State Lawmakers Circulate Care Coordination Medicaid Pilot Legislation

Reps. Rodriguez, Sanfelippo and Sen. Darling see “promising results” in provider care coordination

January 19, 2018

Three Republican lawmakers circulated legislation January 16 to establish an intensive care coordination pilot program aimed at better managing care for Medicaid enrollees who frequent hospital emergency departments. The legislation, modeled closely after a WHA priority provision that was adopted in the Legislature’s version of the 2017-2019 biennial state budget, would provide a payment to hospitals and health systems that agree to provide a set of services to curb emergency department utilization to an identified population of Medicaid recipients.

“In partnership with the legislative authors of LRB 4332, Wisconsin’s hospitals and health systems are identifying a utilization and care management gap in our Medicaid program and developing a proactive solution to address that problem,” said WHA President/CEO Eric Borgerding and WHA Senior Vice President, Government Relations Kyle O’Brien in a January 17 memo to lawmakers in support of the legislation. “These types of innovative reforms from Wisconsin’s hospitals and health systems should come as no surprise, since Wisconsin consistently ranks as having the highest quality health care in the country and has led the nation in health care delivery reform.”

In a cosponsor memo to their colleagues, Rep. Jessie Rodriguez (R-Oak Creek), Rep. Joe Sanfelippo (R-New Berlin) and Sen. Alberta Darling (R-River Hills) said, “While hospitals continue to work proactively to hold the line on health care costs, inappropriate use of hospital emergency departments continues to be a cost driver in our state’s Medicaid program. While hospitals are not able to control who comes through their emergency room doors, hospitals in Wisconsin have developed models that have shown promising results in lowering inappropriate emergency department utilization by providing intensive care coordination services.”

According to the lawmakers, over 10,000 individuals statewide visited emergency departments (EDs) seven or more times in 2016, at an estimated cost of $53.5 million—a 36 percent increase since 2014.  This small population is commonly referred to as “high utilizers,” and accounted for over 111,000 ED encounters last year.

The three lawmakers pointed to existing intensive care coordination programs operated by Aurora Sinai, Aurora St. Luke’s and Wheaton St. Joseph’s hospitals in Milwaukee to reduce emergency department utilization through intensive care coordination services. The legislative authors said the bill is intended to, “provide support for hospitals to create new programs that would work for their unique populations and support further innovation and refinement of models currently in place.”

The legislation will be formally introduced shortly and likely receive a committee hearing in late January.

See more:
Proposed legislation
WHA memo
Legislators’ cosponsor memo

This story originally appeared in the January 19, 2018 edition of WHA Newsletter