Wyoming Department of Health Utilizing Innovative Technology for Medicaid Program
The Wyoming Department of Health has announced that they are on the verge of completing a new project that utilizes new technology utilized to administer both Wyoming Medicaid and the Wyoming Kid Care CHIP.
Wyoming Kid Care CHIP is Wyoming's health insurance program for low-income residents.
This effort, according to a release by the Department of Health, "is nearing the end of an innovative, major, multiyear effort to improve and modernize key technology systems used by the department, healthcare providers and program clients across the state."
WDH is calling this a modernization effort WINGS (Wyoming Integrated Next Generation Systems). According to the release, it involve replacing their current systems through the procurement and installation of modules that are made up of 8 separate components: provider enrollment, claims processing, data warehousing, reporting, program integrity, pharmacy benefit manager, provider call center, third party liability, system integration, electronic visit verification and care case management.
"Several years ago it became quite clear we needed to replace our outdated technology, which was inefficient to modify and had high maintenance and operation costs," said Teri Green, state Medicaid agent and the Division of Healthcare Financing senior administrator with WDH.
The Wyoming Department of Health elected to accept bids for manufacturers of each separate component, rather than working with one individual giant system.
“We did not want to find ourselves with a giant system that needed total replacement again in a few years," Green said. "Our approach allows us to work with specialized vendors on the things they do best and allows for more ongoing updates."
Green said that using just the one system resulted in multiple problems, such as cost overruns and delays in other states.
The WINGS project has an overall budget of approximately $77 million. The Department of Health said it has been paid for with federal money "at 90 percent matching rates, with the state funds representing 10 percent."
Plans for the project began in 2013 and the first system was implemented in 2017. The release notes that currently, 6 of the 8 components are currently being utilized, with electronic visit verification and care case management set to be utilized in the coming months.
This system was designed to reduce administrative burden on medical providers, while also lowering costs for the state.
One of the largest aspects of the WINGS project is the recently completed Medicaid Benefit Management System (BMS). This module replaced the previously-used Medicaid Management Information System, which had been used in Wyoming since 1993, serving as the financial and accounting system for paying medical, dental, vision, and waiver provider claims.
There are many benefits to this new system, accoreding to Jesse Springer, Medicaid Technology and Business Operations Unit Manager with the Wyoming Department of Health.
“With the new BMS system specifically, ongoing programs and federal and state legislative changes in healthcare policy will be delivered more effectively and efficiently to clients,” he said. “Wyoming providers can also now enter claims for payment processing in real time, allowing for quick corrections.”
He continued, stating that “Putting this new WINGS system in place required hundreds of thousands of hours of state staff time over multiple years for procurement, contracting, design, development, implementation, testing and stabilization. State staff took on project duties in addition to their normal jobs, and we thank each of them for the personal sacrifices and dedication that made this possible. The complexity and scope of the project took a true team effort working with vendor staff and other partners.”
The Wyoming Department of Health utilized multiple technology, operations, and consulting vendors, including: CNSI Inc., Deloitte, Change Healthcare, HHS Technology Group, Gannett Peak Technical Services, Happy Jack Consulting, Carebridge Health, Optum Health Services, Magellan Health, Nerthus Consulting, Sharp Decisions Consulting, Cedar Bridge Consulting, NTT Data and Public Knowledge. Other state government partners include the Department of Family Services, Department of Workforce Services, Enterprise Technology Services, the State Auditor's Office and the Governor’s Office.
Jan Stall, Provider and Benefit Management Unit administrator with WDH, said, “As with the implementation of all complex technology projects, some issues are expected as we work with them over time. Our department is committed to making necessary corrections and enhancements.”
WDH reports that approximately $550 million in claims are paid each year to healthcare providers for services rendered to program clients.