Department of Public Health & Human Services

Health Improvement Program Survey

This is a survey from Montana Medicaid/HMK Plus Health Improvement Program. We want to be sure you are getting excellent care from the Health Improvement Program. Your Health Improvement Program care manager (nurse or health coach) is there to help coordinate your health care and give you help you may need for your health issues. You were chosen for this survey because you are actively enrolled in the Health Improvement Program. Please complete this survey so we can see how they are doing and how we can improve the program. Please fill out and e-mail to us. The e-mail button is at the end of the form. The last day to fill out and e-mail the survey is February 27th, 2012. Thank you!

This is an confidential survey and your answers will not affect your Medicaid benefits in any way. We will not show your answers to anyone, including your care manager.

1. What town or county do you live in
How long have you had a care manager (nurse or health coach) from the Health Improvement Program? (check 1 box)
1 - 3 months
3 - 6 months
More that 6 months
Can you reach your care manager when you need to?
Always
Usually
Sometimes
Never
Do you feel like your care manager cares about you and your health?
Always
Usually
Sometimes
Never
Does your care manager answer questions in a way you understand?
Always
Usually
Sometimes
Never
Do you feel like you understand your health issues better since you began working with your care manager?
Yes
No
Has your care manager helped you with any of the following (check all that apply)?
Offered help with making medical appointments
Reminded you to make appointments for doctor visits or medical tests
Helped you with problems with a doctor or other services
Helped you solve non-health related problems
In general, how satisfied are you with the Health Improvement Program?
Very Satisfied
Satisfied
Not satisfied
Do you feel you can better manage your health after working with your care manager?
Yes
No
Not sure
Are you male or female?
Male
Female
Who are you answering this survey for?
Yourself
Child
Other adult
Please tell us anything else you would like us to know about the Health Improvement Program or your care manager, including how we can make the program better.

Thank you again for taking the time to complete this survey. If you have any questions about this survey, you can call 444-1292 or the Medicaid Client Help Line at 1-800-362-8312.

If you would like us to contact you about concerns you have, please give us your name and contact information. Remember, this survey will not affect your Medicaid or HMK Plus benefits in any way. Only put your name on this survey if you want us to contact you.

Name:

Phone Number:

E-Mail Address:

Department of Public Health & Human Services

Health Improvement Program Survey

This is an confidential survey and your answers will not affect your Medicaid benefits in any way. We will not show your answers to anyone, including your care manager.

Once you click on the submit button, you will automatically be re-directed to our home page!