Disease and Case Management
Services are available to help eligible members* manage chronic illness or address a sudden, catastrophic event or medical condition requiring multiple services and intensive management.
One important goal of the State Health Plan is to help members with chronic disease or disease risk factors better manage their condition. Through NC HealthSmart, the State Health Plan offers eligible members* comprehensive educational resources and access to one-on-one health coaching and specialty care.
Disease management programs are available to eligible members* with the following conditions:
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD) –includes chronic bronchitis and emphysema
- Congestive Heart Failure
- Coronary Artery Disease
- Diabetes
Call a Health Coach 24 hours-a-day, seven days-a-week, toll-free at 1-800-817-7044, to discuss these and other conditions such as hypertension, high cholesterol, obesity, migraines, depression and musculoskeletal issues. Health Coaches also provide support for members facing significant medical decisions regarding treatment options, such as:
- Back or knee surgery
- Heart surgery
- Coronary angioplasty
- Various cancer treatments
- Emergency care
- End of life care
Case Management services are offered to eligible members* with complex medical needs. The program focuses on early identification of a member’s need for assistance with multiple hospitalizations or a sudden catastrophic event. If you or a family member need case management support, please contact a NC HealthSmart Health Coach at 1-800-817-7044.
High Risk Pregnancy and Neonatal Intensive Care Services
Case Management services are available for eligible members* with a high-risk pregnancy or an extended neonatal intensive care stay. Contact a NC HealthSmart Health Coach, 24 hours-a-day, seven days-a-week, toll-free at 1-800-817-7044, to discuss a case management referral.
Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) Care Services
Specialty Case Managers are available to assist members with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). To speak with a CKD/ESRD case manager, call 1-866-577-3625.
For other NC HealthSmart services, please visit the Wellness Services overview page.
*Members eligible for NC HealthSmart services are members whose primary health insurance is through the State Health Plan, and who are not on COBRA. Federal law prohibits the State Health Plan from using your personal health information to discriminate against you in any way or from giving this information to your employing agency/school or other unauthorized third party, unless required by law.
