Texas Medicaid Wellness Program

Provider Information

The Texas Medicaid Wellness Program is a comprehensive care management program with no disease exclusions, offered to high-cost and/or high-risk Medicaid fee-for-service and Primary Care Case Management (PCCM) clients.  The Wellness Program takes the place of the Enhanced Care program which concluded on February 28, 2011.

Eligibility

All clients who were eligible for the Enhanced Care program will be automatically transitioned into the Texas Medicaid Wellness Program as of March 1, 2011.

Purpose

The goal of the Wellness Program is to promote improved health outcomes by supporting and sustaining the provider-patient relationship. 

Services

The program supports eligible Medicaid clients with a series of regional care teams consisting of:

• Community-based primary registered nurses.
• Pharmacists.
• Social workers.
• Behavioral health specialists.
• Dieticians.
• Certified diabetes educators.
• Community health workers. 

Other benefits include:

• Diabetes self-management training.
• Weight Watchers obesity program.
• Additional support and resources available via an internet-based patient portal.

Providers with patients in the Wellness Program will receive rosters and summaries for any eligible patients linked to their practice through claims data.  Providers can also refer eligible patients into the program.  In addition, providers have the opportunity to review, approve, or make recommendations for the Wellness Program care plan created for each of the individual patients in the program.

The Wellness Program also offers a variety of new benefits for providers and their practice, including:

• A comprehensive provider portal, where providers can review patient summaries, claims data, care plans, and patient education materials.
• Practice support facilitators, who will provide practice improvement tools and training, assist with Patient Centered Medical Home certification, and familiarize provider offices with other Wellness Program components.
• Learning collaboratives designed to allow physicians to share their clinical improvement experiences.
• Support for practice transformation initiatives.

The Wellness Program considers the provider the leader of their patient’s care team.  The Texas Medicaid Wellness Program is an extension of that team.  Providers are encouraged to take advantage of this program to help improve the ongoing care for their patients.

The Program Director and Medical Director for the Texas Medicaid Wellness Program is
Dr. Esteban Lopez.  If you have any questions about the Wellness Program, or if you need any additional information, please call the new Wellness Program provider phone number at
1-877-530-7756, or you may e-mail Dr. Lopez directly at esteban.lopez@mckesson.com.