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Disease Management Program

Contra Costa Health Plan has developed two disease management programs aimed at improving care for our members and providing additional support for their providers. The programs, focused on adult diabetes and pediatric obesity, offer best practice guidelines, referrals, motivational interviewing, tracking, and education to both providers and patients/families faced with these conditions.

Referral Guidelines

The following patients are eligible for the programs:

  • Pediatric Obesity-children must be ages 2-11, with a BMI%ile for age greater than of equal to 95
  • Diabetes- All members with type I or II diabetes ages 18-75 are eligible

CCRMC PCPs should refer patients to the Disease Management programs via ccLink under Pediatric Obesity or Diabetes in medication/orders.

Community Providers can access the Disease Management Program referral form on the website provider section under "forms and resources".

The programs will send patients quarterly information about their disease, and help them understand how to use both lifestyle and medical tools to address these problems. Providers will be given feedback about return visits, labs, and referrals relevant to their patient. Patients will also be offered special programs, such as classes, incentives, and self-help and community resources. We welcome your feedback about the programs. To find out more, email or call Lourdes Jensen, RN, CDE at 925-313-6968.

See more information designed specifically for health care providers.