In response to a legislative mandate, the Wyoming Healthcare Commission arranged for a study to see where the state could make changes in its Medicaid program to improve cost effectiveness and offer better care.

The study and its recommendations were presented by Milliman, Inc. at Monday's commission meeting in Casper. Milliman Inc., an international consulting firm, offered recommendations on how to restructure Medicaid for long-term care and developmentally disabled patients in the state.

Bruce Pyenson, of Milliman, said that even though the state has a passionate and open attitude about the care of these two groups, there are still some improvements that could be made.

"[The Wyoming Medicaid program] needs to move from a program that manages entitlements to one that manages the care process," Pyenson said.

Pyenson and Kathryn Fitch, a registered nurse who works for Milliman, sorted through Medicaid claims and enrollments and interviewed more than 30 people in the medical profession in Wyoming to come up with data and recommendations for managing the care of these groups.

They found that about 6,600 of the more than 70,000 Medicaid patients in Wyoming fall into the long-term care or developmentally disabled categories.

Fitch said that even though the two groups only make up about 10 percent of the Medicaid population, they make up 40 percent of the state's Medicaid spending.

To try to generate savings for the state, the Milliman consultants recommended that the state's Medicaid program do a better job of case management of personal and medical care.

"This includes providing housekeeping services so an elderly person isn't taking out their trash in the dead of winter and slipping on the ice and ending up in a hospital with a broken hip," Fitch said.

Another recommendation was to get a fixed Medicaid budget from the federal government. Now, the federal government reimburses the state based on how many claims it handles, and Pyenson said this does not reward medical institutions who practice efficient medicine.

Greg Gruman, state Medicaid director, thought such prefunding would be a good idea, but the healthcare commission will now have to decide what recommendations it will bring to the Legislature.

"We asked Milliman to be bold and give us bold ideas," said Dixie Roberts, chairwoman of the commission. "We need to use them as a resource and find out where we can go with this information."