1 Experience HealthND Medicaid Health Management Program

2  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  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 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 HealthND Medicaid 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 HealthND Medicaid 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 HealthND Medicaid 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 HealthND Medicaid 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 HealthND Medicaid 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 HealthND Medicaid Health Management Program Physician/Provider Support Services (continued)  Program Webinars  Program web-site available to include education programs, clinical guidelines and professional links… (  Provider Advisory Committee

11 Experience HealthND Medicaid 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 HealthND Medicaid Health Management Program Experience HealthND Thank you… ND: Communications /Provider/Presentations For further information please contact Abbey Linstad Fraser, CRC at or