As rural hospitals try to determine whether or not they'll be able to form accountable care organizations, hospitals throughout Wyoming are in the early stages of developing the Wyoming Integrated Care Network. So far, the Wyoming Hospital Association, the Wyoming Medical Center, and 13 other hospitals are involved in the project, which aims to transform the primary care delivery system throughout the state using the patient-centered medical home model.
According to Dan Perdue, president of the Wyoming Hospital Association, ACOs were the impetus for starting to develop the network.
"Originally, this group was loosely assembled as a result of the ACO component of the Affordable Care Act," he says. "In fact, a lot of hospitals got together in November of 2010 just to kind of lay the ground work for forming an ACO here in the state."
Like other rural states, though, Perdue says Wyoming fights "the tyranny of numbers." Many rural stakeholders worry that forming an ACO just wouldn't be practical based on their small populations, and Wyoming is no exception.
According to 2010 census data, Wyoming's total population is 563,626, and Perdue says estimates put the state's total number of Medicare beneficiaries at less than 100,000. Not only are the population numbers small, but Perdue says Wyoming faces an addition challenge of having many of its population centers on located on the borders with other states. As a result, Wyoming's patients often head to cities such as Denver, CO Rapid City, SD; Billings, MT; and Salt Lake City, UT for their healthcare.
"I think we're one of the few states in the country that has the out-migration problem that we do and the scarce population that we do," Perdue says. "A lot of our patients seek care outside the state."
The Wyoming Integrated Care Network would aim to change that by making it easier for hospitals to "keep that continuum of care inside the state," Perdue says. It will have as a goal to improve delivery of primary care by focusing on wellness and the coordinated management of patients with chronic needs. The organization is also considering joining a health information exchange. Perdue says it's looking at NeHII, the Nebraska Health Information Initiative.
The Network also hopes that focusing on primary care will help cut down on ED visits, something that's an ongoing problem for rural communities.
"We know rural EDs serve as the primary care center to a higher degree," says Daniel G. Kirkpatrick, MHA, FACHE, director of operations at BestPractices, Inc.
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Perdue acknowledges the problem.
"We're hopeful that having a good network of primary care providers will hopefully cut down on ER visits," he says. "In many locations around the country, primary care providers are very scarce."
Despite ACOs being the reason behind the Network, which is still in the early planning stages, Perdue stresses that "this may be the pre-cursor to an ACO, but it also may not. We may not follow down the path to form an ACO."
Still, he thinks it will be a benefit for not only patients, but also hospitals and physicians in Wyoming.
"I think what this hopes to accomplish is to have some of the features that the ACO calls for," he says. "But if this organization does not decide to form an ACO, I think there'll still be some potential benefits from banding together and forming this network."
Alexandra Wilson Pecci is an editor for HealthLeaders.
