wyoming total population health management and utilization management program overview may 28, 2015
TRANSCRIPT
WYOMING TOTAL POPULATION HEALTH MANAGEMENT AND UTILIZATION MANAGEMENT PROGRAM OVERVIEW
MAY 28, 2015
WY Health…Get Plugged In Program
April 19, 2023
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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
April 19, 2023
3Weight Management Program for AdultsFitLogix
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 YouthBack 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
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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 managerProgram 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
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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
April 19, 2023
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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 of 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
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Telephone - 888-545-1710Website – www.wyhealth.net
04/19/23
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HEALTH HELP
Authorization Process Change
April 19, 2023
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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
April 19, 2023
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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
April 19, 2023
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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
April 19, 2023
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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 4Hours: 6:00AM – 6:00PM MST (after hours
requests can be submitted via the web or fax)
Contact Information
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Provider Support – Xerox (WYhealth) Morris McGaugh, [email protected] 307-554-0317
Network Relations Consultant – HealthHelp Andre King [email protected] Office (281) 582-1741
Client Manager - HealthHelp Michael Ideson [email protected] Office (281) 582-1710
