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As part of their 2010 managed care contracting, Wisconsin Medicaid selected four ForwardHealth (Medicaid) managed care plans serving southeastern Wisconsin (Children’s Community Health Plan, CommunityConnect, Molina, and UnitedHealthcare) to participate in an obstetric medical home pilot for high-risk pregnant members. More information on this pilot can be found in the following PowerPoint presentations found here and here.
Federal Support: Wisconsin has received an Affordable Care Act Section 2703 Health Home for Enrollees with Chronic Conditions planning grant.
Wisconsin has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
Last updated: January 2012
| Aligning Reimbursement & Purchasing |
Medicaid Managed Care High Risk Pregnancy Medical Home Pilot: Beginning July 1, 2011, participating providers receive an extra $1,000 for every birth to a member participating in the pilot. This payment doubles to $2,000 if the birth is designated as a good outcome. Alternatively, the managed care plan would be assessed a $2,000 penalty for each birth with poor outcomes or when the mother did not receive satisfactory care. For the purposes of this pilot, a poor birth outcome was defined as any one of the following:
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| Supporting Practices |
Medicaid Managed Care High Risk Pregnancy Medical Home Pilot: The Wisconsin Department of Health Services is sponsoring best-practice seminars for participating Medicaid managed care plans. Also, Community Advocates, a Milwaukee advocacy organization, is providing patient identification, outreach, assessment, and case management support.
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| Measuring Results |
Medicaid Managed Care High Risk Pregnancy Medical Home Pilot: Participating practices are required to measure quality of performance using:
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