Wrangling Health Data in Wyoming

By Candace Tkachuck

A key goal of health care reform is to give health care providers incentives for delivering higher quality of care instead of higher volumes of care. Wyoming is exploring how integration of health care delivery data with public health data can help improve quality of care.

"I want all doctors in Wyoming to internalize population health management,” says James Bush, Medical Officer for Wyoming Medicaid. “I see a future in which immunization rates go up, and chronic diseases are managed more proactively.”

To work toward this future, Bush works with Wendy Braund, State Health Officer at the Wyoming Department of Health. Together, Bush and Braund are pioneering new ways for the health care delivery system and public health to share data and improve population health in Wyoming.

Wyoming is the nation’s least populous state. Relatively few physicians serve its vast expanse. Many communities have only one or two physician groups, and specialists often work as primary care physicians. As a result, Wyoming physicians take a more community-based perspective than doctors in other more populated states. Because most Wyoming physicians are Medicaid providers, Medicaid reforms designed to improve population health affect most physicians in the state.

National legislation paved the way for this collaboration. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed. From this, Medicaid and Medicare providers are offered staged levels of financial incentives to “meaningfully use” electronic health records (EHRs) to record patient data and improve care. In Wyoming, Medicaid providers have access, at no cost, to an EHR system called the Total Health Record.

HITECH and provisions in the Affordable Care Act that encourage the collaboration of clinical care and public health have fostered development of health information exchanges (HIEs) that share electronic data among EHRs and other health data systems. Wyoming Medicaid’s HIE links Wyoming Department of Health data to Medicaid claims and immunization data in the Total Health Record.

The vision is for the Medicaid HIE to link with a future statewide HIE, as well as with a state-level registry of health care quality indicators. When this happens, every provider in Wyoming will be able to share patient care information and have access to a wealth of population health data. 

The Public Health Perspective

When Braund joined the Wyoming Department of Health in October 2011, the department’s public health functions had just been combined into a single division. Both the Public Health Division and Wyoming Medicaid are housed in the Wyoming Department of Health, so it was natural to look for synergies. Braund says, “Integrating clinical medicine and public health seemed like a great opportunity for the department.”

Bush says, “Historically, Medicaid had never been in the business of tracking or rewarding quality. We were never interested in population health, so we’ve had to design our new focus from scratch and bring doctors along as well.” He quickly adds, “I’ve been impressed with how receptive the physicians have been to including a population health focus to their clinical work.”

Braund says, “It’s important for everyone in the department to have an understanding of how public health relates to all of our programs and how we can be a resource to them. So we’ve been reaching out to explore opportunities for collaboration. We want the focus to be on health and not solely health care.”

Maternal and Child Health

Maternal and child health is an area that lends itself well to integration. The state public health nursing office receives a monthly report from the Medicaid Management Information System that lists pregnant women enrolled in Medicaid. Information from this report is broken out by county and routed to local public health nursing offices. Public health nurses then can set up home visits with the newly pregnant mothers.

The information flow works the other way too. When public health nurses conduct Screening, Brief Intervention, and Referral to Treatment (SBIRT), they can relay information from this screening back to the appropriate physician. At times, the clinician may seek additional information from a public health nurse. For example, if a baby is having failure to thrive, the doctor can consult the public health nurses who also work with the mom about what might be going on at home.

Bush says, “Public health nurses have a high level of awareness of their clients. When I’ve visited some local public health offices, the nurses can locate even those patients who have uncertain housing and are sleeping on someone’s sofa.”
Wyoming recently rolled out “Due Date Plus,” a smartphone app for expecting mothers. The app (free to all Wyoming residents) includes links to public health nurses, obstetric and pediatric physician locators, and many other features.

Other Possibilities

Beyond maternal and child health, there are other ways that health care reform is connecting public health and clinical care.
The data available through the Wyoming Immunization Registry can be analyzed to show where in Wyoming immunization rates are low. This information can be given to Medicaid providers and public health nurses to focus vaccination efforts.
Wyoming’s county health officers also are a critical link between public health and the clinical sector because most of them practice clinical medicine full-time.

The Public Health Division’s Oral Health Unit employs Community Oral Health Coordinators (COHCs) who perform dental screening and provide oral health education in schools, senior centers, and other community settings. The COHCs also connect those in need of treatment to local providers.

Looking Ahead

The vision that both Bush and Braund have is for a strong partnership between public health and clinical care in Wyoming. This partnership makes it possible for patients to get treated for the health issues they are concerned about and also to get good information from providers about prevention and community resources.

Bush says, “Where I see this going is that people will stop thinking ‘my patients, my charts, and my records,’ and instead say ‘Let’s mobilize all resources to provide the best care at the lowest cost.’”