GREEN RIVER – The Wyoming Department of Health is studying “coordinated” or “managed” care approaches that may benefit Wyoming Medicaid. Earlier this year the Wyoming Legislature enacted legislation requiring the Wyoming Department of Health to study the possible use of managed or coordinated models of care for some or all of the people enrolled in Wyoming Medicaid.
Five public forums have been conducted around the state to seek input for the effort. WDH has contracted with Health Management Associates to help complete the study. Each forum was an important opportunity for Wyoming Department of Health and Health Management Associates to get feedback from Medicaid enrollees, providers and other stakeholders. Health Management Associates facilitated the meetings.
During the October 25th forum in Green River, Health Management Associates Senior Consultant Michealle Gady explained that the Wyoming Legislature voted to have the system studied but that doesn’t mean that changes are inevitable. “The study may find that we cannot or should not implement changes,” Gady said.
She explained that the study is focused on two issues, “Payment and care delivery models.”
The spectrum of payment models being considered range from the current model, which is payment to providers for services rendered, all the way to a single payer system administered by the government.
The spectrum of possible care delivery models was equally broad, ranging from leaving decisions on how to best treat patients in the hands of individual providers, to various levels of managed care and fixed prices for services, all the way to universal managed care.
According to health care providers present at the meeting, infrastructure issues and systemic fragmentation are the biggest challenge they see in implementing change in the Medicaid system.
“I don’t think the politicians understand the moral cost of the problem,” a nurse who was present in the audience said during a question and answer period.
“You’re up against the mineral lobby” one medical service provider said. “You might get five minutes with a politician.”
Another service provider explained that just to verify, a patient now on Medicare requires a receptionist to telephone the state and wait on hold for ten minutes. “They used to have a sliding card,” she said, citing staff cuts at the state level for the daily delay.
Others providers and administrators present at the meeting said that their organizations need to make use of telemedicine and other technological advances but can’t due to limitations of technology. An administrator present at the forum said that “If we had the infrastructure we could implement one of these plans, but we have places in the state that don’t even have fiber (optic cable) laid yet.”
A psychologist present explained that because of privacy laws he was unable to really understand the big picture in his own medical specialty much less the future of health care in general.
“Legally we can’t discuss our rates. I don’t know what my colleagues in Jackson are doing, or charging in this day and age when you know what a friend half way across the world is doing through Facebook.” The psychologist lamented.
All the service providers present agreed that Sweetwater County lacks an entity to coordinate care for patients.
“Each county is like it’s own state” a case worker said. She explained that the daily mileage a mobile care professional puts in to reach patients can exceed the cost of the actual treatment.
Mike Lynch, a retired Green River miner, asked how changes in the system might impact his private insurance. Gady said that private insurance would not be impacted by the changes being discussed.
Lynch, who grew up in the United Kingdom, said that in his opinion the State of Wyoming needs to invest in the health care system. “I think we are in crisis.” He said that he has experienced the best in private insurance, which he is lucky to still have, and universal health care in the UK before he immigrated, “What we would call universal health care isn’t that bad.”
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