Care Management

Diabetes is a chronic condition that can be managed with diet, lifestyle changes, and medication management. Whether you have been diagnosed with diabetes recently or have had it for a long time, our Diabetes Management Program can help you to:

• Better understand your diabetes and how to control your blood sugar levels with the right medications and a healthy diet.
• Avoid diabetes complications and emergencies.
• Become more active in your own healthcare.

For more information about diabetes, visit the CDC website.

Coronary artery disease (CAD) is a heart condition that can be managed and improved with diet, lifestyle changes, and medication management. If you have CAD, our CAD program can help you to:

• Learn more about coronary artery disease and cardiovascular disease.
• Reduce your symptoms by taking your medications the right way.
• Avoid complications and emergency room visits.
• Talk to your doctor to set up a sick-day plan.

For more information about CAD, visit the CDC website.

Our Enhanced Diabetes Management program is tailored to our high-risk members with diabetes and other chronic conditions, such as high blood pressure and high cholesterol, who may be having challenges managing their health. When we select members for the program, we offer them an incentive for their ongoing participation.

• The Enhanced Diabetes Management program includes a consultation and quarterly monitoring by a registered nurse to support medication adherence to related to diabetes, high blood pressure, and high cholesterol. 
• In addition, participating members are eligible for a no-cost medication review by our Director of Pharmacy.
• If appropriate, our pharmacist will coordinate with the member’s provider for therapy change recommendations.

If you are interested in learning more about the program and your eligibility, please call our Medical Management Department at 1-844-691-9984.

We want you to have easy access to the supplies you need. Some supplies are covered by your pharmacy benefit, and some are covered by your medical benefit. For details, visit our Pharmacy page and scroll down to For Members with Asthma or Diabetes.

If you have asthma or diabetes, visit our Pharmacy page and click on the button underneath Do You Have Asthma or Diabetes? to find a list of medications and supplies we cover for those conditions. Several of these medications are on our $0 copay list.

If you are receiving an ongoing course of treatment from an out-of-network provider at the time of your enrollment with True Health New Mexico, you may be eligible to continue to receive services from this provider and have the services covered under your True Health plan. This is called transition of care.

Transition of care covers certain medical conditions, including:

• Pregnancy in the second or third trimester
• Chemotherapy or radiation therapy
• Recent major surgeries
• Hospital confinement
• Other conditions

To be considered for transition of care coverage, you must apply for it either at enrollment or no later than 30 days after your effective date of coverage. True Health New Mexico will make determinations for transition of care based on established medical criteria.

Get started by downloading the Transition of Care Guide on our Member Forms page. There is a form for you to complete and submit at the end of the guide.

If you are interested in Care Management services:

1. You can complete and submit our Care Management Enrollment Form. You will find this form on the Member Forms page.
2. You can call us directly at 1-844-691-9984.
3. You can use our secure messaging portal to enroll or request information. Please do not use regular email, as this is not secure.
4. You also can be referred by your caregiver, doctor, or other provider, such as a hospital case manager. If you are referred by a provider, he or she will need to complete the Complex Case Management Referral Form on our Provider Forms page. Please ask your provider to fax the completed form to us.

Participation in these programs is your choice. You may leave the programs at any time.

Our Care Management Programs are optional. They will not cost you anything extra, and you can quit the programs at any time. Your health plan benefits will not change whether or not you choose to take part in these programs.

If you choose to opt out of any of our programs, you can do so in the following ways:

• Call the Medical Managment department at 1-844-691-9984
• Email us via the secure messaging portal.