We appreciate the courtesy and cooperation extended to us by the Department of Administration and other state agencies during the audit.
Sincerely,
Janice Mueller
State Auditor
__________________
A1038
State of Wisconsin
Joint Legislative Council
Madison
December 20, 2010
To the Honorable, the Assembly:
Enclosed is a copy of the General Report of the Joint Legislative Council to the 2009-2010 Legislature, prepared and submitted pursuant to s.
13.81 (3), Stats.
I would appreciate your noting in the Assembly Journal, pursuant to s.
13.172, Stats., that this report has been delivered to your office. Thank you.
Sincerely,
Terry Anderson
Director
__________________
State of Wisconsin
Department of Health Services
Madison
December 22, 2010
To the Honorable, the Legislature:
As required by
2009 Act 28, Section
1301e, this letter provides a brief summary of the Southeast Wisconsin HMO plans for implementing Patient-Centered Medical Homes for high-risk pregnant women in their service area. I have also attached a copy of each of the four complete plans for your information as well as a copy of the relevant HMO contract language.
The four BadgerCare Plus-contracted health plans in SE Wisconsin are: Abri Health Plan, Children's Community Health Plan, CommunityConnect Healthplan and United Healthcare. These four HMOs were selected through a Request for Proposal to serve BadgerCare Plus members enrolled in the Standard and Benchmark plans in Milwaukee County and the five surrounding counties.
I am pleased to report that all four health plans are working together on this initiative and have jointly recruited several clinics to serve as medical home pilot sites. The sites serve predominately low-income, minority populations and provide comprehensive prenatal and postpartum care for high-risk women. A list of the sites is enclosed for your information.
The medical home pilots will begin operation on January 1, 2011 and continue through the life of the current contract, December 30, 2013. By contract, each HMO is required to enroll a minimum of 100 women in the medical homes in year one, 200 per HMO in year two and 300 per HMO in year three. DHS anticipates much higher enrollment rates by the second year of the pilot.
The implementation plans met and, often exceeded, requirements specified in the contract. DHS is pleased with proposed comprehensive efforts to identify women who may benefit from participating in a medical home, including extensive work with community-based organizations to assist with outreach. The plans include a range of incentives designed to help ensure that women remain enrolled in the medical home throughout their pregnancy and through the postpartum period. Centering Pregnancy, an evidence-based program providing group-based care for women with similar due dates, is a key component of patient engagement strategies.
Each implementation plan describes appropriate protocols for ensuring that women keep appointments and for follow-up for missed appointments, including home visits, personal phone calls and the use of collateral contacts. Each plan also emphasizes that an obstetric care provider will be the primary point of contact for the pregnant woman and will be responsible for coordinating all needed care among multi-disciplinary teams. Protocols appear to be in place for ensuring immediate access to care and 24/7 access to medical advice.
Each participating clinic follows prenatal and postpartum guidelines issued by the American College of Obstetrics and Gynecology and other nationally-recognized guidelines for treating women with chronic conditions such as diabetes and hypertension. Care coordinators will work with each clinic to ensure that each BadgerCare Plus member enrolled in the medical home receives the services and supports she needs to have a healthy baby.
Throughout the medical home initiative, the HMOs will monitor and report on a number of performance measures, including three HEDIS (Healthcare Effectiveness Data and Information Set) measures-early prenatal care, frequency of prenatal care and postpartum care-as well as patient satisfaction. Performance information will be shared regularly with practices, providers and patients.
DHS is working collaboratively with the HMOs to develop a comprehensive evaluation of the medical home pilots for high-risk pregnant women. We would be happy to share the evaluation plan when it is completed.
Please feel free to contact Jason Helgerson, Medicaid Director and Administrator, Division of Health Care Access and Accountability,
Jason.Helgerson@wi.gov or 608-267-9466, if you have any questions or need additional information.
Sincerely,
Karen E. Timberlake
Secretary
