Wyoming Total Population Health Management and Utilization Management Program Overview

1. Wyoming Total Population Health Management and Utilization Management Program Overview May 28, 2015

2. WY Health…Get Plugged In Program • 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

3. Weight Management Programs 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

4. Choice Rewards Diabetes Incentive Program 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

5. Support Services • 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

6. Pay 4 Participation • 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

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

8. HEALTH HELP

9. Authorization Process Change • 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

10. Authorization Process Change • 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

11. Authorization Process Change • 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

12. Authorization Request Notification Process • 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)

13. Contact Information • Provider Support – Xerox (WYhealth) Morris McGaugh, Morris.McGaugh@xerox.com 307-554-0317 • Network Relations Consultant – HealthHelp AndreKing kingan@healthhelp.com Office (281) 582-1741 • Client Manager - HealthHelp Michael Ideson idesonm@healthhelp.com Office (281) 582-1710