Program teaches clients how to use medical resources more effectively

HELENA - A state program to help Medicaid clients in Montana avoid overusing the health-care system is doubling its enrollment to 600 people.

Team Care requires healthy people who overuse Medicaid services to enroll in the program and choose one primary care provider and one pharmacy to manage their health care. Those enrolled also are required to call Nurse First, a 24-hour-a-day, seven-days-a-week nurse advice line before accessing health care, even from their primary health provider, except in emergencies.

The Medicaid clients enrolled continue to receive the professional care they need, with a team to help them decide how, when and where to get health care, the state Department of Public Health and Human Services said in a press release.

The program, now a year old, has reduced its members' visits to doctors and emergency rooms by more than 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 department's Medicaid Managed Care Bureau.

Although other states have put on restrictions on those who misuse Medicaid, the Montana Team Care program is the first nationally to require clients to call the Nurse First line before seeking medical care, even from their own doctor.

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."

Ladd said her office has seen a decrease in inappropriate visits, which allows providers to spend more time on patients who really need the health care.

"Team Care is like having an extra staff member without the cost," she said.

The state agency, which administers the Montana Medicaid program, has shifted to a care management approach in recent years to save money by using medical resources more effectively. Health-care providers 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.

Medicaid is the federal-state health care program for the poor, elderly and disabled. The federal government pays 70 percent of the cost, while the state pays 30 percent. It provides annual benefits of $387.2 million and provides health care to 82,322 Montanans. These figures do not include the cost of program administration.

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.