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: % 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 dhs.wisconsin.gov/ltcare / Family Care Partnership dhs.wisconsin.gov/wipartnership / ADRC rcs.htm Family Care Expansion /