Wisconsin Partnership Program

1. Wisconsin Partnership Program Sharon Larson Provider Relations and Contracting Manager Elder Care of Wisconsin & Steven J. Landkamer Wisconsin Dept. of Health & Family Services July 14, 2004

2. The Role of Primary Care Physicians • Member of Care Management Team along with a: • Participant; • Nurse Practitioner (NP); • Registered Nurse (RN); • Social Worker; • Service Coordinator. • Collaborator in Care Plan Development.

3. How do Physicians Become Involved? • Elder Care has an Agreement with Each Large Physician Group. • All Primary and Specialty Physicians Covered Under One Agreement. • Model is Most Effective if the Primary Care Physician (PCP) is Invested in the Model and is Willing to Collaborate.

4. How do Physicians Become Involved? • PCP Becomes Involved in One of Two Ways: • Brought to the Model by a Potential Participant; • Physician Contacts Elder Care to Become Involved in the Program. • Initial Meeting to Provide Information and Assess Interest.

5. How Do the PCP and Care Team Relate? • If the PCP is Interested in Participating in Partnership, the Team Nurse Practitioner Meets with the PCP to Establish a Collaborative Relationship.

6. How Do the PCP and Care Team Relate? • Typically the NP: • Provides Initial History and Physical; • Provides Periodic Re-evaluation of Medical Status; • Provides Evaluation of Episodic Illnesses in the Member’s Home; • Attends All Participant Visits to the PCP.

7. How Do the PCP and Care Team Relate? • Ensures that Health Maintenance Standards are Offered and Accessible; • Assumes Leadership in Collaborating with Appropriate Providers; • Orders Diagnostic or Therapeutic Interventions; • Communicates with the PCP to Keep Him/Her Informed of Medical Status.

8. How Do the PCP and Care Team Relate? • The RN Provides: • Health Assessment and Response to Illnesses and Medication; • In-home Assessment to Identify Functional Limitations and Adaptations; • Skilled Nursing Services; • Oversee the Provision of Personal Care and Evaluate the Effectiveness of Care.

9. How Do the PCP and Care Team Relate? • Team Manages Care on an Ongoing Basis and Communicates and Seeks Input from PCP as Appropriate. • Care Team Serves as Resource for the PCP.

10. Supporting Physicians in Managing Care • The NP Attends All Participant Visits to the PCP. • The NP Communicates Changes in Condition and Changes in Care Plan and Seeks Advice as Needed. • The NP or RN Provides Home Visits.

11. Supporting Physicians in Managing Care • Provide Visits in Nursing Homes and Hospitals and Coordinates Discharge and Post-Institutional Care with Discharge Planners. • The NP and the RN Work with the Participant and Pharmacy to Assist with Medication Compliance.

12. Supporting Physicians in Managing Care • The Care Team Acts as the First Point of Contact for the Participant, 24/7, Reducing Phone Calls to the PCP or the On-call Physician.

13. How are Physicians Paid? • PCPs and Specialty Physicians are Paid Fee-For-Service. • Partnership Sites are at Liberty to Negotiate with Providers to Assure Access and Quality. • In General Physician are Paid as Traditional Medicare Pays.

14. The Results

15. The Results

16. The Results

17. How are Physicians Paid? • Elder Care of Wisconsin: www.elderc.org • Wisconsin Partnership Program: www. dhfs.wisconsin.gov/WIpartnership

18. More Information • Elder Care of Wisconsin: www.elderc.org • Wisconsin Partnership Program: www. dhfs.wisconsin.gov/WIpartnership