Wisconsin Medicaid Strategy Relies on Bolstering Data Infrastructure
Many states, including California, are rethinking their Medicaid managed care strategies. In addition to requiring managed care organizations to participate in the state health information exchange by June 2021, the Wisconsin Department of Medicaid Services (DMS) is developing an updated state Medicaid health information technology plan to bolster quality improvement strategies for managed care.
In a draft document outlining the state’s Medicaid managed care quality strategy, DMS noted that timely access to complete and accurate health data for DMS, clinicians, health maintenance organizations (HMOs), and prepaid inpatient health plans (PIHPs) is essential for the execution of payment and service delivery strategies. A robust quality monitoring plan, enabled by health information technology, will support the programs by evaluating if current data systems effectively support programs and strategies and if they collect relevant and adequate administrative, clinical, and other data from multiple sources.
DMS is requiring all BadgerCare Plus and Supplemental Security Income HMOs to participate in WISHIN (Wisconsin Statewide Health Information Network) by June 2021. Additionally, all SSI HMOs are required to incorporate member care plan information into WISHIN in 2021. These contractual requirements will allow the connection of member’s health information (including care plans for SSI members) among physicians, clinics, hospitals, pharmacies, and clinical laboratories across the state of Wisconsin, DHS said. Adopting such health information exchange leads to faster and better clinical decisions, less duplication, more effective transitions of care, and reduced administrative costs.
DMS is modernizing and enhancing its legacy Medicaid management information system (MMIS) to be compliant with CMS’ modular standards. This includes procurement of a fiscal agent and MMIS contract that will create efficiencies and improvements to DMS’ data warehouse and analytics to support data-driven decision-making. The DMS data and technology plan also will establish an electronic quality measurement system.
Wisconsin’s DMS also aims to help HMOs and PIHPs proactively share information with members about their health status and delivery and quality of care. This could include greater use of telehealth, remote patient monitoring, member education, and other tools to engage members in their care. Many HMOs offer mobile applications and/or online patient portals, just as DMS has seen increased adoption of eligibility application and use of the online and mobile eligibility portals. DMS provided increased flexibility to adopt telehealth during the 2020-2021 COVID-19 public health emergency, and is developing permanent policy for coverage of telehealth and remote patient monitoring services, which it said would provide further member choice and improve access to care.
Focus on reducing disparities
BadgerCare Plus and SSI HMOs have specific and increasingly advanced quality measure reporting requirements in the state’s pay-for-performance initiative. This strategy puts financial incentives and withholds on BadgerCare Plus and SSI HMOs to help achieve quality goals. It also uses public reporting on pay-for-performance measures through report cards as a way to drive provider quality improvement and support other strategies, such as member engagement and activation. Beginning in 2020 and expanding in 2021 is the use of HMO Performance Improvement Projects (PIPs) focused on reducing health disparities and increasing cultural competence and screening for drivers of health as part of the HMO P4P withhold. This recent expansion of P4P provides financial incentive for HMOs and partner clinics to specifically target identified health disparities in their quality improvement projects.
