Montana's Quality Higher Education System

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Managed Care Program

 

FOCUSED CASE MANAGEMENT, DISEASE MANAGEMENT,

AND HEALTH COACHING

 

Focused case management, disease management, and health coaching services are provided by MUS care professionals (Benefits Department and Wellness Program) or contracted vendors.  These professionals work with Plan Participants who can benefit from these services as well as their attending physician, and/or their family to identify and arrange the most appropriate, effective, and cost-efficient treatment possible.  Services are focused on Plan Participants identified as having:
      • a catastrophic illness or injury; or
      • significant medical risks; or
      • chronic health care needs, which can be reduced through prevention or disease management; or
      • needs for wellness promotion and/or health coaching.
Plan Participants will be identified through analysis of information, such as medical/pharmaceutical claims data, and/or wellness screening results to determine who is most likely to benefit from these services.  You or an adult family member enrolled in a MUS health plan offering will be individually contacted by a care professional if you (or the enrolled family member) qualify.  Program provisions require that the care professional which provides these services keep all claims data and other medical information strictly confidential.  When offered focused case management, disease management, or health coaching services, Plan Participants are encouraged to give them careful consideration, but are free to reject some or all proposals or advice.  Use of these services is voluntary, free of charge to the MUS Plan Participants and helpful in several ways:
    • It can permit treatment options not normally available under the MUS plan through plan exceptions.  The MUS plan may, at its sole discretion, make payment for medical or dental services that are not listed as covered services or benefits of this Summary Plan Document in order to provide quality care at a lesser cost.  Such payments shall be made only upon mutual agreement by the Plan Participant and the MUS plan; and
    • It saves both the MUS plan and its Plan Participants money by providing a third party to help identify the more efficient/lower cost suppliers of medical goods and services, coordinate services, work out cost reductions, and make arrangements for special treatment plans. 
For assistance, contact Sherri Rickman, RN/BSN, Case Manager
406-444-3853  or 1-800-287-8266 ext. 3853

(page 40 of Summary Plan Document)