WYOMING TOTAL POPULATION HEALTH MANAGEMENT AND UTILIZATION - - PowerPoint PPT Presentation

WYOMING TOTAL POPULATION HEALTH MANAGEMENT AND UTILIZATION MANAGEMENT PROGRAM OVERVIEW

MAY 28, 2015

WY Health…Get Plugged In Program

June 10, 2015

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• Integrating Utilization Management (UM), Care Coordination (CC), Disease

Management (DM) and Case Management (CM) into one product/program

• Case management is a critical component of the overall integrated care management

program

• Inclusive of both behavioral and medical conditions
• The program assist Medicaid clients requiring care coordination as well as clients with

multiple or complex conditions; helping them navigate the health care system; and adopting strength based self-management practices

• Program Outcome Goals:
• Decrease emergency room visits
• Decrease hospital admissions (preventable)
• Decrease hospital readmissions
• Improved health status

Weight Management Programs

June 10, 2015

3 Weight Management Program for Adults



FitLogix



Criteria for program:



Desire to lose 5% (or more) of current body weight



18 years of age or older



12 month commitment



Access to computer with high speed internet



Clinically appropriate



Program Components



FitLogix Health Coach



FitBit and Digital Scale provided

• Healthy Habits



Criteria for program:



18 years of age or older



3 – 6 month commitment



Program Components



Frequent telephonic teaching and support



Nutrition/weight reduction strategies, tips and support



Weekly client centered goals

Weight Management for Youth

 Back in Whack



Criteria for program:

 Ages 6 – 18  Adult participates with child  2 – 6 month commitment  Have access to a DVD player

 Program Components

 Regular interaction with

WYhealth care manager

 Educational materials  Incentive

Choice Rewards

Diabetes Incentive Program

June 10, 2015

4 Choice Rewards provides education, support and accountability through one-on-one care manager coaching, educational materials and telephonic interaction. The goal of the program is to provide Medicaid clients who have a diagnosis of diabetes with knowledge, skills, motivation and tools to help them make life style changes and adopt long-term habits for managing their diabetes.

 Criteria for program

 All Medicaid patients with a diagnosis of diabetes  Engagement in WYhealth Diabetes Care Management  Completion of assessments with questions asked by WYhealth care

manager

 Program components

 Clients engage in a year long diabetes program focused on health risk

identification, self management practices and addressing mental and emotional aspects associated with diabetes

 Wyhealth care managers provide phone coaching sessions  Incentives are available to those that are 18 and older that meet

criteria

Support Services

June 10, 2015

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 24/7 Nurse Line:

Medicaid clients may call a nurse 24 hours a day seven days a week at no cost to ask questions about health problems or discuss a need to go to the Emergency Department

 Due Date Plus App:

• Free for all Wyoming pregnant women
• Week-by-week guide
• What to expect
• Look up symptoms

Pay 4 Participation

June 10, 2015

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

The P4P program allows Medicaid providers to receive reimbursement for:

 Providing health education to Medicaid clients with chronic illnesses  Referring clients to the WYhealth Care Management program



The program gives healthcare providers additional support to help clients live healthier lives and prevent costly complications associated with chronic disease. The primary goals

• f the program include:

 Preventing gaps in care  Improving clinical outcomes  Promoting compliance with plans of care  Reminders for annual preventive screenings



When a client is referred, a care manager will contact the client and complete an

• assessment. The individualized care management program will include reminders to:

 Receive annual preventive screenings  Make follow-up appointments with their provider as needed  Comply with their plan of care

WYhealth Contact

June 10, 2015

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Telephone - 888-545-1710 Website – www.wyhealth.net info@wyhealth.net

6/10/2015

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HEALTH HELP

Authorization Process Change

June 10, 2015

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 Effective June 1, 2015, authorizations will be

required for Advanced Imaging Services (CT/CTA/MRI/MRA/PET/CNUC)

 Radiation Therapy

(2D3D/BRAC/STER/PROT/IMRT/IGRT

 Cardiology Diagnostic Cardiac Services

Catherterization/Cardiac Devices/Implantable and Wearable Devices/Echo

Authorization Process Change

June 10, 2015

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 List of CPT Codes are available at

www.wyhealth.net/Cardiology_Radiology.html

 Claims for these services will require authorization

for DOS 6/1/15 forward

 Authorization numbers are to be requested by the

referring provider and provided to the rendering facility

Authorization Process Change

June 10, 2015

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 Radiology, radiation therapy or cardiology services

rendered in an ER setting that are determined to be non-emergent or elective (in accordance with WDH Policy and NUBC guidelines), will require an authorization through HealthHelp

 When services are provided after hours, the

consultation may occur after service delivery and authorization will be issued retrospectively with appropriate documentation.

 Services that are emergent do not require an

authorization

Authorization Request Notification Process

June 10, 2015

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 Internet/Web:

www.wyhealth.net/Cardiology_Radiology.html

 Fax: 1-866-778-6483 (form on website)  Phone: 1-888-545-1710 prompt 4  Hours: 6:00AM – 6:00PM MST (after hours

requests can be submitted via the web or fax)

Contact Information

June 10, 2015

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 Provider Support – Xerox (WYhealth)

Morris McGaugh, Morris.McGaugh@xerox.com 307-554-0317

 Network Relations Consultant – HealthHelp

Andre King kingan@healthhelp.com Office (281) 582-1741

 Client Manager - HealthHelp

Michael Ideson idesonm@healthhelp.com Office (281) 582-1710