If evidence exists that the Wyoming Healthy Frontiers Demonstration Project can save the state money on public health costs and divert residents away from Medicaid, the Project’s designers are keeping it a secret.
Despite receiving numerous public records requests over the past several months, neither the state nor the private firms it contracts with have been able to provide evidence of any research used to develop the Project or support its theories.
“You’re looking for data that does not exist,” said Sen. Charles Scott, R-Natrona, when asked for research used to support funding the program. “You can’t know what the benefit is until you try it.”
Scott was the 2010 Senate sponsor of Healthy Frontiers [Scott twice failed to secure funding for the project prior to 2010]. Originally granted $750,000 in appropriations, the project received an additional $1 million for operating expenses this year from legislators. According to Scott, the additional funding will allow up to 250 residents to enroll with Healthy Frontiers.
Healthy Frontiers targets uninsured, low-income residents through prior involvement with Wyoming Department of Workforce Services programs. Project enrollees are expected to participate in preventive-care screenings in order to earn public funding into their respective Personal Health Accounts (PHAs). The PHAs are then used to cover the premium and co-pay costs of enrollees.
The state guarantees all costs exceeding individuals’ PHA balances up to $50,000. Any medical costs exceeding the cap become the responsibility of the individuals.
Scott and other players in the state’s socialized healthcare programs have credited the Cheyenne-based, private health care and consulting firm Human Capital Management Services [HCMS] and its founder Dr. Hank Gardner with creating the design for Healthy Frontiers.
Gardner says HCMS possesses large amounts of data and research to support Healthy Frontiers design.
“We’ve kept a pretty exhaustive database,” said Gardner, regarding HCMS’s claims of possessing files on thousands of state welfare recipients. “The difference between [HCMS] data and what the [the state] produce[s] is we provide cross-agency analytics.”
But despite numerous requests made to HCMS since May, the company has delayed and withheld access to any information relating to the project’s design. Similar requests made with project’s insurance administrator, Blue Cross Blue Shield of Wyoming, and multiple state agencies have turned up little else regarding the research or development of Healthy Frontiers.
On April 29, Wyoming Liberty Group began making email, phone and in-person requests to representatives of The Office of the Governor, the Department of Workforce Services, The Department of Insurance, The Department of Health, Human Capital Management Services and Blue Cross Blue Shield for information regarding the Healthy Frontiers Demonstration Project.
“I don’t think we can get you someone to talk substantively for a week or two,” wrote Renny MacKay, communications director for the Governor Mead’s office in a May 4 email.
During a phone interview the same day, Gardner said he could produce the requested project research and data, but that he was very busy and “it might take him awhile.”
Wendy Curran, senior director of planning and development for Blue Cross and former health policy advisor for the Governor’s Office, responded to requests for HCMS and Healthy Frontiers data on May 13 through email. “There aren’t many ‘set in stone’ financial data since the design and concept(s) of this program are ‘pilot’ in nature,” wrote Curran. “If you could let me know where you’re headed, that might make it easier to see what I might have.”
On May 23, Curran emailed Wyoming Liberty Group again: “there is some concern about providing information that might be mis-interpreted or used in a misleading way.” Curran’s email contained several cost estimates attributed to Gardner and Scott regarding Healthy Frontiers. “These are only projections based on estimates and comparisons,” wrote Curran.
The Wyoming Liberty Group acquired copies of numerous contract agreements between various state agencies and HCMS on May 27 from the State Purchasing Office. According to the contracts, HCMS signed $3,605,000 in agreements with the state beginning in 2003 for consulting and data accumulation projects. The contracts also show in 2010 — the year Healthy Frontier received legislative approval — annual payments from the state to HCMS increased 398 percent over previous years’ averages.
Several weeks passed without responses to the inquiries of Healthy Frontiers. On June 8, Wyoming Liberty Group mailed records requests to the Office of the Governor, the Department of Workforce Services, Human Capital Management Services and Blue Cross Blue Shield of Wyoming. The requests, pursuant to the Wyoming Public Records Act, pointedly sought records of research, data and communications regarding the development of the Wyoming Healthy Frontiers Demonstration Project.
The public records requests were met with varying degrees of cooperation.
“We have kept a pretty exhaustive database,” said Gardner during a call to Wyoming Liberty Group offices on June 13 in response to the records request.
Gardner offered to provide all of the information and data HCMS had accumulated regarding Healthy Frontiers to the state. Gardner declined to provide a timeline or details as to which agencies HCMS would submit its research. Gardner deferred any further questioning to Heather Roe Day, an HCMS consultant.
In a June 20 email, Roe Day wrote: “(HCMS) received your request and are working with the State regarding next steps. We don’t have an exact timeframe to provide, but it will be as soon as possible.”
Blue Cross Blue Shield chief legal counsel John McBride responded by letter on June 17 to the records request his office received. McBride wrote: “In the spirit of cooperation, (Blue Cross Blue Shield) has gathered the documents it possesses on the Wyoming Healthy Frontiers Program and provided them to the Wyoming Health Insurance Pool (WHIP) Board to review and disclose, as appropriate pursuant to (Wyoming Public Records Act).”
Wyoming Department of Insurance staff attorney James Mitchell reviewed the documents and on June 24, the Department released 817 pages it received from Blue Cross. Wyoming Liberty Group was charged $326 for the copies.
The released documents contained inter-company correspondences between Blue Cross employees and with state and HCMS contacts regarding Healthy Frontiers implementation. Also detailed in the emails is an agreement to pay HCMS a $7.40 per enrollee per month commission for “clinical prevention services” for Healthy Frontiers enrollees.
Joan Evans, director of the Department of Workforce Services, responded to Wyoming Liberty’s records request in a letter dated June 28: “the Department provides the enclosed documentation which includes information that can be readily and feasibly obtained… it must be noted that further extraction of records to the detail requested will require considerable time and significant expense to acquire.”
The included documents featured photocopies from the Department’s website describing its programs and receipts of payments for services to HCMS.
On June 29 MacKay responded by email regarding the Governor’s Office receipt of the request: “I have met with HCMS to find out more about what they do and what they produce. Yesterday, a CD from HCMS arrived at our office… We will respond as soon as we can.”
In a separate email dated June 29 MacKay wrote: “It is likely that this request will involve State Archives locating archived documents from past administrations at their facility. That is a challenging and time-consuming process.”
On July 28, the Governor’s office agreed to release the CD received from HCMS. At a meeting in the Governor’s offices in the Capitol, MacKay told Wyoming Liberty that the information contained on the CD is largely inconsequential to the requests. According to MacKay, HCMS submitted only copies of state contracts and work statements to the Governor’s office. MacKay stated it would be extremely difficult for his office to locate any of the requested documentation, as it had been produced during the previous Governor’s administration.
No information pertaining to research or data regarding Healthy Frontiers was included on the CD given to the Governor’s office by HCMS.
MacKay stated HCMS may be the only available source for the information used to develop the state project. Gardner and HCMS, however, have refused to comment further or respond to specific inquiries.
Tobi Wickham, an administrator for the Department of Workforce Services, agreed to a second interview on July 12 regarding her office’s involvement with Healthy Frontiers. Wickham spent an hour with Wyoming Liberty at her office in the Herschler Building, describing the finer points of recruiting recipients into Healthy Frontiers.
Wickham operates as the front line in implementing the project by identifying applicants and contacting them directly. Although Healthy Frontiers has the funding for up to 250 residents, at the time of the July meeting, less than 30 had been successfully recruited. According to Wickham, the project’s Design Committee may have to consider loosening several of its qualifying restrictions concerning individuals’ training and employment if project enrollment is ever to reach its allowable limits.
But Wickham and Workforce Services are not the designers of Healthy Frontiers – they simply implement the project. The responsibility of creating the project’s structure, she acknowledged, was left to Hank Gardner. Only Gardner understands the how and why of Healthy Frontiers; the state is simply a tool for implementing and funding his theory.
“(Healthy Frontiers) is definitely born on data,” said Wickham. “The problem is finding it.”
Wickham, who divulged she is a former HCMS employee, promised to reach out to Gardner for the research and data used to develop the Project. It does exist, she assured, somewhere in the Cheyenne offices of HCMS.
“I apologize in the delay in getting this to you,” wrote Wickham in a September 8 email. “I have had several discussions with HCMS and they are suppose(d) to be getting me the research documentation we discussed. I will follow up with them to see where they are at and when we can expect something and will get back to you asap.”
The Legislature did not pass Healthy Frontiers simply on good faith.
Sen. Scott was able to offer the state’s lawmakers one figure — $4,559 – an estimate of annual costs to enroll residents in the project.
But two other numbers also stood out: $3,068 – the average annual cost to enroll a Wyoming adult into a private insurance plan (Blue Cross estimate), and $2,316 – the state’s average share for covering non-disabled adults enrolled in Medicaid (2010 figures).
“I’ve got enough data already,” said Sen. Curt Meier, R-Goshen/Platte, at this year’s Senate session. “[Healthy Frontiers is] not going to work – it’s going to be too expensive.
“Ask yourself the question: Do you want to pay $2,316 — or $4,559? And what is the better deal for the state of Wyoming?”
“We could buy insurance for these people and it would be more cost effective,” noted Sen. Phil Nicholas, R-Albany.
Soon after Meier’s and Nicholas’s comments, the Senate and House voted to expand Healthy Frontiers funding through 2012.
See part 1: “Private Profits Drive Public Health Program”