Joint Labor, Health, and Social Services Co-Chair Senator Charles Scott (R-Casper) speaks to his
committee during last week’s Committee meeting in Casper.
By Tom Lacock
Wyoming Medical Society
There was no lack of discussion or spirit to last week’s Joint Labor, Health, and Social Services Subcommittee meeting in Casper. The committee of Wyoming lawmakers who primarily oversee healthcare discussed everything from legislative changes at the federal level to the next steps involved in standing up a statewide Health Information Exchange.
Perhaps the more interesting aspects of the meeting came during State Healthcare Finance Director Teri Green’s presentation on health data and Wyoming Medicaid’s Total Health Record. Green pointed out an HIE is a tool to securely transfer data from EMRs around the state. The Total Health Record is a tool by the state that allows physicians to see the health records of Medicaid patients at no cost to the provider. However, committee member Sen. Anthony Bouchard (R-Laramie/Goshen) offered concern that the Total Health Record and other EMR’s are instructing physicians to ask their patients if there are firearms in the home. Bouchard’s concern is that the federal government could then get to that data and use it to take the guns of those who are suffering from depression or other ailments.
“The standards used in any EHR are standardized,” Green said. “We have data that is logical.”
Bouchard shot back, “I am hearing from doctors that there are fields that go beyond what a doctor feels is necessary. What are the fields? What information is being exchanged? I would like to see the fields mandated in the system.”
Green offered to send Senator Brouchard screenshots of what data fields are on the Total Health Record.
The sharing of data showed itself to be a flashpoint with the committee. Questions were offered by the committee around whether Medicaid patients are allowed to opt-out of the Total Health Records (Green said yes), and which providers can see the data entered into it, as well as how the data is stored (hosted by Conduit with data housed in Atlanta and a back-up in New York); and susceptibility to hackers.
Green reported the data they receive at the Department of Health is used for public health trends and is de-identified. She added that physicians who have access to the data are aware of the standards expected of those who can see the data. The Department of Health also receives back-end data allowing them to know who has signed in and looked at the data. Still, the question of data security was pervasive through the conversation.
“I think what we are uncovering here is whether there is sufficient concern and valid reasons to see how data is used by third parties and the (federal) government itself. Is there concern to assign to a committee more to look into this,” asked committee Co-Chair Sen. Charlie Scott (R-Natrona County).
Wyoming Department of Health Director Tom Forslund offered an update on the Department’s budget during the committee meeting and suggested a loss to the Department’s budget of 9.53 percent over a year ago. He pointed out that 89 percent of the budget of the Department is limited to the top five categories of the WDH’s budget. In all $608 million of the $1.4 billion spent by the state on the Department of Health goes to Medicaid.
Forslund said at the end of the week a hard freeze went into effect for all open state positions funded at 80 percent or more by state funds would be eliminated in a cost-cutting move by the state. He said 75 percent of the Department of Health’s staff is located in five state facilities, such as the State Hospital in Evanston and the Life Resource Center in Lander. Forslund said his organization was trying to fill all the open positions by the time the freeze took effect but it is still struggling with low numbers of applicants and the lack of employees may lead to shutting down a wing at the state hospital. Scott said budget issues have been rough thus far, but it could get worse.
“If we don’t get this education spending under control, brace yourselves. This has been relatively mild so far,” Scott said.
Multi-Payer Claims Database
After a Legislative session in which it was learned the State Employees Health Insurance Group had agreed to enter data into a multi-payer claims database through the Wyoming Business Coalition on Health (WBCH, the Wyoming Department of Health and Anne Ladd of the WBCH spent time testifying on databases during last week’s meeting in Casper.
The Department of Health said the contract to become a part of the claims database was negotiated in January and went through a sole source contracting process. The data is owned by the Wyoming Department of Administration and Information, which is paying the Montana Association of Healthcare Purchasers to aggregate and analyse its data.
The Montana Healthcare purchasers are to provide standardized reports including monthly data extracts, comparing state data to other groups within the database. The state will also receive a final report which it hopes to help answer the question of why healthcare costs for self-insured companies is so high, as well as how self-insured companies cover their employees according to price and utilization.
Ladd said Humana and Aetna are among other firms who have pooled their claims into a national database, which the Montana Healthcare Purchasers will also send its data to in order to see how procedures received by its members compares to national trends. The contract will end with the Montana Healthcare Purchasers on June 30, 2018 unless re-appropriated by the state legislature.
Ladd made a pitch to continue funding the program and said data is necessary but not sufficient to driving down costs. She said if employers want to drive down costs through competition, a database is one way to get the information needed to find out where to direct insurers to best secure pricing. She admitted the model is unproven, but hoped the information would help insurers to offer incentives to keep shopping around for better healthcare pricing by using cost sharing, co-pays and out-of-pocket costs to help direct employees to a specific place where a procedure such as a knee replacement may be less expensive.
Scott questioned whether the change to ICD10 codes, which contain more than ICD-9 would hamper the state in getting usable data. He also suggested he wasn’t sure pricing data would help determine the cost of healthcare as much as utilization data.
“This needs to be discussion of full legislature and are we going to get useful information out of it?,” asked Scott. “I will say one of my fears is to do it right and well enough that we get information that we can make good use of, we will have to spend more money than I think will be available during the coming budget session. That is quandry I am faced with. “
Ladd said her clients with the Wyoming Business Coalition on Health are ultimately trying to answer the question of why are they at a competitive disadvantage in buying healthcare in Wyoming where it is more expensive than New York of Los Angeles. They also hope to use data to direct conversations preventative healthcare for those with chronic diseases. They are currently asking hospitals in Wyoming and Montana for help with quality of care measures.
Ladd said the data they receive from the Montana database is generally six months old when her members see it and admitted the data has some limitations, specifically that it is just billing information. She added her group cannot release contracted rates for providers. She added mandating providers to join a database is “not the Wyoming way,” and probably won’t happen. Her coalition currently has 11 employers.
Ladd wasn’t alone in her testimony as she brought Steve Lofton, co-owner of 71 Construction in Casper, who is a member of her coalition.
“When I try to get prices for healthcare it is difficult in healthcare world,” Lofton said. “There are gigantic changes in prices from one places to another. And going out-of-state is cheaper. Hundreds of percent differences. I need a way to get information. I am a payer of healthcare expenses.”
Ladd and Lofton said the database was not able to denote quality of the procedures done. The hope is that the database will be robust enough to help employers make decisions on healthcare purchasing.
Title 25 Update
There was some good news on the Title 25 front during last week’s meeting. The state has overspent its $4.6 million Title 25 budget for the current biennium, which still has about 11 months left. However, involuntary commitments are down thus far this year. Statewide there are 111 fewer patient commitments less than Department of Health projections. The one exception to that has been Laramie County which has 33 commitments this year, up from 21 a year ago. At present there is no real hypothesis for the changes.
During the recent session the Legislature allocated another $10 million in reserves to be tapped for overages. The Department of Health is beginning to tap into those funds. The Department of Health continues to help Community Mental Health Centers with one-time grants to get the infrastructure ready to become gatekeepers. Thus far 13 county community health centers have applied for and received these grants.
One of the largest percentage cuts to the Department of Health’s budget came to the prevention services where the legislature remove $2.5 million from the state’s alcohol, tobacco, and suicide prevention services. After the session the Legislature put out two new RFP’s for these services, one for implementation of services and another for technical support. The Prevention Management Organization (PMO) was the highest scoring applicant for both grants and will retain the grant.
However, the reduction in funds means there are changes coming to the program itself. Now 15 counties will have just one community prevention specialist (down from 2-3 per county). Eight counties will share resources of one prevention specialist for every two counties. Because suicide prevention is 100 percent funded through state general funds, the state will attempt to address suicide prevention through injury prevention funds and offer no local funding to communities. The state’s focus with the prevention funds will go towards tobacco, as well as opioid abuse prevention.
Among the provisions of their legislation is the fact only 10 percent of the PMO contract money can be used for administrative purposes.
Last session the Legislature also dipped its toe into the CHIP waters asking the Department of Health why a contract renewal for CHIP services had not been achieved. Jan Stall with the Department of Health said the organization asked for an RFP last November to 100 groups but received just one bid – from Blue Cross Blue Shield. However the proposal was found in sufficient. Department of Health and Blue Cross then discussed receiving a second proposal from Blue Cross with more detail and new federal requirements coming from the federal government. The second proposal also did not meet the requirements of the program, according to Wyoming Department of Health.
Stall said among the items missing from Blue Cross’ proposal were sufficient detail on moving forward for more managed care, as well as what she described as help for provider networks as well as the procedures involved in notifying providers and clients of changes. She also said early diagnostic programs and new program testing requirements were not met by Blue Cross in their early proposals. Many of those items were to be put in-place by July 1.
The two parties have since met and discussed what was missing and they believe they can agree on a contract extension of the program that would start July 1, but Blue Cross still needs to address some issues to meet federal requirements.
“I would encourage you to get this resolved one way or another,” said Scott. “If you can’t comply with the feds, we may have some very tough decisions to make about what we are going to do about that statute. That is real important to get done.”