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CONTACT: Seth Boffeli, (608) 266-5862
Department
Requests Proposals for Medicaid Managed Care Contracts in Southeast
Wisconsin
Effort Will Save Money and Improve Quality
MADISON - The Department of Health Services released a request for
proposals for its Medicaid managed care contracts in Southeast Wisconsin.
This request for proposals (RFP) seeks an innovative approach to providing
high quality health care to approximately 240,000 members in Milwaukee,
Racine, Kenosha, Washington, Ozaukee, and Waukesha Counties who receive
care through the State’s BadgerCare Plus Standard and Benchmark
programs. The proposals are due January 13th, 2010 at 2:00 p.m.
“This RFP is a bright opportunity to both improve health care quality
and save taxpayer money,” said Secretary Karen Timberlake. “We are
looking for managed care organizations that will provide high-quality,
cost-effective care to our members. The RFP will allow us to find savings
in the administration of the Medicaid program and address deficiencies in
quality performance in Southeast Wisconsin.”
Significant portions of the new managed care contracts will be
performance-based, requiring the managed care organizations to annually
reach performance benchmarks in a variety of areas, including diabetes
testing, blood lead testing, childhood immunization, asthma management,
tobacco cessation, emergency department utilization management, and dental
utilization. In addition, the organizations will be required to implement
a medical home pilot for pregnant women known to be at high risk for poor
birth outcomes.
Through this RFP, the Department plans to:
- Make substantial improvements in health care outcomes for BadgerCare
Plus members;
- Improve care coordination, especially for high cost individuals with
chronic illness;
Reduce the number of inappropriate service encounters such as using
hospital emergency room visits for routine health care delivery;
- Lower overall health care costs borne by the state; and,
- Simplify and strengthen the healthcare marketplace in southeastern
Wisconsin.
The proposals will be evaluated for their potential to provide and
manage health care services as well as their demonstrated ability to
manage a Medicaid population in similar urban settings; meet quality
benchmarks; and, ensure members receive high-quality care appropriate for
their needs. Proposals will also be evaluated based on their proposed
administrative costs for providing and managing the health care services
of BadgerCare Plus members.
For the first time in Wisconsin, the new Medicaid managed care
contracts will include financial penalties for managed care organizations
that do not meet the Department’s quality performance benchmarks.
Organizations that do not perform well could lose up to 3.25% of their
capitation rate. No state Medicaid program has ever put this much funding
at-risk based on performance.
Visit http://dhs.wisconsin.gov/rfp/index.htm
for more information about the RFP or to submit a proposal.
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Last Revised: November 03, 2009 |
