1 / 18

Managing Care in Wisconsin

Managing Care in Wisconsin. Donna McDowell, MSS, Director Bureau of Aging & Disability Resources Division of Long-Term Care Dept. of Health Services NASHP October 4, 2011. Publicly-Funded Long-Term Care Clients by Setting. 66%. 61%. 39%. 34%. How Does Change Happen?.

alvin-sears
Download Presentation

Managing Care in Wisconsin

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing Care in Wisconsin Donna McDowell, MSS, Director Bureau of Aging & Disability Resources Division of Long-Term Care Dept. of Health Services NASHP October 4, 2011

  2. Publicly-Funded Long-Term Care Clients by Setting 66% 61% 39% 34% D. McDowell - Wisconsin

  3. 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 D. McDowell - Wisconsin

  4. Look Familiar? D. McDowell - Wisconsin

  5. END WAITING LISTS “There’s No Place Like Home!”

  6. Medicaid LTC Funding • Waivers – residential, vocational • Nursing Home • Home health, DME, DMS, therapies • State-only Community Options D. McDowell - Wisconsin

  7. Coordinate v. Integrate • Hospital • Physician • Acute • Primary • Rx • Hospice D. McDowell - Wisconsin

  8. Medicaid Managed Care Program for SSI and SSI Related Recipients • 2003-05 Biennial Budget required certain SSI recipients to enroll in MA managed care • Individuals dually eligible for both Medicare and Medicaid may enroll voluntarily. • All eligible individuals, aged 19 and older who are SSI MA not currently enrolled in a managed care program (Family Care, PACE, or Partnership), are enrolled. Choice, after an initial two month mandatory trial period, to opt out of the program. • Fifth month enrollees are locked into the managed care plan for an additional eight months. D. McDowell - Wisconsin

  9. Aging & Disability Resource Centers • One-stop shopping for information and advice about issues of age, disability and long-term care. • Easy access to knowledgeable professionals about programs, housing and eligibility. • Counseling about array of options for private pay and indigent clients D. McDowell - Wisconsin

  10. 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 D. McDowell - Wisconsin

  11. 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 D. McDowell - Wisconsin

  12. 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 their choice D. McDowell - Wisconsin

  13. Expansion • Current 35 ADRCs for 55 counties • Serve 85% of population • Statewide expansion by 2013 • $50 million AF; claim MA thru time reporting • 350,000 contacts/year • Tribal Aging & Disability Specialist • Milwaukee ARC & DRC D. McDowell - Wisconsin

  14. OPTION: Family Care • Elderly, physically or intellectually disabled • Over 40% have mental health problems • Integrated, person-centered LTC • Social Worker/Nurse Care Team • Comprehensive Assessment • Care Plan identifies personal goals • 8 MCOs:non-profit, county,public authority • Provider network to met all needs D. McDowell - Wisconsin

  15. Family Care Costs • 31,256 members in 2010; av. $2900 pmpm • $976 million Family Care: adaptive ,DME,day, care mgt, home care, home health, therapies, housing, residential (no room/ board), respite, transport, vocational, nursing home • $94.8 million Medicaid: acute, primary, hospital, doctor, Rx fee-for-service not in cap rate • Approaches to incentivize care at home are key to cost-effectiveness & sustainability D. McDowell - Wisconsin

  16. 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 (also SSI managed care) • One PACE: two sites D. McDowell - Wisconsin

  17. Self-Direction • IRIS – Include Respect, I Self-direct waiver services • 3393 IRIS participants • Family Care has 3,000 members self-directing services of their choice • IRIS waiver does not include MA ffs; participants can self-direct MA personal care D. McDowell - Wisconsin

  18. Information on Website • Family Carehttp://dhs.wisconsin.gov/ltcare/ • Family Care Partnershiphttp://dhs.wisconsin.gov/wipartnership/ • ADRChttp://dhs.wisconsin.gov/ltcare/adrc • Family Care Expansion http://dhs.wisconsin.gov/managedltc/ • Medicaid SSI HMO Choice Booklet http://www.dhs.wisconsin.gov/publications/p1/p12770a.pdf • ForwardHealth Enrollment and Benefits handbook http://www.dhs.wisconsin.gov/em/impubs/pubs/p-00079.pdf D. McDowell - Wisconsin

More Related