For Immediate Release
Cheyenne, Wyoming
October 10, 2005

Wyoming Medicaid program avoids $15 million in costs; Emergency room visits made by Medicaid clients in Health management program Drop 11%

APS Healthcare and the Wyoming Department of Health (WDH) today announced that Wyoming's Medicaid health plan, EqualityCare, avoided more than $15 million in state and federal costs in the first six months of 2005, as a result of several cost containment measures, including an innovative Health Management program managed by APS. The APS Healthy Together program offers education, support and coordination of health care to the entire EqualityCare population. For the most at-risk client intervention group, the program also marked an 11 percent decrease in the number of emergency room visits, as well as other key clinical indicators within a defined population who were enrolled in EqualityCare prior to APS' Health Management services and after the program started.

“Even as the number of people covered by EqualityCare increased from 2004-2005,” explained Greg Gruman, PhD, State Medicaid Director for Wyoming, “an overall cost avoidance of approximately 9.1 percent, or $15,675,048.14, was recognized after implementation of the Health Management program.” Gruman also noted that, “this is our first analysis of the program to determine if we are on the right track and accomplishing what we originally intended in the health management program. We will continue to monitor the data to ensure that we are moving in the right direction with APS and our providers to meet our targeted savings by the end of 2005.”

Wyoming Department of Health Director, Brent Sherard, M.D, MPH said, “we're very pleased to note this progress under our health management plan. Most important to the health department; however, is the increased patient education, proper utilization of services, and quality care from our providers. Those are our ultimate goals.”

“Treatment delivered in emergency rooms (ER) is expensive; therefore, when patients seek care delivered in the ER for conditions that are not emergent, it unnecessarily drives up the cost of health care. Additionally, high ER utilization can be a symptom of patients facing barriers to primary care and seeking treatment in an environment which may not always offer optimal continuity of care,” Sherard concluded. Non-emergent medical claims costs alone dropped over 11 percent from the 2003-2004 expenditures before the Healthy Together program began.

“APS is extraordinarily fortunate to work with such a dedicated group of professionals in the Wyoming EqualityCare program. Through a skillful blend of evidence-based interventions, grass roots teamwork with medical and public health professionals, and better engagement with consumers in their communities, we've achieved some of the best results ever shown in the nation” said David Hunsaker, President, APS Public Programs.

Healthy Together - which is offered at no cost to EqualityCare clients—reinforces the need for clients to find a “medical home” or primary care provider (PCP) so that when they have a minor illness or injury, a provider who knows their medical and social history is able to care for them. In addition, the program offers support and education in an effort to empower EqualityCare clients to take more responsibility for their own care.

The EqualityCare program also provides clients and families with educational information on how to treat minor ailments at home, such as minimizing pain from an ear infection, until they can see their PCP, and provides support and encouragement for those EqualityCare clients who have been diagnosed with a chronic illness. Program participants are provided a nurse “Health Coach” who contacts them regularly over the phone to answer questions about their illness, insure they are following their PCP's treatment regime and that they are receiving the services and resources they need to mitigate complications and maintain their quality of life.

Wyoming's cutting edge approach which offers services to its entire Medicaid plan membership, as opposed to just a select group of recipients—is being touted as one of the most effective Medicaid disease management programs in the nation.

According to Al Lewis, f ounder of the Disease Management Association of America and president of the Disease Management Purchasing Consortium International, Inc., “Wyoming's program is currently the most innovative and comprehensive health management program in the country. The state's program has more conditions, more disabled enrollment, more ways in which health is being improved, more valid measurement and, most importantly, by a factor of two, more savings per capita than any state Medicaid health management program. The end result is going to be an absolute positive one with clients leading healthier life styles and the state recognizing an economic impact.”

Teri Green, the Wyoming Department of Health's Medicaid Policy Manager, who originated the program, cautions that although EqualityCare has realized cost avoidance so far this year, cost containment strategies such as the Health Management program will become even more important in the future as funding from the Federal government for state Medicaid programs is reduced.  “For Wyoming, matching funds from the Federal government will drop more than three percent beginning this month (October), which equates to over $26 million of funding over the next year.  The match is projected to drop again in October of 2006,” Green explains.

“Therefore, even as we strive to implement cost containment measures, our funding resources continue to be reduced. Nevertheless, we are committed to continuing our efforts to be responsible stewards of public funds and constantly strive to improve our processes, while serving citizens of Wyoming,” echoes Sherard.

For more information on Healthy Together and the programs other outcomes, please call Jerry Kiplinger, Executive Director, APS Healthcare at 307-433-0970.

APS is a provider of specialty healthcare solutions that cover more than 20 million members in the United States and Puerto Rico. The company's portfolio of products encompasses the full-range of healthcare services, including disease management programs, behavioral and medical management programs, employee assistance programs, work/life services, absence management, as well as physical medicine and informatics consulting. APS operates three dedicated business units: APS Public Programs, which offers a wide variety of specialty physical, disease management and behavioral health services to government clients including 20 states, the Tricare Department of Defense program and Medicaid programs that cover approximately 30% of the U.S. Medicaid population; APS Health Management Programs, which offers a wide variety of disease and medical management services to employers and health plans; and APS Commercial Behavioral Management, which serves more than 900 clients, including corporate and public sector employers and health plans. All of APS' programs combine the company's core competencies in behavioral, disease and medical management into a holistic patient-centric approach, which improves clinical outcomes and creates a superior return on investment for customers.

APS is committed to “Helping People Lead Healthier Lives” through the implementation of customized programs that meet each customer's unique needs.