Wyoming – Medical Homes

Wyoming’s 2013 Supplemental Budget included a $300,000 earmark to “[develop] a primary care medical home network in Wyoming.” The Wyoming Department of Health, which administers the state’s Medicaid program, leveraged a $14 million Health Care Innovation Award led by the Wyoming Institute for Population Health to help achieve this goal. The Department of Health allocated $250,000 of the earmarked funds to increase the number of practices receiving TransforMED support through the Innovation Award.

As a pilot, The Wyoming Department of Health began making enhanced payments ($3.00 per-member per-month) to four NCQA-recognized medical homes participating in WyHealth, a care management program for Medicaid enrollees. Beginning April 10, 2015, the Wyoming Department of Health will make enhanced payments to any WyHealth-participating primary care practice that completes a PCMH attestation form. The attestation form is built off of NCQA PCMH standards, but practices will not be required to achieve NCQA PCMH recognition to receive the enhanced payments.

Last updated: March 2015

Forming Partnerships The Wyoming Department of Health has partnered with the Wyoming Institute of Population Health, a division of Cheyenne Regional Medical Center.
Defining & Recognizing a Medical Home Recognition:
The Wyoming Department of Health developed an attestation form built on NCQA PCMH standards; however, practices are not required to receive NCQA recognition in order to receive payment.
Aligning Reimbursement & Purchasing Beginning in April 2015, The Wyoming Department of Health will pay medical homes an extra $3 per-member per-month. In order to receive payment, practices must:

  1. Participate in WyHealth, a care management program for Medicaid enrollees;
  2. Attest to implementing core medical home functions, based on NCQA PCMH standards.
  3. Pull continuity of care documents for at least half of their Medicaid patients from the state’s health information exchange on a quarterly basis, and
  4. Submit nine clinical quality measures into the State Level Registry on a monthly basis.
Supporting Practices The Wyoming Department of Health provided $250,000 in funding to increase the number of practices receiving support from TransforMED through a Health Care Innovation Award led by the Wyoming Institute for Population Health.
Measuring Results The Wyoming Department of Health selected nine clinical quality measures that practices are required to report in 2015:

  1. Tobacco Use Assessment and Cessation Intervention
  2. Breast Cancer Screening
  3. Cervical Cancer Screening
  4. Colorectal Cancer Screening
  5. Childhood Immunization Status
  6. Diabetes: Hemoglobin A1C Poor Control
  7. Diabetes: Blood Pressure Management
  8. Diabetes: LDL Management and Control
  9. ADHD: Follow-up Care for Children Prescribed Medication.