managing care in wisconsin donna mcdowell, mss, director bureau of aging & disability resources...
Post on 29-Dec-2015
214 Views
Preview:
TRANSCRIPT
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
Medicaid LTC Funding
• Waivers
• Fee-for-Service Nursing Home
• Home health, DME, DMS, therapies,etc.
• State-only Community Options
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/
top related