Two-Month Report, Vol. 14

From: T. Chris Muirhead, Chairman

For Period: June 1 – July 29, 2005

To: Governor Dave Freudenthal

Joint Labor, Health and Social Services Committee

Senator Charles Scott, Chairman

Representative Doug Osborn, Chairman

Items attached to report:

  • June and JulyWyoming Healthcare Commission meeting agendas
  • June and JulyWyoming Healthcare Commission meeting minutes
  • June 29 Governor’s Toolbox of Ideas Notebook
  • June 10 Health Information Technology Technical Management Subcommittee Meeting Minutes
  • July 18 Regional Health Information Organization meeting agenda and minutes
  • July 19 Total Health Management meeting agenda and minutes
  • Reinsurance pool actuarial study briefing

Activities

June and July, the Wyoming Healthcare Commissiondeveloped 25 ideas, 18 of which were finalized and submitted to Governor Freudenthal as a “Toolbox of Ideas” for responding to the healthcare delivery system. This responsibility waslaid out in the Commission’s enabling legislation, W.S. 9-2-2803, and specifically:

  • Access to an affordable, effective and quality health care system for Wyoming, including rural areas of the state;
  • Access to affordable health insurance;
  • Issues of wellness and individual responsibility for personal health;
  • Disease prevention and management;
  • Cost shifting by medical providers that occurs as a result of low reimbursement from public and other programs.

The Commission works within a committee framework, gathering information and drafting reports and findings before compiling recommendations and sorting them by priority for the Governor and Legislature’s assessment. The Commission anticipates requests for further investigation of recommendations made now to come from the Governor’s Office and Legislature as they establish their priorities for healthy policy and incorporate the Commission’s opinions.

Health Information Technology Technical Management Committee (IT2)

The Health Information Technology Technical Management Committee has focused on the formation of a regional health information organization (RHIO) and completion of a six-month analysis of the steps toward electronic health records implementation as required by Enrolled Act 31 – including funding, privacy and other legal issues, and governance. A recommendation was made in the Toolbox for RHIO formation (see No. 2), and a meeting with over 50 attendees representing a wide range of stakeholders was held in Casper on July 19 (see attached minutes).A follow-up meeting is scheduled for August 11, 2005 in Casper during which we plan to identify individuals willing to serve as the RHIO’s executive board.

A final report on electronic health records implementation will be made to the IT2 Committee in August, recommendations will be made to the Commission and a final report will be made to the Legislature’s Labor, Health and Social Services Committee in September.

The IT2 overseers from the Commission are Carol Jenkins and Jack Glode, M.D. Project coordination is provided by John Snow, Inc. and Emily Genoff. Committee members are Geoff Smith, M.D., Chair, John Fagnant, M.D., Joy Lewis, M.D., Jim Lugg, M.D., Scott Tenney, M.D., Larry Biggio, David Squires, Steve Hopkins, Matt Rodosky, Jeff McSchooler, and Laurie Hansen.

Purchasing Pools Subcommittee (Demand Side)

The Purchasing Pools Subcommittee has focused on the following key issues:

  1. A study of the role of reinsurance pools in making employer sponsored medical insurance more accessible and more affordable.
  2. Health Risk Appraisals, wellness programs, and Health Savings Accounts as cost containment mechanisms (see Recommendations 8, Offer health risk appraisals and a wellness program to all state employees, and 9, Offer HRAs and a wellness program to all state employees).
  3. Increasing electronic communication between medical providers and patients to increase efficiency (see Recommendations 3, provide reimbursement for physician e-consultation and 4, expand and promote PharmAssist).
  4. Increasing the availability of funding to promote health through comprehensive school health and tobacco use prevention (see Recommendations 17, extend the Healthy Living/Healthy Learning Program and 18, Increase Funding for Tobacco Prevention and Cessation).
  5. Development of WyoCare, a unique model for increasing the availability of healthcare benefits made available by employers through pooled contributions and Total Health Management (THM) (see 20, WyoCare Executive Summary and 21, WyoCare Briefing). On July 19, 2005, representatives from the Legislature, the Wyoming Medical Society, the Wyoming Hospital Association, Blue Cross/Blue Shield, Great West and the Commission met to discuss the role and implementation of Total Health Management as a cost containment tool (see attached minutes.)

The members of the Purchasing Pool Subcommittee are George Bryce, Chair, Carol Jenkins, John Vandel and Ken Vines. Project coordination is provided by Emily Genoff and Segue Consulting (Claire Brockbank and Michele Patarino). Leif and Associates will be studying reinsurance under contract with the Commission following an RFP process.

Supply Side Committee

The Supply Side Committee has focused on the following key issues:

  1. Health professions tracking:

The Committee made several recommendations (see Recommendations 12, Increasing Nursing Faculty Salaries, 13, Creative Solutions to the Nursing Faculty Shortage, 14, Increase Nurse Clinical Training Sites, 15, Support Magnet Hospital Designation, and 16, Fund Physician Training) intended to promote the supply of nurses and physicians working in Wyoming in the next five years.

At the same time, the Committee is completing a contract with the University of Nebraska Health Professions Tracking Center to providethe Commission with the foundation for a high-quality workforce database intended for policy makers. Working with the Center, the Healthcare Commission will, in about one year create critical healthcare workforce information on physicians, physician assistants, nurse practitioners, pharmacists and dentists licensed in Wyoming. We will also collect data on clinics, pharmacies, and hospitals throughout the state. The Commission will receive customized surveys and a robust and secure comprehensive relational database equipped with customized web-based reporting and mapping capabilities. The intention is to have these data maintained over many years. In the contract the Commission agrees to pay the University of Nebraska just under $277,000 for the first year of data gathering and maintenance and $199,000 per year afterward, plus an inflation adjustment equal to the Consumer Price Index.

According to the Centers for Disease Control and Prevention, The Nebraska Health Profession Tracking Center’s meticulous research and continuous maintenance is unmatched.The centralized repository provides the foundation for:

Accurately informing policy decisions

Monitoring state and federal healthcare practitioner retention programs

Sound decisions regarding workforce, educational, and strategic planning

Healthcare professional trends data

Recruitment and retention strategy formulation

Accurate health professional shortage area designation applications

Effective grant applications

Improved service coordination for proper referrals

Rapid identification and assistance in the solicitation of available trained professionals willing to respond to emergencies

Rapid deployment and retrieval of information critical to streamlined bioterrorism preparedness and public health issues

Linking academic expertise to state and local health agency needs

Targeting competency gaps to address front-line workforce high-priority training requirements

Increasing the number and type of health professionals needed to form an adequate healthcare delivery system

Standardized data for health professional mapping with geographic information systems

  1. Healthcare access points:

The Supply Side subcommittee developed long term (see Recommendation 10, develop a healthcare delivery system plan to meet Wyoming citizens’ needs) and short term (see Recommendations 11, review impact of surgery and specialty hospitals, and 19, increase the number of free clinics across the state) responses to the need to carefully allocate healthcare resources in the state to assure adequate coverage and availability.

  1. Healthcare quality as a healthcare cost driver:

The Supply Side subcommittee sees the need for immediate action to address healthcare quality in the state but recognizes the challenges of statewide guidelines. Therefore, medium range recommendations were developed to be immediately “do able” but also to serve as examples for the state as a whole (see Recommendations 5, create and publish quality/cost report cards and 6, implement clinical guidelines in state employee benefit plan).

  1. Elimination of unnecessary healthcare expenses:

The Supply Side subcommittee identified the use of an End-of-Life Care Document Registry/Database as the most immediate means of reducing unnecessary, unwanted medical care costs in the near term.

Supply Side Committee members are Steve Mossbrook, Chair, Jack Speight, Marlene Ethier, T. Chris Muirhead, and Brent Sherard, M.D. Project management is provided by Emily Genoff and Anne Ladd.

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