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Experience Health ND Medicaid Health Management Program

Experience Health ND Medicaid Health Management Program. Experience Health ND Medicaid Health Management Program. Partnership between North Dakota Department of Human Services, Medical Services Division & USCM began in 2007

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Experience Health ND Medicaid Health Management Program

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  1. Experience HealthND Medicaid Health Management Program

  2. Experience HealthND Medicaid Health Management Program • Partnership between North Dakota Department of Human Services, Medical Services Division & USCM began in 2007 • Community-based care management program for Medicaid recipients with chronic health conditions including: • Asthma • Chronic Obstructive Pulmonary Disease (COPD) • Congestive Heart Failure • Diabetes

  3. Experience HealthND Medicaid Health Management Program • On October 1, 2011 NorthDakotaMedicaid made the Health Management Program available through multiple providers • Experience Health ND is now a Health Team Provider providing program services to enrolled members as well as new eligible recipients

  4. Experience HealthND Medicaid Health Management Program Program Design: • Participation is voluntary and recipients may opt-out at any time • Collaborative services working closely with providers and community organizations to maximize adherence to providers treatment plan • Evidence-Based National Practice Guidelines • Information to educate/empower recipients • Clinical decision making for encouraging adherence

  5. Experience HealthNDMedicaid Health Management Program Program Goals • Increase adherence to doctor’s treatment plans, improve self care practices and augment patient-centered care • Improved the quality and timeliness of care • Enhance member’s decision-making, understanding of conditions and use of available health services • Reduce utilization and cost of resources including unnecessary ER visits and hospitalization • Improve health outcomes

  6. Experience HealthNDMedicaid Health Management Program Program Service Delivery • Registered Nurse Care Managers working with members & • their families • Telephone Health Information Line 24 Hours/Day • Tele-health home monitoring for high risk in remote areas • Physician/Provider Collaboration & Adjunct Support • Community Resource Coordinator builds partnerships

  7. Experience HealthNDMedicaid Health Management Program Registered Nurse Care Manager Support • Enrollment and comprehensive assessment • Care planning in collaboration with providers, recipients and families • Education on importance of medical home, regular office visits • & adherence to provider’s treatment plan • Coordination of care for health care needs • Assistance to access & utilize community resources

  8. Experience HealthNDMedicaid Health Management Program Telephone Health Information Line (THIL) • 24 Hour/7 Day A Week • Inbound and Outbound Calls (All eligible recipients) • Staffed by Experience HealthND nurses

  9. Experience HealthNDMedicaid Health Management Program Physician/Provider Support Services • Program information, toolkits & orientation to Program objectives • Ongoing feedback on patient status, progress & needs that facilitate treatment plan & health outcomes • Collaboration between medical providers & community resources • Use of national evidence-based practice guidelines

  10. Experience HealthNDMedicaid Health Management Program Physician/Provider Support Services (continued) • Program Webinars • Program web-site available to include education programs, clinical guidelines and professional links… (www.provider.experiencehealthnd.com) • Provider Advisory Committee

  11. Experience HealthNDMedicaid Health Management Program • Collaboration with community service organizations • Community Resource Coordinator supports RNCMs • Program service, referral and education partnerships • Health Management partnerships with Experience Health ND Community Outreach & Partnerships

  12. Experience HealthNDMedicaid Health Management Program Experience HealthND Thank you… ND: Communications /Provider/Presentations 10.31.11 For further information please contact Abbey Linstad Fraser, CRC at 701-205-2526 or alinstad@uspreventivemedicine.com

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