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
April 21, 2017

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
3 – 6 month commitment
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
April 21, 2017

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
April 21, 2017

5. Support Services 24/7 Nurse Line: Due Date Plus App:
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
April 21, 2017

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
April 21, 2017

7. Telephone - 888-545-1710 Website – www.wyhealth.net info@wyhealth.net
WYhealth Contact
Telephone Website –
April 21, 2017

8. HEALTH HELP
4/21/2017

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
April 21, 2017

10. Authorization Process Change
List of CPT Codes are available at
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
April 21, 2017

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
April 21, 2017

12. Authorization Request Notification Process
Internet/Web:
Fax: (form on website)
Phone: prompt 4
Hours: 6:00AM – 6:00PM MST (after hours requests can be submitted via the web or fax)
April 21, 2017

13. Contact Information
Provider Support – Xerox (WYhealth)
Morris McGaugh,
Network Relations Consultant – HealthHelp
Andre King
Office (281)
Client Manager - HealthHelp
Michael Ideson
Office (281)
April 21, 2017