1. Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1

2. 2 Burden of Injury & Disease Falls surpass car crashes and suicide as the cause of injury-related deaths. (87% elders) Hospitalizations and emergency visits due to falls cost $800 million per year (70% elders) 70% of costs are Medicaid and Medicare LTC Consumers have 4-7 chronic conditions and co-occurring disabilities

3. D. McDowell3 Intersection Chronic disease is at the intersection of health care and long-term care Chronic illness and disability are complex Health care prevents disease; medical care treats disease Long-term care supports the person’s independence and normal lifestyle Self-management is a key to prevention, treatment and long-term living

4. D. McDowell4 State Strategy Evidence-based Prevention Partnership: a Medicare/Medicaid Managed Care Program: age & disability Family Care: Medicaid Managed LTC Program: age & disability IRIS: Self-directed waiver supports/service ADRC with a culture of prevention

5. D. McDowell5 Self-Management Is Important Fatigue Depression Pain Stress Emotion Disease

6. D. McDowell6 Statewide CDSMP 262 Lay Leaders 16 Spanish Leaders 5 Spanish MT 41 Master Trainers 2 T-Trainer

7. D. McDowell7 Living Well Data Sample 1,717 participants 44% (748) responded 293 ED visits 6 months Decrease: 62 visits Net savings: $60,202 151 hospital stays in prior 6 months Decrease 22 stays Net savings $1,177,282

8. D. McDowell8 Stepping on Falls Prevention Building Confidence, Reducing Falls Empower older adults to carry out healthy behaviors that reduce risks of falls and improve self management Community workshop 1x 7 weeks Improves balance, strength, home and environmental safety, vision and medication management

9. D. McDowell9

10. 10 Partnership/PACE Hospital contracts: focus on reducing admission and repeats Care at home Combine Medicare/Medicaid long-term care, acute and primary care. Capitation from feds and state Nurse practitioner and social worker team Physicians invited into network Issues with SNP, Advantage plans (4 MCOs)

11. D. McDowell11 Partnership/PACE DD 586 ELDERLY 2,703 PD 1,120 Total: 4,423 Unknown** 1 5

12. D. McDowell12 Family Care Capitation: all Medicaid long-term care (includes nursing home, home health, DME, therapies, hcbltc waiver services, residential & home care) Nurse, social worker, member team Provider network and rate setting by MCO Extensive contract provisions Lower cost than waivers and fee-for- service

13. D. McDowell13 Family Care Outcomes Focus on individual goals = outcomes Reduced nursing home and hospital Care management continues during hospital or nursing home to plan transitions Nursing home transitions due to Section Q or ADRC referrals (700 in 2010) Downward substitution of services

14. D. McDowell14 IRIS Include Respect I Self-Direct Waiver + FFS 4,100 enrollees Access through ADRC Same eligibility & benefits as managed care Budget built from functional screen Independent consultants Financial consultants

15. D. McDowell15

16. D. McDowell16 Aging & Disability Resource Centers County/tribal/regional 38+ ADRCs Board of directors State funds – 35% FFP $45 million Info & Assistance to families, elders, adults with disabilities Web-based functional screen for LTC Options counseling Enrollment counseling Benefits counseling Transitions: youth, hospital, nursing home Prevention

17. D. McDowell17 ADRC Goals Unbiased information about LTC, aging and disability Access to skillful, informed experts Focus on quality and customer service Access to publicly funded LTC Resources data for private pay and community Ease referral to to APS, crisis, other systems

18. D. McDowell18 Systems Change All LTC: elders, CD/DD, Physical disability Choice; Quality; Cost Effectiveness Integrate funding and services for these populations Enrollment: 41,000 in managed care and self directed waiver 330,000 ADRC contacts/year Consistency, coordination, collaboration