Population Health Programs

Members having difficulties managing health conditions or treatments outside the definition of complex.  May have unmet social needs.  Providers invited to care conferences to discuss member.

Our First Year of Life nursing team reaches out to mothers of newborns to encourage enrollment in the program. This innovative program is designed to encourage consistent well-child care, including appropriate receipt of immunizations; provide education on appropriate use of the ER as well as home and child safety; prevent injuries and shaken baby syndrome; and identify signs of postpartum depression. The staff continues support and education throughout the baby’s first 15 months of life.

Learn more about First Year of Life (PDF)

This is a state-led program working closely with members who are experiencing opioid misuse. Members are followed up to one (1) year postpartum. 

My Health Pays® is an incentive program that encourages members to make healthy choices. MHS members can earn rewards on a My Health Pays® Visa® Prepaid Card for getting regular checkups and exams. Members can use My Health Pays® rewards to help pay for everyday items at Walmart, utilities, transportation, telecommunications (cell phone bill), childcare services, education and rent.

MHS offers incentives to providers that help our Hoosier Care Connect members quit tobacco.  MHS covers all tobacco cessation counseling and prescription cessation aids. 

MHS has a care management team consisting of nurses and social workers to work with members to manage acute episodes, multiple chronic conditions or events, provide education on new chronic conditions, and link them with health and community resources. The goals of the program are to: A) Identify members who could benefit from case management B) Help members obtain appropriate medical and social services C) Help the member understand the importance of adherence to the provider treatment programs and medication adherence D) Help the member better understand their medical condition and prevent exacerbation of the condition.

This is a signature program for MHS.  High-risk pregnant members are provided culturally appropriate support, advocacy, education, and resources throughout pregnancy, birth, and up to one year postpartum through the use of Doulas and Maternal Community Health Workers.  Members are encouraged to engage in preventative maternal outpatient healthcare for conditions that don’t require emergency inpatient care.  SDOH needs, face to face visits, and custom made care plans are utilized in this program.        

Learn more about Doula and Me (PDF)

The MHS Lead Disease Management Program provides disease management services to its members, including case and care management to ensure timely, effective services for members identified as having exposure to lead. MHS provides assistance with issues such as, but not limited to, coordination of and referral to services for lead testing, lead level monitoring, education, follow-up and identification of any gaps in care as well as providing providers lead level information regarding their members. MHS has adopted the State of Indiana Lead Guidelines. MHS contracts with MEDTOX to provide MHS providers with free lead screening toolkits. Supplies, lab and reporting are all included for free as part of the toolkit.

Members at high risk for pregnancy complications are enrolled in Special Deliveries. These members are assigned to a nurse with high-risk OB experience who follows the members throughout their pregnancies to support their treatment plans and monitor members for potential signs of complication through home visits and over-the-phone communications. Our nurses provide status reports throughout the member’s pregnancy and are available to assist the member at any time. MHS also offers several home-based programs to address complications related to pregnancy, such as gestational diabetes and hyperemesis gravidarum.

Learn more about Special Deliveries (PDF)

Assists members with chronic conditions (including neuro disorders, developmental disorders (i.e., autism), blood diseases, and muscular skeletal disorders.  A multidisciplinary team from MHS will be able to assist the member and the member’s family in obtaining the services they need to achieve optimal quality of life. The main goals of the unit are: A) To reduce/eliminate barriers to care, education, and social activities. B) To reduce/eliminate fragmentation of services and complications relating to co-morbidity frequently seen in special needs children. C) To increase a member’s ability to perform activities of daily living. D) Connect members and their families with community-based resources and support Improve members’ quality of life.

Learn more about Special Needs (PDF)

Assists members in appropriate ED use and utilizing other resources.

HealthWatch, Indiana’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is a comprehensive preventive healthcare program designed to improve the overall health of infants, children and adolescents.

MHS Healthy Celebration events focus on getting members in need of service to the doctor’s office to receive their needed preventive care. MHS partners with a PMP office to schedule a specific day and time (four-hour minimum) for MHS members within that panel and in need of service to visit the office and receive specialty visits and screenings for: Children’s Health: EPSDT/well-child (lead screen age appropriate) or Women’s Health: Mammography & Chlamydia.  After the visit, the family can enjoy games, prizes, refreshments and more before they leave the doctor’s office. Each member receives a goody bag full of MHS informational materials, giveaways and a healthy snack.

MHS offers our award-winning Start Smart for Your Baby program to all of our pregnant members. The program provides educational materials and guidance to encourage our members to obtain prenatal healthcare as well as information about how to stay healthy during pregnancy to improve health outcomes. Members identified with any risk factors are encouraged to enroll in our OB Case Management program. Our nurses contact members to encourage compliance with their treatment plans as well as to answer questions and provide assistance in preparation of delivery.

Assists members who have overuse of narcotics and ED usage.  Members are assigned one PCP and one pharmacy to allow members to make right choices.