centers for Disease Control and Prevention offers information on topics ranging from disease and conditions, to healthy living, travelers’ health, emergency preparedness and more.

Text4Baby offers a free text messaging program to provide new moms with tips on the importance of prenatal and postpartum care, breastfeeding, lead poisoning prevention, immunizations, nutrition, exercise, and much more. Pregnant women and new moms who sign up will receive messages timed with their due date or baby's date of birth.

2-1-1 is a nationwide service connecting individuals and family members to local resources such as food, shelter, health services, and more. Members can call 2-1-1 at any time.

Healthy Moms and Healthy Babies Program

The Alliance's Healthy Moms and Healthy Babies program is designed to encourage pregnant women to seek early prenatal and postpartum care. These members can earn up to $50 in gift cards.


Early Prenatal Care - Pregnant members who have a prenatal visit (Early Prenatal Care) within their first 13 weeks of their pregnancy or within 42 days of becoming an Alliance member can receive a gift card. PCPs who submit the form to the Plan within 21 business days from the date of services to indicate members have received an initial prenatal consultation will receive payment through our CBI program. The prenatal visit does not need to be a comprehensive official prenatal exam and can simply be a diagnosis of pregnancy and referral to the relevant specialist or PCP for continued prenatal services.


• The Early Prenatal Care Form is available in English, Spanish, and Hmong.

Please fax this form to the Alliance at (877) 793-8504.


Postpartum Care - New moms can also receive a gift card for their postpartum visit (Postpartum Care) if they see their PCP within 21-56 days of the birth of their child. The member will receive this incentive once the PCP has billed the Alliance for the visit - no form is required. The provider to which the member is linked at the time of the visit will receive payment for either 1) performing the visit or 2) the visit being performed by an approved referral specialist.



Tobacco Cessation Support Program

The Tobacco Cessation Support (TCS) Program offers many ways to help members quit smoking or enroll members in an approved smoking cessation class. Providers can complete the program application form to make a referral, or a member can self-refer.


• Click here for the Tobacco Cessation Support program application, including eligibility and referral process information.

• Click here for the Tobacco Cessation Benefit Description.

In addition, providers can bill for tobacco cessation counseling using the following Evaluation and Management (E&M) codes:


• CPT Code 99406 (Smoking and Tobacco Use Cessation Counseling Visit; intermediate, greater than 3 minutes up to 10 minutes) and

• CPT Code 99407 (Intensive, greater than 10 minutes) not to report 99407 in conjunction with 99406

Click here to learn more about how providers can be reimbursed for smoking cessation counseling sessions.



Women's Preventive Screenings

The Alliance is committed to encouraging early detection and preventive screenings for women's health issues. The Alliance sends quarterly mailings to remind members who, according to claims data, are due for a chlamydia screening, breast cancer screening, or cervical cancer screening. Reports listing linked members who are due for breast cancer and cervical cancer screenings are available to all providers in the Alliance Provider Portal.





Disease Management

Diabetes Prevention and Self-Management Education

Live Better with Diabetes Program

Health Programs staff work with members with diabetes and provide education on diabetes management. Alliance staff can also refer members to Alliance-approved clinical diabetes management education providers.


• Click the links below for Diabetes Eye Exam Services Resource Lists: English, Spanish, Hmong.

Diabetes Prevention Program

Pre-diabetes can be reversed by losing weight, eating healthy, and being more active. To support our members who are at risk for developing Type 2 Diabetes, the Alliance covers pre-diabetes education for members of all ages however some education programs may have certain age criteria.


• Click here for more information about this benefit and how you can refer your members.

Healthier Living Program

The Alliance’s Healthier Living Program (HLP) is based on Stanford’s Chronic Disease Self-Management Program, and is designed to help Alliance members diagnosed with chronic conditions gain self-confidence in their ability to control their symptoms and understand how their health problems affect their lives. The program focuses on problems that are common to individuals suffering from any chronic condition, such as pain management, nutrition, exercise, medication usage, emotions, and communicating with doctors. The HLP is led by two trained Alliance staff facilitators and the workshops consist of six, 2½ hour sessions. For a list of upcoming classes, click here.



Healthy Breathing for Life Program

As part of the Healthy Breathing for Life program, Alliance Health Programs staff work with members 5-64 years of age to assess their level of understanding about asthma management and assist them in creating an Asthma Action Plan (AAP).


The AAP guides members and provides instructions and information on daily asthma self-management including taking medications appropriately and how to recognize and handle worsening asthma. Members can also be referred to an Alliance-approved asthma education provider.


• Click the links below for the AAP forms.
  – English, Spanish, Hmong

• Click here for the Healthy Breathing for Life program overview.

• Click here for the Asthma Self-Management Education Benefit Description.

• Click here for a list of Alliance Approved Asthma Education Providers.

Healthy Weight for Life Program

Healthy Weight for Life (HWL) is an Alliance health program designed to promote healthy lifestyles, self-care and the prevention of chronic disease. The Alliance staff works with contracted providers to identify and refer members 2-18 years of age whose Body Mass Index (BMI) is at or above the 85th percentile. Members who lower their BMI percentile by 3 or more percentile points can receive up to $50 in gift cards. PCPs that complete and fax the initial referral form and follow-up form 6-12 months later may be eligible for payment through our CBI program. Forms must be completed by the linked PCP site to receive credit. Payments are per approved form, per linked member, per year. The fax number for the program is (877) 793-8504.


Click the links below to view additional information about BMI calculations, the HWL Program, and how to access the HWL Program forms. Referring providers must use these forms to refer members to the HWL Program.

Fax only the completed referral form to the Alliance, not the prescription form. The completed prescription form should be given to the patient and include a copy in the patient's file.

• Initial Referral, 6-Month and 12-Month Follow Up Referral Form:

   – English, Spanish, Hmong
Instructions for Calculating BMI
CDC BMI Percentile Calculator for Child and Teen

Weight Watchers Support Program

The Weight Watchers Support (WWS) program provides scholarships for members to participate in the Weight Watchers weight management program. This program is not a Medi-Cal benefit, but an Alliance covered service.


In order to join the WWS program, the member must:

• Be referred by a PCP and a WWS program application form must be completed by the PCP.

• Have a BMI of 30 or above, and

• Be 18 years of age and older to be considered. Please note: the Alliance also offers the Healthy Weight for Life Program for members’ ages 2-18.


Members can only be enrolled in the WWS program once due to a limited number of scholarships available. Please fax the completed WWS program application form to (831) 430-5852, attention: Health Programs Care Coordinator.

• Click here for the Weight Watchers Support Program application.

• Click here for the Weight Watchers Support Program description (including eligibility and referral information).




How to Become an Alliance-Approved Clinical Health Education Provider

The Alliance offers clinical health education and self-management services. If you are interested in becoming an Alliance-approved Clinical Health Education (CHE) provider, please review the appropriate documents below for details on application, reimbursement rates, and the approval process.


Clinical Health Education Alliance-Approved Provider Application


Clinical Health Education Benefit Descriptions/Checklist:

•  Diabetes Prevention and Self-Management Education Benefit Description and
   Checklist

•  Asthma Self-Management Education Benefit Description and Checklist

•  Breastfeeding Support and Breast Pump Benefit Description and Checklist


If you would like to become an Alliance CHE provider, please complete the application and submit copies of current medical license(s) and other documentation outlined in the appropriate checklist linked above. You may submit this information via mail, email, or fax to:


Mail: ATTN: Health Programs Unit
Central California Alliance for Health
1600 Green Hills Road, Suite 101
Scotts Valley, CA 95066-4981


Email: cheb@ccah-alliance.org


Fax: (831) 430-5852


For information about or referrals to Health Education and Disease Management Programs, please call the Alliance Health Education Line at (800) 700-3874 ext. 5580.


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