Whole Health Dimensions^SM Program and Services

Whole Health Dimensions offers a comprehensive suite of health management programs and services to assist your patients meet the goals you’ve helped establish.

Whole Health Dimensions Programs and Services links:

• Personal Health Assistant
• Wellness Services
• Disease Management
• Pregnancy Care
• Complex Case Management
• Pharmacy Management
• Utilization Management

Personal Health Assistant

A single phone number gives members 24/7 access to a team of registered nurses and other health professionals for information, decision-making assistance, and assistance in navigating the health care system:

• Nurse Support 24/7: Answers to care questions from an R.N.
• Care Navigation 24/7: Helps locate the right resources.

Wellness Services

Wellness services promote healthy behaviors. Services include:

• Lifestyle Management: an integrated program tailored to the patient’s needs. Includes a personal health assessment and online support services to help members assess and maintain or improve health status.
• Wellness Clinics: On-site biometric screening with individualized consultation.
• Health Coaching: Personalized telephonic program for at-risk participants. Addresses specific health risk behaviors identified in the personal health assessment.
• Workplace Wellness: Consultation and tools to help employers tailor and implement lifestyle management programs for their companies.

Disease Management

Provides support to patients with conditions that require significant self-care through coordinated interventions and communications. This includes members with the following core and impact conditions.

Core Conditions

• Asthma
• Diabetes
• Congestive Heart Failure
• Coronary Artery Disease
• Chronic Obstructive Pulmonary Disease (COPD)

Impact Conditions

• Acid Related Stomach Disorder
• Atrial Fibrillation
• Decubitus Ulcers
• Fibromyalgia
• Hepatitis C
• Inflammatory Bowel Disease
• Irritable Bowel Syndrome
• Low Back Pain
• Osteoarthritis
• Osteoporosis
• Urinary Incontinence

Clinicians, nurses, and Wellmark members are encouraged to make referrals to the Disease Management program using our referral form.

Pregnancy Care

This program supports pregnant women with personalized health information, education, and assistance, focusing on women who are at risk for preterm births or other complications. A primary obstetrical nurse is assigned to the highest risk cases.

Complex Case Management

One-on-one support is provided to members with the most complex conditions, such as those dealing with a serious illness, preparing for surgery or a transplant, or receiving end-of-life care. It offers coordinated interventions and assistance for both the patient and his or her family.

Clinicians, nurses, and Wellmark members are encouraged to make referrals to the Pregnancy Care program using our referral form.

Pharmacy Management

This innovative, multidimensional program is designed to provide a pharmacy benefit that supports the most clinically effective drug therapy at the lowest net cost.

Representatives from Catalyst Rx, Wellmark’s pharmacy benefit manager, are available to answer your questions regarding the pharmacy benefit plans and clinical programs. In addition, they have clinical pharmacists and support staff available to provide physician-specific reports on prescribing patterns, generic utilization rates, and more.

To request a visit from a Catalyst Rx representative, contact your Iowa or South Dakota Network Relations representative.

Utilization Management

This program evaluates medical necessity, appropriateness, and efficacy of health care services using established guidelines and criteria. Utilization management helps employer groups manage overall medical costs, and provides early indication of potential high-dollar benefit claims.

Programs include:

• Notification of hospital admission
• Precertification of services
• Preauthorization of certain outpatient diagnostic imaging services
• Prior approval of targeted procedures, drugs, and durable medical equipment
• Monitoring changes in medical technology through medical policy

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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.