Situation
It is common for Medicaid members to not seek preventive health care services from their primary care providers. Coventry Health Care’s Michigan Medicaid members were no exception. We saw the need and an opportunity to improve preventive health interventions by partnering with providers and the Women, Infants, and Children (WIC) nutrition program.Solution
Coventry’s Michigan Medicaid HMO, OmniCare Health Plan, revitalized its provider office-based WIC program in May 2006. OmniWIC provides high quality nutrition and health risk assessments, nutrition counseling, and referral coordination for children under age five years, pregnant women and new breastfeeding mothers in Coventry network provider offices. Food vouchers provided by WIC are a strong incentive to get members to visit the provider offices. This creates one-stop access for members’ health and nutrition services while enabling WIC staff greater ease in facilitating referrals and appointment scheduling.OmniWIC services are contracted by the local health department in order to expand public health outreach and access to nutrition support services. OmniWIC is provided to Coventry members, as well as other county residents eligible for WIC.
OmniWIC is well promoted through a vast outreach network. Clients are referred by local health departments, health care providers, and Coventry’s health services team. Information on WIC, the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program and immunizations are included with the Plan’s prenatal and new mother welcome mailings. Finally, the program is promoted through various community outreach activities, provider orientations, member and provider newsletters, and the Coventry Web site.
WIC frequently serves as the entry point to the health care system for Medicaid recipients. WIC clients in need of supplemental food vouchers are also assessed as to whether they are in need of primary care services or other preventive health services such as immunizations and blood lead level testing. Both the MDCH Bureau of Laboratories and the Joint Venture Hospital Laboratories (through the St. John Medical and DMC University systems) are most supportive in facilitating point-of-service hematological testing on location. This allows for prompt identification of WIC members’ health risks and permits timely service interventions.
With OmniWIC, the traditional services of the WIC nutritional program are coupled with primary care to offer more comprehensive access to services. Enhanced services are provided by OmniWIC staff, not customarily found in most WIC programs. For Coventry members, this includes the review of access to care data via our member-tracking database. Furthermore, all WIC medical records of OmniCare members are reviewed by the Plan’s Quality Improvement team to further identify and address any gaps in care or health management issues. WIC staff serve as “care manager” extenders, facilitating improved wellness and health risk management through:
- Health screenings and anticipatory guidance
- Client intake histories to review compliance with perinatal care, scheduled EPSDT, blood lead level testing, and immunizations
- Identification of barriers to accessing preventive services
- Client referrals to providers and community-based resources
Better Health Lower Costs
Until the implementation of OmniWIC, WIC clinicians had limited access to clients’ clinical information through the WIC database and the State’s immunization registry. Now the OmniWIC program gives WIC staff access to more clinical information for Coventry Medicaid members. As a result, gaps in care are readily identified and supplemental assistance is provided through Member Services and nursing case management.Improved clinical outcomes mean improved health. The WIC screening process includes a health and nutrition screening as well as bloodwork to rule out nutrition risk, anemia and lead poisoning. Such assessments have resulted in improved compliance with appointment visits and health screenings; referrals to providers and community resources for addressing health risk needs; and therefore, healthier children.
Coventry’s Michigan Medicaid Health Plan has demonstrated consistent improvement in appointment visits, as evidenced by the following measurement for Well-Child Visit Administrative Claims/Encounter Data for Children in the Third, Fourth, Fifth, and Sixth Years of Life (as defined as the percentage of children of ages 3, 4, 5, or 6 years old, who were continuously enrolled in the Plan and received one or more well-child visit during the measurement periods).
Coventry’s MMHP has also made significant gains with blood lead screening rates over the past years, as shown below.
Blood lead level compliance outcomes continue to improve, as evidenced with the July and August 2007 rates at 80 percent.
In conclusion, OmniWIC has a current caseload of approximately 1,000 clients composed of about 200 Plan members. We anticipate further growth in overall WIC client volume and Plan member casemix due to enhanced provider, member and outreach initiatives. In addition, there will be the implementation of information technology resources, targeted for Spring 2008, that are designed to improve point-of-service efficiency in addressing clients’ immediate needs. As a result of projected OmniWIC service growth and Coventry’s other process improvement efforts, such as enhanced wellness and case management services, member incentives and education, and provider incentives and outreach, appointment visits and health screening compliance outcomes are expected to further improve.
