January 20, 2006

Program to Reduce Medicaid Misuse to Double Enrollment

Healthy people may have many reasons to see a doctor more than 20 times a year: Some may truly be confused about when to seek care. Some may need reassurance. Others may be looking for drug prescriptions.

This month, Team Care, a program designed to help Montana Medicaid clients avoid overusing the health-care system, will double the number of its enrollees to 600.

Team Care requires healthy over-users of Medicaid services to enroll in the program and choose one primary care provider (PCP) and one pharmacy to manage their health care. All Team Care enrollees are also required to call Nurse First, a 24-hour-a-day, 7-day-a-week nurse advice line, before accessing health care (even from their PCP), except in emergencies. Team Care clients continue to receive the professional care they need, and a team to help them decide how, when, and where to access care.

Now a year old, Team Care has reduced its members’ visits to doctors and emergency rooms by over 20 percent.

“Team Care is a win for everyone: providers who are frustrated with over-users of health care services, Medicaid clients who are taught how to use medical resources more effectively, and Montana citizens whose tax dollars are used more economically,” said Mary Angela Collins, chief of the Medicaid Managed Care Bureau of the Montana Department of Public Health and Human Services (DPHHS).

While other states have initiated restrictions for those who misuse the Medicaid program, Montana’s Team Care program is the first to require clients to call the free Nurse First Advice Line before seeking any medical treatment, even from their own doctor.

Montana health-care providers are enthusiastic about the Team Care program.

“Because Team Care clients are required to call the Nurse First Advice Line before seeking care, my office is able to operate more efficiently,” said family nurse practitioner Ladonna Ladd of Missouri River Healthcare in Great Falls. “Non-urgent phone calls to our office have decreased, which means we spend less time on call-backs. We’ve also seen a decrease in the number of inappropriate visits to our office, which means we can focus our time on higher acuity patients. Team Care is like having an extra staff member without the cost.”

DPHHS, which administers the Montana Medicaid program, has shifted to a care management approach in recent years in order to save money by using medical resources more effectively. Health-care providers also played a significant role in the design and expansion of the Team Care program.

Team Care clients are assessed for “graduation” from the program based on their first year’s experience. The first group of successful Team Care members will graduate this spring back into standard Medicaid.

For more information about the Team Care program, contact Chris Silvonen at the DPHHS Managed Care Bureau at (406) 444-1292 or e-mail csilvonen@mt.gov.

Page last updated: 06/13/2006