Prevention/Care Management, 2010
State of Montana
Montana's Department of Public Health and Human Services changed design components for a new program as a result of participating in the Medicaid Care Management Learning Network, an AHRQ Knowledge Transfer project. The Learning Network serves State Medicaid agencies that operate care management programs for chronically ill beneficiaries in fee-for-service plans or primary care case management programs. Montana is one of 17 States participating in the Learning Network.
The Learning Network provides expertise to participating States in four key areas critical to ensuring a quality-driven care management program:
- Helping patients become active in their care.
- Encouraging provider participation in care management programs.
- Creating program interventions aligned with the State's measurement strategy that will impact patient care.
- Designing valid and reliable evaluations to determine program success.
In 2004, Montana officials began operating a disease management program serving Montana Medicaid members, with the exception of those in nursing homes and institutions and who are also eligible for Medicare. Through a contract with its vendor, Montana officials provided disease management services for members with asthma, diabetes, heart failure, and chronic pain. The program served approximately 6,300 members through a nurse triage phone line, nurse care management, and disease education.
After technical assistance from AHRQ staff, Montana officials adopted a population-based care management approach for its new health improvement program. This strategy is preferable to a disease-specific approach because many Medicaid members have multiple chronic conditions. AHRQ staff provided technical assistance through several calls to discuss the following areas: selecting program goals, assigning members in categories of health risk, evaluating program outcomes, and engaging stakeholders in the program.
AHRQ staff also reviewed a request for proposals and recommended that State officials incorporate provisions requiring vendors to ensure that patient materials are culturally sensitive; propose innovative approaches for contacting hard-to-reach populations; and educate patients on managing their health conditions. Based on these recommendations, the request for proposals required vendors to foster a working relationship with a patient's primary care provider, teach patients to manage their own health, and educate them on available community resources.
Mary Noel, Bureau Chief, Medicaid Managed Care, Montana Department of Public Health and Human Services, comments, "Through the Learning Network, Montana made critical decisions about the future of care management for people with Medicaid. The expertise of AHRQ staff, together with best practices from other States, enabled us to craft a program unique to Montana and our specific frontier challenges."
For more information on the Learning Network, go to: http://www.ahrq.gov/qual/medicaidmgmt/.
Knowledge Transfer Case Study Identifier: KT-OCKT-23
AHRQ Product: Medicaid Care Management Learning Network
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