WHA Medicaid Workgroup Proposal Heard in Assembly Health Committee

Bill creates emergency department intensive care coordination program for Medicaid enrollees

January 26, 2018

WHA Senior Vice President, Policy & Research Joanne Alig joined a group of WHA members, including Ascension’s Linda Puccini and Aurora’s Robert Marrs, Jane Pirsig-Anderson and Andrew Hanus, to testify in front of the Assembly Health Committee January 25 in favor of Assembly Bill 871, legislation enacting an intensive care coordination pilot program in Medicaid.

The group of WHA members followed testimony from Reps. Jessie Rodriguez (R-Oak Creek) and Joe Sanfelippo (R-New Berlin), lead authors of the legislation, who used examples from work being done by Aurora Sinai, St. Luke’s and Ascension - St. Joseph’s Campus in Milwaukee to provide better care management for high utilizers of the hospital emergency department.

Alig informed the Committee the proposal was developed by a statewide WHA Medicaid workgroup in 2016, after seeing the positive experience with the programs established by these Milwaukee hospitals. Alig, Puccini and the team at Aurora testified that provider care coordination services are currently not reimbursed in the Medicaid program, requiring hospitals to self-fund or pursue grants to fund their work. Alig said the workgroup discussed policies that would support the ability of WHA members to expand current models and replicate this model in rural and urban parts of Wisconsin.

Puccini and Aurora’s team said providers are in the best position to work with this small subset of patients, who frequent their emergency departments, and transition them back into an ordinary relationship with the enrollee’s Medicaid managed care organization. These care management programs utilize a team of providers, including physicians, nurses and social workers, to establish a regular pattern of primary care for a high-utilizer patient.

Rep. Dave Murphy (R-Greenville) said the program could have significant impacts across the health care system, not just on providing better care for Medicaid patients but lowering the overall health care spend in Wisconsin—especially in the Medicaid program, as lawmakers need to figure out ways to save money and balance the state budget.

Sanfelippo said the bill was targeted at hospitals and integrated health care systems because they are in the position to work with all types of providers, including physicians, nurses and social workers, to operate a care coordination program.

WHA expects this priority legislation to receive a Committee vote in Assembly Health February 1 and be ready for floor action in the Assembly some time in February. WHA and member organizations are also working with members of the state Senate to move the bill in that chamber.

This story originally appeared in the January 26, 2018 edition of WHA Newsletter