Medicaid managed care services in the state of Indiana for the HIP and HHW populations in conjunction with the existing HCC membership population.
Client will deploy a “Locate and Engage” Program, operated by Professional Management Enterprises (Supplier), an Indiana Veteran Business Enterprise, to deploy community-based, Member engagement professionals to assist client in finding and engaging hard-to-locate members throughout the state of Indiana.
A significant proportion of these members will have behavioral health diagnoses or other complex health and/or social situations.
Scope of Work:
Community Health Workers’ will provide community-based, face-to-face support to locate targeted Indiana Medicaid Members who are most at risk for disengagement from the healthcare system, and will build trusting relationships with such Members, thereby increasing their positive engagement with the Client Care Management team and the healthcare system and addressing their key health and social determinant risk factors through best practice and evidence-based interventions.
Client will identify the members to be targeted for this outreach.
The primary will be as follows:
Locating hard to find members referred to Supplier by Client
Developing a personal relationship that allows for ongoing communication and engagement with the Member
Assessing the current state of the Member’s environment and lifestyle – identifying risk factors that are contributing to the Member’s disengagement from the healthcare system
Problem solving and breaking down barriers, recommending and engaging resources as appropriate to address identified risk factors through best practice and evidence-based interventions
Assisting the Member in understanding and making appropriate use of their health benefits
Providing information and education that promotes the Member’s engagement in their own health and empowers self-care
Promoting engagement with the client Care Management team and key medical providers
Motivating the Member to seek healthcare on a regular basis from the appropriate professional on a self-directed basis, with the support of an Client Care Manager as needed.