Common use of Disease Management Clause in Contracts

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise HIP members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 7.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs, as well as HIP medically frail members enrolled in the disease management programs. For example, the diabetes disease management quarterly report will include (i) all medically frail members with two or more claims in the calendar year for diabetes, and the numerator shall include all members with two or more claims in the calendar year for diabetes; and (ii) all members with two or more claims in the calendar year for diabetes, and the numerator shall include those members enrolled in case or care management as defined below. Separate, mutually exclusive calculations for members in case and care management shall be conducted. The reports shall also identify any member at least three (3) standard deviations outside of the mean of utilization of inpatient days, emergency department visits and home health service days for the population group. All disease management programs must shall encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. ‌ The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-population- based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community community-based services such as Connect2Help211Xxxxxxx0Xxxx000, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP XXXX believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-population- based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategiesstrategies , outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community community-based services such as Connect2Help211Xxxxxxx0Xxxx000, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-under- utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP believes that the Contractor’s disease Contractor management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any th time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community based services such as Connect2Help211, food pantries, housing and housing supports, legal, employment and disaster services.

Disease Management. The Contractor shall offer, at minimum, asthma, depression, pregnancy, ADHD, autism/pervasive developmental disorder, COPD, coronary artery disease, chronic kidney disease, congestive heart failure, HIV, Hepatitis C and diabetes disease management programs for eligible Hoosier Healthwise members. Members with excessive utilization or under-utilization for conditions other than those listed shall also be eligible for the disease management services described in this section. Members with these conditions should be identified through the health needs screening tool described in Section 4.2.3 and by identification of conditions based on claims. The Contractor shall make a spectrum of disease management tools available to the population, including population-based interventions, care management and complex case management, as described below. All care and case management programs should identify psychosocial issues of the members that may contribute to poor health outcomes and provide appropriate support services for addressing such issues. The Contractor shall submit quarterly reports to OMPP regarding the selection criteria, strategies, outcomes and efficacy of these and any other disease management programs offered by the Contractor. The quarterly reports shall include participation rates and utilization and cost statistics of both total members enrolled in the disease management programs. All disease management programs must encourage compliance with national care guidelines (e.g., American Diabetic Association) and incentivize healthy member behaviors. All members shall be sent population-population- based disease management materials (e.g., educational fliers, screening reminders, etc.). OMPP XXXX believes that the Contractor’s disease management programs will serve as a critical area for pursuing continuous innovation in improving member health status, and disease management programs may be subject to onsite visits or external quality reviews. OMPP reserves the right to require the Contractor to have disease management programs for additional conditions in the future. OMPP will provide three (3) months advance notice to the Contractor if OMPP decides to add new diseases to the disease management program requirements. The Contractor is encouraged to offer additional disease management programs beyond those required in the Scope of Work. If the Contractor provides additional disease management programs, the Contractor shall also provide annual updates to OMPP documenting the strategiesst rategies, outcomes and efficacy of the additional disease management programs. OMPP reserves the right to examine the Contractor’s disease management programs at any time, including during the proposal review process, prior to Contract execution, during the readiness review and during the term of the Contract. Disease management consists of three levels of Contractor-member interaction, including population-based interventions, care management and complex case management. For the purpose of this Contract, the term care coordination will serve as a global reference for case management, care management, complex case management or any other term referencing the organization, synchronization and/or management of health care services for the benefit of the member. Similarly, the term care manager is used for ease to describe the staff person performing the functions of disease management, case management, care management, or complex case management when organizing, synchronizing and/or managing health care services servi ces for the benefit of the member. Members served in the Contractor’s disease management, care management and complex case management services may require additional resources to meet their biopsychosocial needs. To meet these needs, the Contractor shall make every effort to assist members in navigating community resources and linking members with community community-based services such as Connect2Help211Xxxxxxx0Xxxx000, food pantries, housing and housing supports, legal, employment and disaster services.