Shilpa Patel, PhD and Rachel Yard

May 4, 2020

Increased alignment between health care quality and payment is supporting new ways for Medicaid and public health agencies to enhance care and control health care costs. Cross-agency partnerships provide an opportunity to leverage each other’s skills and resources to address shared agency priorities. However, there is little available guidance on how to sustain or advance these relationships to focus on additional coverage and service changes or broader agency priorities.

As part of the Centers for Disease Control and Prevention’s 6|18 Initiative, Wyoming’s Medicaid agency and Chronic Disease Prevention Program (public health) partnered to prevent Type 2 diabetes among Medicaid beneficiaries in the state. This collaboration, which started by obtaining coverage of the National Diabetes Prevention Program for Medicaid beneficiaries, has grown to include other shared priorities, such as maternal health. The Center for Health Care Strategies recently spoke with Audrianna Marzette, prevention specialist in the Chronic Disease Prevention Program at the Wyoming Department of Health, and Dustin Brown, previously the Medicaid benefits quality control manager at the Wyoming Department of Health, to learn about their successful cross-agency partnership.

Q: How did your work on the National Diabetes Prevention Program (DPP) fit within the strategic priorities of both agencies?

By leveraging Medicaid’s already-existing diabetes network, public health can make better decisions about outreach strategies to reach priority audiences about diabetes prevention, including Medicaid beneficiaries, uninsured Wyomingites, American Indians, Hispanic, and African American populations.

A: D.Brown: We saw DPP as an opportunity to control costs through preventive care. Anything that addresses preventive care that will potentially decrease chronic care costs later aligns with Medicaid’s strategic priorities. We’ve also used the DPP program to expand Medicaid’s telehealth program, which can extend the reach of Lifestyle Coach Training through virtual sessions. By leveraging telehealth, we’ve been able to reach far more people than we could otherwise — we now have more online than in-person participants in the training sessions. We can get more individuals to attend the Lifestyle Coach Training because they can now hold virtual meetings in libraries, health clinics, public health nursing offices, churches, and other locations — as long as the bandwidth is available and the facility is set up for services.

A. Marzette: From the public health side, we saw this collaboration to address prediabetes as a way to build on Medicaid’s Choice Rewards program, which addressed chronic care management for individuals with diabetes. By leveraging Medicaid’s already-existing diabetes network, public health can make better decisions about outreach strategies to reach priority audiences about diabetes prevention, including Medicaid beneficiaries, uninsured Wyomingites, American Indians, Hispanic, and African American populations. We are placing DPP in high-burden communities to give those who often do not have support or access to the community support and tools they need to stay on track with their diabetes prevention efforts.

Q: How have you leveraged your partnership to expand beyond the DPP work?

A: D.Brown: Through our partnership, I became more familiar with public health and their work. I worked with them to update Medicaid’s immunization policy, and we’re now looking at maternal health policies. Medicaid currently covers mothers post-birth for 60 days, but we are considering how we might extend that to six months or one year, which is influenced mainly by what we have learned from our public health peers.

A. Marzette: We have pushed cross-collaboration internally, and it makes a difference externally to our community partners because we’re sending the same message. I joined the Perinatal Quality Collaborative to address gestational diabetes. Through this collaborative, we are exploring how women with gestational diabetes who are also WIC and Medicaid eligible can be referred to DPP. Part of that exploration includes how Medicaid can pay for their participation in DPP.

Q: What mechanisms will you use to keep the partnership going?

It took time to get to where we are today; the relationship we built didn’t happen overnight.

A: A. Marzette: Flexibility — we’re both swamped. We work well together because we know our roles and are very willing to follow when needed, but take the lead when that’s necessary, too. And overall, we’re always looking at the big picture — how to reduce the number of people with diabetes, increase the prediabetes screening rates, and maximize our resources in Wyoming. I have the utmost respect for our partnership and will do everything I can to support it.

D. Brown: In our partnership, I provide the support structure to show public health how to get things through Medicaid, how to understand CMS requirements, etc. It took time to get to where we are today; the relationship we built didn’t happen overnight. But our relationship is built on trust. If public health needs something from Medicaid, I’m going to figure out how I can support that.

Q: Leadership engagement is essential to sustain a cross-agency partnership. How have you kept leadership apprised of your work?

A: A. Marzette: Our senior administrators meet bi-monthly to discuss collaborative public health/Medicaid projects. We each work to keep them up-to-date in between those meetings so that they are already familiar with the agenda and topics going into the meetings. I meet with my manager weekly, and sometimes daily if my work requires ad hoc attention. We also use instant messaging for short conversations to stay engaged and communicate in real-time as necessary.

Additionally, I create a monthly Diabetes Action Council newsletter, which is distributed to leadership, among others. The newsletter is a convenient way to share and store information that leadership often asks for, such as DPP videos, schedule of events, spotlights on current programs and partners, and upcoming learning opportunities. My goal with the newsletter is to deliver relevant, timely, and consistent information — it’s another tool to keep us all on the same page.

Q: One of the key changes that occur as collaborative partners deepen their partnership is how they make decisions together. Have you observed changes in joint decision-making?

It became clear that for it to be a successful collaboration, Medicaid also needed to be involved in every decision.

A: A. Marzette: At the beginning of our DPP collaboration, public health was making a lot of the decisions. But once we dug in, it became clear that for it to be a successful collaboration, Medicaid also needed to be involved in every decision. Now, I always let Medicaid know of anything and everything I receive, and I wait to respond externally until I hear back from them — all of our decisions are made together.

D. Brown: As familiarity and understanding increased, the relationship evolved into a joint decision-making relationship. In learning the contribution public health could provide to Medicaid, I often engaged their thoughts during the decision making process. These requests would spur further conversation to examine increased flexibility to support initiatives and, in many instances, make implementation easier.

Q: As you use your DPP work as an opportunity to sustain your collaboration, how do you define success for your partnership over the next few years?

From the qualitative side, it’s primarily based on the continuation of the partnership that we’ve formed with public health, and expanding it to other areas, like telehealth and maternal care.

A: D. Brown: We have quantitative and qualitative measures. On the quantitative side, we’ll measure success based on our DPP work, which is in its first year of roll-out. Specifically, we’ll look to see an increase in the number of people referred to DPP, including Medicaid beneficiaries; the number of licensed health care providers who are educated about prediabetes and DPP; how many Medicaid recipients with prediabetes have attended a DPP class; among others. We’ll see how it goes over the next few months and then look for areas where we can refine our process to create a stable, effective, and efficient program. From the qualitative side, it’s primarily based on the continuation of the partnership that we’ve formed with public health, and expanding it to other areas, like telehealth and maternal care. I hope that we create a cultural change that values the collaboration of our departments.

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