Here is my pared down list Bobbie, Mary Pittaway

 

 

A  Time Savers

 

1.      OUTREACH:  Institutionalize an annual coordinated State WIC outreach effort for WIC that includes targeted advertising in those places with underserved populations.  We still need data on the eligible population by region, county or reservation to do this which we understand is being assessed at this time. For example, $25,000 was spent on the most recent WIC outreach effort, but the ads were put on AM radio stations that target the agriculture community listeners.  How many new clients were brought in?  And how many more would have been brought in if it had been aired in high density areas?  As part of the annual plan, include the principal of evaluating outcomes of various outreach strategies rather than repeating ones that don’t work.  Coordinate WIC outreach with each and every other state run program that is likely to serve families who may be eligible for WIC such as Child and Adult Care Feeding, School meals, Food Stamps, Medicaid, CHIP, LIEAP, TANF, MCH, Children with Special Health Care Needs, etc.  It appears that some of this is done, some of the time, rather than a more routine and comprehensive program

 

2.      LOCAL INPUT: Develop a systematic process of soliciting input and feedback for program changes from local staff, and/or clients or other affected groups (grocers, physicians, etc). Recent fiascos and costly mistakes, such as eliminating organic foods rather than focus on lower priced brands; pulling out of the computer consortium, and mandating an inappropriate hemoglobin testing system would be avoided.  Before making financial decisions, that impact local agencies, send idea out for consideration and comment, including justification (data rather than gut reactions), anticipated outcome etc.  If DPHHS were to use data to make decisions and include the data in justifications for changes, buy in and follow-through by local agencies will be enhanced E.g. “Based on x, y, z data, we anticipate food costs will exceed the USDA grant.  We propose x, y, z to prevent this problem. E.g “Please comment on the pro‘s and cons of each of these strategies by x date. “

 

3.      “WIC CERTIFIERS” freeing up valuable professional RD, RN and home economist time for higher level services.  We are told that our regional office doesn’t like certifiers. So what, if it s allowed under the regulations, we should consider doing it.  That way para-professional staff could perform certification and food package assignment duties, as part of the routine certification appointment.  Those clients with specific nutritional risks would be seen by an RD, but many WIC clients only require routine care, which could be handled by RD driven protocols.

 

4.      DISCONTINUE REQUIRING MORE OF WIC STAFF THAN IS REQUIRE DIN THE FEDERAL REGULATIONS; E.G. HEMOGLOBIN TESTING: Montana’ State plan requires that hemoglobin testing be done for infants and children at 9, 12, 18 and 24 months and then once each year thereafter if result is normal.  The federal regulations require hemoglobin’s be done at 9, 15, 26 months and then once a year there after, if result is normal.   This additional hemoglobin test results in an additional 5500 tests at $1.24 per test.  Extra testing costs tax dollars and adds an additional invasive procedure with it’s inherent risk. It increases the work load of local staff, not to mention the increased apprehension of the parent.  Locals are told that one by one, we can petition to do the process differently, but why not change it for all at once?  Even after a pilot program in 2005 was run for over a year in two clinics, showing that the additional test wasn’t warranted, a statewide change has not been made. Here is the break down of the cost of supplies for a single hemoglobin test: So it looks like a total of around $1.24-1.39    PROOF OF PREGNANCY for certification of prenatal clients, except if there is question as to the pregnancy.  It is optional.  (Page 331 WIC regulations.  

 

5.    INFANT FORMULA Follow the process used by other states (e.g. Washington State) of not allowing issuance of non contract formula.  E.g. if Ross has the contract, then Mead Johnson routine formulas aren’t allowed.  What they do is switch client from powdered formula to concentrated formula as the alternative. This would save MT staff time, and would assure that the full formula rebate on infant formulas was made available to the state. According to DPHHS staff, in MT just last year, almost 6000 non-contract formulas were issued, along with the required MD prescription.  It takes local staff an additional 15-30 minutes to process each non contract formula request.  Eliminate tracking of returned and then donated formula. 

“ The WIC Program works at the Federal, State, and local levels with various programs affecting the health of children and families, including the Centers for Disease Control (CDC), the Maternal and Child Health Program, the Center for Medicare and Medicaid Services, and the Indian Health Service at the Department of Health and Human Services, the Food Stamp Program, the National Immunization Program, the Breastfeeding Consortium, and CDC's National Breastfeeding Awareness Campaign. FNS has worked with Medicaid to develop policy encouraging WIC and Medicaid to work collaboratively at the State and local level to ensure that nutritional needs of mutual clients are met, and stating that Medicaid should be the primary payor for WIC-eligible exempt infant formulas and medical foods issued to WIC participants who are also Medicaid beneficiaries. FNS and the National Immunization Program at CDC have an ongoing cooperative effort aimed at increasing immunization rates of pre-school children participating in WIC. FNS and CDC together develop national policy and guidance on immunization promotion activities in the WIC Program; CDC provides funding to State immunization programs to help communities create networks to provide access and improve the quality of immunization service. FNS recently worked with the HHS Indian Health Service to update a memorandum of understanding promoting coordination and co-location of WIC services at Indian Health Service facilities. www.whitehouse.gov/omb/expectmore/detail/10003027.2006.html

 

Smoother Running Office

 

6.      TRAINING ;Develop a “new to WIC” employee training program that includes client services,  food packages, risk issues, care plan development, referrals, how to manage a clinic, the computer system, vendor relations, trouble shooting computer problems, all the issues that confront a new employee who now often has to learn this on the job through trial and error.   Could WIC 101 be incorporated into an existing annual meeting such as MPHA or the summer Public health institute for Montana? Update training systems, e.g. the lap top program to train new employees on the WIC system is fraught with errors and bugs and is nothing short of an insult for use in training.  Combine the Spring Public Health meeting with the MPHA meeting to improve attendance at both, to minimize duplication of planning effort, decrease costs and enhance WIC staff’s exposure to the broader public health field.

 

7.      AUGMENT WIC FUNDING: Research and present how WIC RD’s could augment funding through billing Medicaid, EPSTD and CHIP for nutrition care services?  Most local agencies are not currently providing or billing for these services.  Also the reimbursement for RD services would enhance client access to expert care for metabolic disorders, diabetes and other endocrine anomalies, Cystic fibrosis, food allergies, GI illness, and any number of conditions requiring nutrition therapy.   Can DPHHS create a service delivery model, forms,  etc to assure access to funding for RD services under the MCH program? This process works in other states, why not Montana?   Apply for supplemental WIC grants through USDA and limit state agency funding increases to the same percentage provided to local agency funding based on the distribution between state and local agencies that was in effect when the banded funding formula was established.

 

8.      STATE FUNDING: Approach the legislature about funding cost allocation expenses charged to WIC by the state agency for a specified period of time, while measures to increase caseload can be put into place? Or permanently?   

 

9.      PROGRAM EVALUATION Assure that if data is entered into the automated system locally, reports of that data by clinic site are available.  For example if we enter a code for the ethnicity of a client, we should be able to access information on the number of clients with that ethnicity.  If we enter the date about exclusive breastfeeding for mothers, we should be able to get a report of the same, etc.

 

9  .WIC CHECKS Go back to putting the maximum food price on vouchers as allowed in the federal regulations. This will curtail the “lowest price” enforcement issue, as indicated on page 358 of the Federal Regulations

 

 

 

 

 

Mary Pittaway, MA, RD, CLC

Mary Pittaway, MA, RD
Nutrition Services Supervisor
Missoula City-County Health Department
301 W. Alder      Missoula MT 59802
406-258-4837  F 406-258-4906
pittawaym@ho.missoula.mt.us