WIC Medical Provider Survey

HOW IS WIC WORKING WITH MEDICAL PROVIDERS & HEALTH CARE PROGRAMS?

The California Women, Infants, and Children (WIC) Supplemental Nutrition Program, Food Package Policy Unit, sent out a medical provider survey through WICTALK on March 5, 2004. Three states returned substantial responses to our questions. The survey questions and responses are listed below. Also refer to the table of highlighted responses (PDF) for a quick comparison between California and three other states. 

Survey Questions

1. Do you have formalized relationships with medical providers and other health care programs in your state? Please describe.
2. What specific efforts have you made to work with medical providers or other health care programs? For instance, have you surveyed medical providers regarding the WIC program? If so, what was the outcome?
3. Which aspects of your program elicit effective contact with medical providers and other health care programs?
4. What communication methods have you used with medical providers and other health care programs? For instance, do you conduct medical provider advisory meetings or send out letters or newsletters?
5. Does your agency align with organizations, collaboratives or other sources that allow you access to medical providers and other health care programs?
6. Does your agency employ, contract or consult with medical providers and/or professionals from other health care programs?
7. As a result of your efforts with medical providers and other health care programs, how have your program and participants benefited?
8. Was there any negative impact on your program? For instance, were there increased costs related to WIC Program operations, such as, providing training or training materials, accommodating increased referrals or requests for special nutritional products, etc?
9. What recommendations do you have for working with medical providers and other health care programs in the current health care environment? 

Responses to Survey Questions:

Do you have formalized relationships with medical providers and other health care programs in your state? Please describe. 

Response from Georgia:
Our State Division of Public Health has a contract with the State chapter of AAP. It allows us to have several liaisons (hired by them) to facilitate communication and education between the two groups. Our liaison is a Nutritionist/RD/LD. We have two advisory groups that meet by telephone on a quarterly basis: the WIC Advisory Group and the Breastfeeding Advisory Group. These have representatives from AAP, OB-GYN and FP associations.

Response from Nevada:
We have very recently gotten an AAP representative for the state. At this point, the providers are generally not receptive to information from anyone who is not a peer of theirs.

Response from Rhode Island:
Our state WIC breastfeeding coordinator (SBC) is integrally involved with Physicians Committee for Breastfeeding and the Breastfeeding Coalition. The SBC attends all group meetings, manages listserves for both groups, acts as a community organizer and liaison between breastfeeding professionals (IBCLC, VNAs, health insurers, MDs, midwives). This is a very effective arrangement. SBC receives Title V funding to do this work.

Response from California:
We have a few medical providers who are on our Breastfeeding Advisory Committee and meet with them regularly. They represent AAP, ACOG and Family Practitioners. Otherwise, we have no formalized relationships at the Branch level. Some local agencies have Memorandums of Understanding (MOUs) with their respective Health Maintenance Organizations (HMOs). Some local agencies are under medical entities that allow them to easily refer to primary medical care, for example, WATTS Health Foundation.

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What specific efforts have you made to work with medical providers or other health care programs? For instance, have you surveyed medical providers regarding the WIC program?
If so, what was the outcome?

Response from Georgia:
Our liaison with the medical community conducted surveys to find out what the main needs of the MDs were regarding health issues and WIC. We found out there were some serious myths about the true purpose of WIC - such as, we used WIC in public health to attract patients away from private providers. We also found out they were hungry for information and resources on childhood overweight, breastfeeding and feeding behaviors.

Each year, we will be focusing on four of our health districts (we have 19), in order to help establish better communication, to foster referrals back and forth, and to help provide WIC resources in a way that MDs will make sure their patients utilize. The AAP liaison does lunch and learns, mail-outs, education sessions (about public health services, WIC and the three areas mentioned above). She arranges for dialogue sessions between WIC/Public Health and the MDs, when necessary.

The AAP liaison has created a web page dedicated to WIC and Nutrition - on the State AAP site. She updates this as needed, with BF info, infant formula updates, etc. She also includes articles in the chapter newsletter and does mass mailings or faxes. One mailing was used to show progress in the area of breastfeeding - as well as to discuss the gaps in providing ongoing support for moms.

Response from Nevada:
There are two IBCLCs who work for WIC who see nearly all WIC newborns (d3 and d10-14) at the newborn care clinic five mornings a week. They work directly with two physicians who are very happy to have their help and support. We would like to duplicate this program statewide.

Response from Rhode Island:
We have a provider liaison who visits medical offices with local WIC agency staff to do a brief in-service on WIC and provide information and brochures. This piece sometimes includes a breastfeeding component.

The State Breastfeeding Coordinator (SBC) is planning a meeting with a large birthing hospital to develop a feedback mechanism to provide hospitals with patient input on their birthing and breastfeeding experiences. The SBC is currently working with health insurers about getting information about breastfeeding benefits out to consumers and providing information to providers about accessing these benefits.

Response from California:
Breastfeeding
We surveyed neonatologists in our state to assess their knowledge and attitudes toward breastfeeding and banked human milk for premature infants.

Exempt Formula
When developing the current screening and medical justification forms for therapeutic formulas, we piloted the form with a small group of MDs in order to see if the form was user friendly.

Contract Formula
An official letter was sent to medical providers regarding WIC’s contract formula change.

Outreach
We have a medical provider packet that promotes breastfeeding and offers nutrition education materials that medical providers can freely order.

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Which aspects of your program elicit effective contact with medical providers and other health care programs?

Response from Georgia:
Because most of our WIC programs are health department based, it is a bit simpler establishing lines of communication.

Our Medicaid participants are given a medical home with private providers (PH can only provide these services if there are no medical providers, none willing to see all Medicaid, or the MD's agree to share provision of health services or if the children are in foster care). So - if we detect a medical problem we immediately initiate a referral to the MD (anemia, low head circumference, medical emergency, whatever).

We also have increased the number of in-hospital (bedside) WIC certifications we do. This allows for very close contact with medical providers.

We have provided our physicians with the Georgia contract infant formula policy as well as our infant formula guide. This has kept most of the providers aware of what we will or will not accept as a diagnosis or reason for switching from contract to a non-contract formula, and which infant formulas will not be issued. If we become aware of a physician or practice that disregards the WIC policy, we work through our AAP liaison to provide appropriate education to the physician. The chair of the GA AAP Nutrition Committee (a gastroenterologist) will, at our request, provide education to physicians who continuously recommend inappropriate formulas.

Response from Nevada:
When there is a discrepancy with information recommended by the provider, we make sure to diplomatically provide peer reviewed information in an attempt to educate without shutting down the lines of communication. Sometimes it works and sometimes not, but it seems to be the least threatening method at the moment.

Response from Rhode Island:
WIC Provider Liaison

Breastfeeding peer counselor program at local agencies provides readily available breastfeeding resource to health clinics.

WIC updates and collaboration at Physicians Committee for Breastfeeding and Breastfeeding Coordinator meetings.

Response from California:
Breastfeeding
Other programs in our agency have implemented activities to promote breastfeeding, i.e. the Medi-Cal Managed Care Division sent a letter to all contracted health plans clarifying their expectations for breastfeeding support. This was done with input from WIC and as a result of the Medi-Cal Managed Care Division participating on our Breastfeeding Advisory Committee.

Formula
By using WICs screening and medical justification form for exempt formula, the medical provider saves time, because participant information is gathered for their review.

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What communication methods have you used with medical providers and other health care programs? For instance, do you conduct medical provider advisory meetings or send out letters or newsletters?

Response from Georgia:
I think I mentioned these above. We also had a breastfeeding telephone conference training in September, and are in the process of developing another one in child health. Our AAP liaison provides in-service training to medical practice groups in the target areas for the year. Based on the needs of the practice, the training might be a face-to-face training with the entire practice (from physicians, to nurses, to front-office staff) or a mailing that includes resources, WIC and other health department contract information, and referral forms. In addition, updates and “hot’ information is sent through blast faxes and letters to members, as well as posted on the chapter web page. Our liaison, in collaboration with physicians who strongly support breastfeeding (including one who is MD, IBCLC) have worked to have a breastfeeding room available and a breastfeeding talk scheduled at each of the two annual chapter conferences.

We are in the process of finalizing a revised referral form. Previously, the forms were provided to physicians for the purpose of soliciting referrals to WIC. The new form is designed to be used for both referrals from WIC to the medical community and from the medical community to WIC.

Response from Nevada:
The new AAP representative will do some of that for us with her grand rounds presentations etc. There is much provider resistance.

Response from Rhode Island:
•  Site visits
•  Blast faxes
•  Direct mailings
•  Public forums (grand rounds)
•  Physicians Committee for Breastfeeding and Breastfeeding Coordinator meetings

Response from California:
We send emails to our Breastfeeding Advisory Committee Members who are physicians and a few other interested physicians that we know about.

We send direct mailings to the Child Health and Disability Prevention Program (CHDP) medical providers and write articles for HMO newsletters.

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Does your agency align with organizations, collaboratives or other sources that allow you access to medical providers and other health care programs?

Response from Georgia:
Yes, this is one thing that this state is working on as a priority - regarding not only WIC and Nutrition, but we have staff who help physicians with requirements for EPSDT services (provide training of their staff, and monitoring of services). We have close ties with immunizations as well since the State provides the free and low cost immunizations for MDs to provide to our community.

Response from Nevada:
Same as above. We have task forces with physicians as members with whom I am in contact.

Response from Rhode Island:
Same as #1.

Response from California:
When we distributed our neonatologist survey, we went through the neonatologist on our Breastfeeding Advisory Committee.

When sending out information, we access medical providers through the State Child Health and Disability Prevention Program (CHDP).

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Does your agency employ, contract or consult with medical providers and/or professionals from other health care programs?

Response from Georgia:
Some of our local agencies operate in health departments in which medical groups have been given space and/or contracts to provide medical services. This eases the ability to cross-refer and to coordinate needed services.

Response from Nevada:
Only RDs, IBCLCs and cooperative extension at the moment.

Response from Rhode Island:
Not sure.

Response from California:
We have volunteer medical providers on our Breastfeeding Advisory Committee.

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As a result of your efforts with medical providers and other health care programs, how have your program and participants benefited?

Response from Georgia:
We will be evaluating this, this year. Anecdotally, it has been wonderful. I think the mutual respect that is developing will result in more referrals and in consistency of the medical messages.

Response from Nevada:
Too early to tell as we haven’t been at this very long. Ask me in three to five years.

Response from Rhode Island:
Incremental growth in breastfeeding awareness among providers and breastfeeding infrastructure changes.

Response from California:
By informing medical providers about the recent formula contract change, WIC saved time and money by avoiding prescriptions for non-contract formula.

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Was there any negative impact on your program? For instance, were there increased costs related to WIC Program operations, such as, providing training or training materials, accommodating increased referrals or requests for special nutritional products, etc?

Response from Georgia:
It has all been positive.

Response from Nevada:
Not yet.

Response from Rhode Island:
Less time available for the State Breastfeeding Coordinator to focus on WIC issues.

Response from California:
There has been no negative impact.

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What recommendations do you have for working with medical providers and other health care programs in the current health care environment?

Response from Georgia:
First of all, it is critical. Our recommendations include:

• Get to know the medical community. Find out who they are, where they practice, whom they serve, their perception of WIC and Public Health, what they would like out of the relationship.
• Find common ground – what will be of mutual benefit in the relationship.
• Work with local agencies to get their staff talking with the medical providers.
• Build staff competencies so that local agency nutritionists/dietitians feel comfortable calling a physician to discuss a referral, breastfeeding information or a formula prescription.
• Sell the WIC staff competencies to the physicians so that they see the value in working with WIC staff and referring back to WIC.
• Invite physicians to participate as task force or coalition members, even if they can only do it in an advisory capacity.
• Keep the information flowing – rather than having a one-time communication or information campaign.

Response from Nevada:
You need to be very diplomatic and encourage dialogue without being overly zealous.

Response from Rhode Island:
Help providers with their administrative burden. They don’t have time for that aspect, but are often enthusiastic to work on the issues (in this case, breastfeeding). Provide them only with information needed, process information for them as needed, be very explicit about what you need from them, especially effective in writing.

Response from California:
Our recommendation is that you find providers or health care programs that are interested in your work (passionate about it) as they often work on their own time to help out.

In the changing health care environment, WIC can assist the community medical provider by providing assessment information, nutrition education, breastfeeding assistance and MNT referrals. This creates a working partnership between WIC and health care providers where WIC is seen as a positive resource instead of a public health program that makes additional administrative demands.

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