CHEYENNE, WY – In early 2004, the Wyoming Department of Health began developing a program within Medicaid (EqualityCare) to improve the health management of its population, regardless of individual health status or cost burden and throughout the continuum of care.
EqualityCare chose APS Healthcare to oversee the health management of its Medicaid clients.
Since then, EqualityCare has helped improve clinical outcomes and assisted the state in avoiding more than $29 million in healthcare expenditures during 2005 and 2006.
The program, which covers all eligible members, encompasses chronic health management, complex case management and wellness and prevention.
Michelle Harker, RN, medical care coordinator for EqualityCare, noted that at the time of development Wyoming was the only state focusing on total population health management. “We didn’t want to eliminate anyone from obtaining appropriate services,” she said.
The program also included wellness and prevention – again, at the time unaddressed elsewhere – to “break the cycle” of focusing only on costly treatment. The emphasis on client self-management and behavioral change, strengthened relationships between provider and patient and coordination with other agencies within the department have contributed to the program’s success.
Based on claims data, the department has seen a reduction in ER visits and inpatient stays, according to Harker.
The benefit of including all eligible members, as opposed to focusing on members of a particular chronic disease, far outweighs the cost, said Megan Cormier, RN, executive director of APS Healthcare’s Wyoming program, called Healthy Together! By being all inclusive, Cormier said, the program can help patients prevent the onset of chronic conditions, delivering both short- and long-term cost avoidance.
“We’re seeing great financial successes and clinical outcomes,” she said, such as an increase in smoking cessation and medication compliance by members.
EqualityCare is also rolling out its Total Health Record, which includes pay-for-participation for physicians who provide services in the prevention piece and an electronic health record implementation.
Mary Kahn, spokesperson for the Centers for Medicare and Medicaid Services, noted the agency doesn’t compare state programs or endorse any particular program. Still, with the program’s positive financial and clinical outcomes, Cormier hopes a holistic approach of capturing everybody and emphasizing prevention is considered a model to follow.