Embed Size (px)
DESCRIPTION
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 - PowerPoint PPT Presentation
Citation preview
1
Experience HealthND Medicaid Health Management Program
Experience HealthND Medicaid Health Management Program
2
Experience HealthND Medicaid Health Management Program
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
Experience HealthND Medicaid Health Management Program
Experience HealthND Medicaid Health Management Program
On October 1, 2011 North Dakota Medicaid 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
3
4
Experience HealthND Medicaid Health Management Program
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
Experience HealthNDMedicaid Health Management Program
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
Program Goals
6
Experience HealthNDMedicaid Health Management Program
Experience HealthNDMedicaid Health Management Program
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
Program Service Delivery
7
Experience HealthNDMedicaid Health Management Program
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
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
Experience HealthNDMedicaid Health Management Program
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
Physician/Provider Support Services
10
Experience HealthNDMedicaid Health Management Program
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
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 HealthNDMedicaid Health Management Program
Experience HealthNDThank you…
ND: Communications /Provider/Presentations 10.31.11
For further information please contact Abbey Linstad Fraser, CRC
at 701-205-2526 or [email protected]
