Condition Management Services

The Vendor is required to provide condition management services for Medicaid enrollees.
- Condition management programs for select chronic conditions:
• Asthma;
• Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD); and
• Autism and pervasive developmental disorder.
- Requirement:
• Assists enrollees in understanding their chronic condition, educates means to access potential treatment options, sets goals, and achieves self-selected outcomes through education, counseling, and on-going support.
• Enrollee call line for provider and community information, linkage to community resources and disease specific and general preventive health education and reminders for members.
• Offers assistance with appointment scheduling and connecting enrollees to network providers via a warm handoff.
• Information and specific preventive care reminders, resources, and referrals as requested by enrollees and other stakeholders.
• Promotes and uses evidence-based practices for chronic conditions
• Condition management services reflect each enrollee’s medical and health concerns, specific medical information, and information on how to access available community resources.
• Reaches out to enrollees and network providers during the initial assessment period as well as on an ongoing basis, via phone, in person and through written notification, as well as through the use of community-based supports, to physically make contact when enrollees cannot be reached or when condition management via phone is not successful.
• Enrollees with a condition management specific contact phone number to call with questions.
• The use of collaborative practice models to include physician and support providers
• Enrollee self-management education (including primary prevention, behavioral modification, and compliance surveillance)
• Process and outcome measurement, evaluation, and management
• Routine reporting and feedback loop (including communication with the health plan, enrollee, physician, and ancillary network providers, and practice profiling)
• Tracks data related to activities and outcomes and has reporting available to provide the health plan.