Managing Care in Wisconsin

Donna McDowell, MSS, Director

Bureau of Aging & Disability Resources

Division of Long-Term Care

Dept. of Health Services

ASA April 27, 2011

How Does Change Happen?

• People want something better

• Choice matters

• Access to an array of opportunities

• Quality is very personal

• Cost-effectiveness is essential

• Combine available resources

• Create good business models

Look Familiar?

END WAITING LISTS

“There’s No Place Like Home!”

Medicaid LTC Funding

• Waivers

• Fee-for-Service Nursing Home

• Home health, DME, DMS, therapies,etc.

• State-only Community Options

Coordinate Not Integrate

• Hospital

• Physician

• Acute

• Primary

• Hospice

OPTION: Family Care

• Integrated, person-centered LTC

• Social Worker/Nurse Care Team

• Comprehensive Assessment

• Care Plan identifies personal goals

• Capitation: av. $3000 pmpm

• 8 MCOs – non-profit, county, public

• Elderly, physically or intellectually disabled

• Nursing home level of care

OPTION: Partnership

• Integrates Long-Term and Primary Care

• Integrates Medicare and Medicaid

• Nurse Practitioner & Social Worker team

• Special needs plan

• 3 non-profit MCOs in 8 counties (incl. Milwaukee) also provide Family Care

• For-profit (provides SSI managed care)

• One PACE: two sites

FUNDING FAMILY CARE

• $1.4 BILLION: 2001-2013

• 75% of state has access – expansion frozen

• 30,000 + participants

• Legislative audit and APS Evaluation (+)

Self-Direction

• IRIS – Include Respect, I Self-direct

waiver services

• 3393 participants

• Family Care has 3,000 members self-directing services of their choice

Aging & Disability Resource Centers

• One-stop shopping for information and advice about issues of age, disability and long-term care.

• Easy access to knowledgeable professional about programs, housing and eligibility.

• Counseling about array of options for private pay and indigent clients

Objective and Prompt Service

• Uniform questionnaire screens individuals to determine what difficulties person has functioning (functional screen).

• Web-based functional screen automatically determines eligibility for public programs: Family Care, Partnership, IRIS

• Easy access to prompt financial eligibility determination

Enrollment Counseling

• Mandatory for managed care

• Organizationally independent of MCO

• Public entity

• Functional eligibility (home visits)

• Explain program elements

• Support decision-making

• Enroll individual in program of her choice

Combining Services Under One Umbrella

• Elderly benefit specialist

• New disability benefit specialist

• Prevention of disability, e.g. elderly falls prevention

• Transitions for children with disabilities to adult programs

• Information and assistance for persons with mental health concerns

Expansion Proposals

• Current 35 ADRCs for 55 counties

• Serve 85% of population

• Proposed statewide expansion by 2013

• $43 million AF

• 350,000 contacts/ year

Information on Website

• Family Care http://dhs.wisconsin.gov/ltcare/• Family Care Partnership

http://dhs.wisconsin.gov/wipartnership/• ADRC http://dhs.wisconsin.gov/ltcare/Generalinfo/

rcs.htm• Family Care Expansion

http://dhs.wisconsin.gov/managedltc/