Wyoming Super-Utilizer Program (WySUP)

Johansson S, Fuchs F
Patient Need Addressed: Care Coordination/Management
Population Focus: Complex care
Type of Literature: Grey
link: https://www.wyoleg.gov/InterimCommittee/2016/10-0825AppendixT.pdf
Abstract

N/A

Insights Results

Overview of presentation

  • This presentation provides an overview of the development, objectives and methodology of Wyoming Department of Health’s program targeted at super-utilizers
  • The program was developed through 3 main channels: 1) Legislature mandated Medicaid reform in 2013 that required study of managed care; 2) Implementation of the managed care study in 2014. This study suggested that the Wyoming Health Department should continue the Patient-Centered Medical Home initiative, the state should not pursue full-risk managed care and the state should develop a Super-Utilizer Program (SUP); and 3) National Governors’ Association Policy Academic in 2015, where the WySUP concept was developed
  • The objectives of WySUP include the following: 1) Lower overall Medicaid costs. This includes both medical and WySUP costs with a demonstrated return on investment; 2) Improve clinical outcomes using claims data and EHR data; and 3) Build care coordination capacity in the state, especially in the longer-term
  • Phase 1 of the program was the design phase in collaboration with the Governor’s Office and National Governors’ Association. The Department developed 2 prospective risk-scoring methods to predict future healthcare costs from demographics and past experience. Model 1 focused on clinical risk and uses open-source Chronic Illness and Disability Payment System applied to previous 13 months of all recorded diagnoses. Model 2 focused on utilization risk using past 13 months of emergency department and inpatient use and overall costs. Both models fit using Wyoming Medicaid claims data
  • Phase 2 shifted towards implementation of the program. The state identified 1500 of the highest-risk clients who were randomly assigned into “treatment” and “control” groups (750 in each group). Next, the “treatment” list was given to a care management organization where 500 clients received intensive, in-person care coordination focusing on building self-management and resilience. Finally, the state tracked outcomes for clients
  • Phase 3 is ongoing. In this phase, the State identifies clients prospectively. Results from evaluations will allow the State to iterate towards better risk-scoring algorithms. This phase also began including mental health clients. Additionally, regional entities, made up of primary care, behavioral health, EMS, hospitals, case managers and other providers, were formed to conduct care coordination activities in areas where regional entities hadn’t formed. They began cost-based and shared savings model, gradually moving to shared-risk models
  • Most clients were low-income adults receiving supplemental security income
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