For Immediate Release
Cheyenne, Wyo.
July 24, 2007
Wyoming Medicaid Program Encourages Preventative Screenings, Patient Education by Promoting Financial Incentives to Providers
Today the Wyoming Department of Health (WDH) EqualityCare (Medicaid) Program announced that it is expanding its effort to encourage providers to offer preventative screenings and services to their Medicaid clients. EqualityCare has launched its “Pay for Participation” program which offers incentives to Wyoming healthcare providers when nationally recognized, evidence-based clinical guidelines are used for screening for and educating patients on preventing illness.
The Pay for Participation effort supports EqualityCare clients who have a chronic illness such as diabetes, heart disease or asthma. The new program places a stronger focus on all EqualityCare clients practicing healthy lifestyles and on preventing illness before it occurs, giving providers a financial incentive to offer those services to their patients.
“While many of our activities focus on supporting clients with chronic illness, taking steps to prevent disease is just as important in our effort to provide quality care at a lower cost,” explains Teri Green, manager of the EqualityCare program. “Therefore, we’re promoting the use of certain Medicaid reimbursement codes to incentivize healthcare professions to provide screenings and education services. We’re hoping this focus will encourage providers to comply with clinically proven guidelines, and eventually make an impact on improving health within the state.”
Promoting Healthcare Quality Using Monetary and Non-Monetary Incentives
Through Wyoming’s Pay for Participation program, providers can receive a higher reimbursement for a traditional office visit if they complete a health assessment on each patient – including assessing their level of depression, tobacco use, alcohol consumption, weight and nutrition and vaccination history. Providers will also be rewarded for helping patients with chronic illnesses understand how to reduce their risk factors for developing complications, such as educating diabetics on the importance of checking their feet daily for ulcers and getting routine eye exams.
“Another goal is to support the provider-patient relationship by paying practitioners to spend quality time and provide education and self-management tips,” adds Dr. Brent Sherard, WDH director and state health officer. Several Pay for Participation incentives are based on the time that providers spend with their patients on education – such as providing 15 or 30 minutes of tobacco cessation education – and others encourage “group visits” whereby 15 to 20 patients receive in-depth guidance on managing a disease.
The Healthy Together! health management program offers providers technical assistance with coding and conducting group visits, patient education material and provider education sessions on clinical guidelines. Staff is currently working with a few providers who treat a large number of Medicaid patients in their practice on implementing the incentives into their practices.
Study: Preventative Services Not Reaching the Masses
A recent Partnership for Prevention study sponsored by the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ), found that more than 50 percent of Americans who need preventative services do not receive them. The study went on to list the top 25 recommended preventative services based on those that provide the greatest health benefits.
In response the study, Dr. Sherard states, “This study demonstrates the value of investing in prevention, as well as which screenings and services can help benefit health and cost outcomes for a state. The Wyoming Pay for Participation program directly supports the use of these services.”
Some of the highest ranking services also supported by Pay for Participation incentives include:
- Screening adults over 50 for colorectal cancer
- Counseling smokers to help them quit
- Screening all patients for depression
- Vaccinating adults against bacterial pneumonia
- Screening sexually active youth for STDs
- Offering nutrition counseling for individuals with obesity or that are overweight
Paying for Participation, Not Performance
“States have a responsibility to help providers recognize opportunities to improve the care of their citizens,” Green continues. “By developing incentives that motivate change and supplying providers with technical assistance and health information technology to support that change, Wyoming anticipates reaping rewards in the form of cost savings and positive health outcomes.”
“While simultaneous ‘pay for performance’ efforts are being monitored by Medicare and used in managed care around the nation – the payment of fees is contingent upon physicians’ performance on certain measures – Wyoming stakeholders wanted a mutually developed, supportive model of participation and reward that would produce satisfaction amongst providers and clients, as well as improved adherence to evidence-based guidelines and positive outcomes,” Green concludes.
Wyoming leveraged guidance from other state programs, the Center for Medicare and Medicaid Services, and from a diverse set of stakeholders on an advisory board. The board – addressing operational, methodological, and political issues that arise – developed the list of guidelines for preventative and chronic care which are part of the incentive program, the type and level of incentives, methods of tracking and provided feedback on potential barriers to participation.
The Pay for Participation program – a key component of Wyoming’s cutting edge approach to linking services and providing customized, preventive healthcare to clients – is the first step in an ambitious effort to give patients, families and the entire provider team access to a broad range of intelligent data on the patient’s health condition via a Web-based total health record (THR). The state is exploring providing incentives to providers to use the THR as a data registry in their practice which would enable tracking of labs, screenings and other outcomes valuable to the state.
About Healthy Together!
Healthy Together! is offered by the Wyoming Department of Health to all Wyoming EqualityCare clients. The program provides clients with one-on-one support from a nurse health coach, educational materials to encourage the self management of their health and assistance in coordinating their care among multiple providers at no cost. Healthy Together! also provides EqualityCare clients with information on weight loss, smoking cessation and how to adopt healthy lifestyles. Healthy Together! was named the Best Government Disease Management Program by the Disease Management Association of America in 2005.
For more information:
Sarah Clark-Lynn
Manager, Corporate Communications
800-305-3720, ext. 3266
sclynn@apshealthcare.com
Kim Deti
Public Information Officer, Wyoming Department of Health
307-777-6420
KDETI@state.wy.us
|
