W.Va. Medicaid wellness plan comes up short in evaluation

A West Virginia Medicaid reform effort that rewards enrollees' healthy behavior needs work before it significantly improves participants' health, says a recent report on the program.

The report on Mountain Health Choices -- released in late April by West Virginia University's Institute for Health Policy Research and funded by the Robert Wood Johnson Foundation -- summarizes conversations with participating physicians and their staffs, patient advocates, state Medicaid employees and others in late 2008. The Medicaid reform program offers new or expanded benefits to patients who agree to a wellness plan and follow physician orders. Those who don't opt for the enhanced benefits automatically are signed up for a basic benefits package.

The interviewees said the state took Mountain Health Choices statewide from three counties before the West Virginia Bureau for Medical Services had evaluated the program's performance adequately. They also said state efforts to educate Medicaid enrollees, physicians and physician staffs about the program were inadequate. Still, interviewees supported the program's goal of improving enrollee health by encouraging personal responsibility and healthy behavior.

Shannon Landrum, spokeswoman for the state medical bureau, said the university report contains errors. For example, the report mentions a target enhanced benefits enrollment of 10% of those eligible, but the state did not set a specific enrollment goal, she said. The report also appears to perpetuate the myth that people can't be poor and still be competent enough to make good choices, she said.

Landrum also said a different group of researchers at West Virginia University are close to finishing a scientific Mountain Health Choices evaluation involving Medicaid enrollees.

Relatively few people eligible for Mountain Health Choices' enhanced benefits opted for them. More than 160,000 were given the choice between enhanced and basic benefit packages as of May 1, but only about 21,000 people had opted for the expanded benefits. The added services include weight management programs and more generous vision and medical equipment coverage. About a third of all Medicaid enrollees are eligible for the program, mostly children.

Two area medical society representatives gave the state mixed reviews on Mountain Health Choices. Both said the state should take heed of the Institute for Health Policy Research report. "I hope they do not discount it or try to dispute its relevancy," said Evan Jenkins, executive director of the West Virginia State Medical Assn.

Fernando Indacochea, MD, president of the West Virginia Chapter of the American Academy of Pediatrics, said the state hasn't acknowledged that any problems exist. "They just keep going with the same plan."

Dr. Indacochea said the Medicaid agency has not taken advantage of his chapter's offers to work with the state on refining Mountain Health Choices. But state Medicaid officials have been in regular contact with the medical association on the program's progress, Jenkins said.

Despite the problems, Jenkins said few want to scrap the program outright. But he said state efforts to instruct physicians and their staffs on how the program works have fallen short. Dr. Indacochea said state Medicaid officials visited his practice in Petersburg several weeks ago as the program implementation reached the eastern portion of West Virginia.

Jenkins also said the enhanced benefits enrollment must increase for Mountain Health Choices to improve Medicaid enrollees' health. "I think the jury is out from a long-term perspective whether this will bear fruit in terms of better health and better personal responsibility."