Medicaid Expansion Health Care Management Support

Blue Cross Blue Shield of North Dakota (BCBSND) Medicaid Expansion Care Management team works with patients’ primary care team to help provide supplemental coordinated care to Medicaid Expansion patients at no additional cost to the patient or provider.

This support is all about meeting patients where they’re at and closing gaps where they may otherwise fall through the cracks.

This team will include a multidisciplinary team of register nurses (RNs), care coordinators and social workers, who recognize the emotional impacts of serious illness and are trained in:

• Motivational interviewing
• Crucial conversations
• Care coordination

Services in support of Medicaid Expansion Patients and Providers

By serving as an extension of the primary care team, Care Management will proactively engage Medicaid Expansion patients and walk with them through their care needs in alignment with their primary care practitioner. By walking with them, they can help improve quality, while managing costs by leveraging telephonic care management services. Through care management work they aim to reduce unnecessary spending on hospital admissions and emergency department visits and help close critical gaps in care.

Example services of ways this helps members:

• Engaging with patients after a hospital stay to ensure the patients filled their prescribed medications and made necessary follow-up visits with their primary care provider.
• Helping patients know where to go for care.
• Assessing and coordinating community resources.
• Helping patients comply with their prescribed treatment plan.

Examples of how this helps providers:

• Relieve provider of some administrative and care coordination work that can often be a challenge outside the clinic office, hospital or emergency room.
• Transitional care management, which coordinates care for patients following an acute inpatient admission.
• Emergency department coordination to help patients best determine when to use the ER.

Assessments

Care management often includes voluntary assessments including:

• Comprehensive health screening
• Screening for depression and anxiety
• Assessment of Member’s Health Engagement
• Medication reconciliation

Interventions

Care coordination interventions include:

• Goal setting with members to achieve optimal health outcomes
• Motivational interviewing to assess barriers to change
• Assessment of member engagement into their health
• Providing education regarding health risks and needs assessment
• Collaboration/referral to Patient Centered Medical Home/primary care provider
• Transition of care planning for complex cases
• Coordination of local, regional and nationwide health care services
• Ongoing care management for especially complex and chronic cases
• Referrals to disease management professionals for rare and complex disease management
• Assisting members in making informed health care decisions
• Connecting the members to the right resources within BCBSND to help them understand their benefits

Care management referrals

A member or their authorized representative must consent and agree to participate in the care management program. Enrollment is voluntary, at no additional cost to the member.

Patients may be referred because of:

• Multiple emergency visits
• Acute care admissions
• Chronic conditions
• New cancer diagnosis
• Treatment regimen
• Low utilization of primary care providers and high utilization of specialists
• Other triggers

Care management referrals can be initiated by:

• The member/patient
• The member's authorized representative
• A health care provider

To initiate a referral to care management, contact BCBSND at 800-336-2488.