More changes may be in store for Wyoming Medicaid as lawmakers look to cut costs in one of the state’s most expensive programs.

The state Department of Health is already redesigning its Medicaid eligibility system, as well as a program that pays for disability services. Now it’s exploring what could be the biggest modification yet: altering how it manages health care for the roughly 90,000 poor and medically needy people who use Medicaid annually.

Wyoming is one of only three states that don’t already use some form of managed care in their Medicaid programs. Earlier this year, Wyoming lawmakers asked health officials to study whether such a system could save the state money while providing care that’s at least equal to what patients now receive.

In the traditional managed care model, a state pays a private group to run a provider network that serves the Medicaid population. The company monitors care of Medicaid recipients, controlling costs along the way.

However, the study isn’t confined to the traditional model, said Meredith Asay, who administers the Health Department Director's Unit for Policy, Research and Evaluation. Instead, it will examine many options for managing or coordinating care.

“We are really focusing on what would work for Wyoming because Wyoming is unique,” she said, referring to the state’s rural population.

Escalating costs prompted the move toward reform. Medicaid is expected to cost the state $560 million during the ongoing two-year budget cycle.

Under the existing system, physicians are typically reimbursed by Medicaid for each service they perform. Patients receive assistance from a case manager, but in some cases, their primary doctor might not coordinate with specialists who are also providing treatment. That can lead to redundant services and waste.

Lawmakers want to know whether the state can address rising costs by changing how a patient’s care is paid for and managed. For example, instead of getting paid for each individual service, a doctor might receive a bundled payment for an entire diagnosis – such as the care a woman receives for the duration of her pregnancy.

Another option would involve paying providers based on the outcome of their care. A doctor might get a bump in pay for a drop in her patients’ hospital readmission rate.

The study will also look at ways to encourage more coordination between medical providers. That could come in the form of patient-centered medical homes, physician-led practices that use teams of providers to provide comprehensive care. The approach focuses on prevention while avoiding waste that can happen when patients seek care from multiple independent doctors.

Some Wyoming physicians are leery of the traditional managed care model, believing it’s not an effective approach for addressing their patients' needs. But their support is essential if that state decides to move forward with changes.

Next week, the health department will host five forums to gather public input for the study, which is expected to finish next spring. But health officials have already begun reaching out to physicians for feedback, said Wyoming Medical Society Executive Director Sheila Bush. The group represents about half of the state’s doctors.

Doctors generally support a coordinated care system, such as a medical home, over the traditional managed care model, Bush said.

“It gives them an opportunity to spend more time with patients,” she said.

Doctors need to be involved in the study because new models could sound good in theory, but might not work as well in practice, according to Bush.

“Physicians want to be part of the solution,” she said. “They absolutely recognize the need for addressing some of the inefficiencies in the system. They just want to make sure the efforts are directed in the right way.”

Contact Joshua Wolfson at 307-266-0582 or at josh.wolfson@trib.com. Visit http://trib.com/news/opinion/blogs/wolfjammies to read his blog. Follow him on Twitter @joshwolfson.

(1) comment

side oiler
side oiler

There is no doubt that Medicaid is ripe with fraud,especially from single mommies on welfare,something republicans sure condone anymore.

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