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PROPOSED NEW MODELS OFPROPOSED NEW MODELS OFLONG TERM CARELONG TERM CARE

Calumet, Outagamie, and Waupaca CountiesCalumet, Outagamie, and Waupaca Counties

October, 2008October, 2008

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CommunityCommunity--Based Care inBased Care inWisconsin A Historical ViewWisconsin A Historical View

Wisconsin has been viewed as a leader among states in establishing community-based, long-term care for many years.

Began state-funded, county-based community services in 1974.

Community Options Program (COP) in 1981.

Community Integration Program (CIP) for persons with developmental disabilities in 1983.

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Why did the State of WisconsinWhy did the State of Wisconsinwant to change the current LTCwant to change the current LTCsystem?system?

Contain Statewide Cost Growth

Expand Consumer Choice (Nursing Home vs. Waitlist)

Simplify Access to LTC Services

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What were the Goals for LongWhat were the Goals for Long--Term Term Care Reform?Care Reform? Purchase better consumer outcomes, not services

or processes.

Allow consumers and care managers flexibility to respond to individuals’ needs, preferences, and resources.

Enable individuals to live in the most integrated setting suited to their needs and preferences.

Reduce reliance on institutional and residential care.

Include and support informal caregivers.

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How Does the Current SystemHow Does the Current SystemCompare to the New?Compare to the New?

Current SystemCurrent System

Entitlement to nursing Entitlement to nursing home care: wait list home care: wait list for community carefor community care

Specific types of Specific types of service availableservice available

Many different federal, Many different federal, state and county state and county funding streamsfunding streams

Proposed ModelProposed Model Entitlement to both Entitlement to both

communitycommunity--based and based and nursing home carenursing home care

Single, expanded, Single, expanded, flexible benefit flexible benefit packagepackage

One primary funding One primary funding streamstream

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Comparing SystemsComparing Systems

Current SystemCurrent System No $ incentive for No $ incentive for

intervention & intervention & preventionprevention--person person automatically enters automatically enters nursing homenursing home

Service authorization Service authorization limited by available limited by available funds, or by state prior funds, or by state prior authorizationauthorization

Proposed ModelProposed Model Intervention and Intervention and

prevention in care prevention in care plans; must provide plans; must provide services if condition services if condition deterioratesdeteriorates

Service authorization Service authorization by local teams with by local teams with access to needed access to needed fundingfunding

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Current LongCurrent Long--Term Care Reform Term Care Reform AlternativesAlternatives

Family Care: Family Care: System that arranges and manages longSystem that arranges and manages long--term term care and works closely with acute and primary health care care and works closely with acute and primary health care providers to better coordinate care and services.providers to better coordinate care and services.

Currently available in Fond du Lac, La Crosse, Portage, RichlandCurrently available in Fond du Lac, La Crosse, Portage, Richland, , Milwaukee, Racine, Kenosha, Sheboygan, Ozaukee, Washington, Milwaukee, Racine, Kenosha, Sheboygan, Ozaukee, Washington, Waukesha, Dodge, Jefferson, Columbia, Green Lake, Waushara, St. Waukesha, Dodge, Jefferson, Columbia, Green Lake, Waushara, St. Croix, Croix, Pierce, and Marquette counties.Pierce, and Marquette counties.

Partnership: Partnership: System that delivers longSystem that delivers long--term care and term care and integrates acute and primary care that integrates acute and primary care that includesincludes medical care.medical care.

Currently available in Chippewa, Dunn & Eau Claire; Milwaukee, RCurrently available in Chippewa, Dunn & Eau Claire; Milwaukee, Racine, acine, Kenosha; Dane, Columbia, Pierce, and St. Croix counties.Kenosha; Dane, Columbia, Pierce, and St. Croix counties.

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What is Family Care?What is Family Care?

Comprehensive, flexible longComprehensive, flexible long--

term care program to fosterterm care program to foster

independence and quality of lifeindependence and quality of life

for the elderly and people withfor the elderly and people with

disabilities in Wisconsindisabilities in Wisconsin

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Who is Eligible for FamilyWho is Eligible for FamilyCare?Care?

FINANCIAL • Be Medicaid-eligible,

FUNCTIONAL

TARGET GROUP

• Be otherwise eligible to receive services in a nursing home.

• Be one of the following:- 65 years or older- 18+ years with a physical disability- 18+ years with a developmental

disability

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What does Family Care Offer toWhat does Family Care Offer toConsumers?Consumers? Comprehensive AssessmentComprehensive Assessment Interdisciplinary Team (including Interdisciplinary Team (including

consumer)consumer) Identification of appropriate longIdentification of appropriate long--term term

care outcomescare outcomes Identification of natural and paid Identification of natural and paid

supports to help consumers attain supports to help consumers attain outcomesoutcomes

A network of qualified service A network of qualified service providersproviders

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Family Care TeamFamily Care Team

Manages servicesManages services Ensures consumer’s outcomes and Ensures consumer’s outcomes and

needs are addressed as needs changeneeds are addressed as needs changeThe Team includes:The Team includes: MemberMember Care ManagerCare Manager Nurse Care ManagerNurse Care Manager Others Others (i.e. other professionals, guardian, (i.e. other professionals, guardian,

relatives, friend)relatives, friend)

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What Services are in theWhat Services are in theBenefit Package?Benefit Package?

XXXXXXTransportationTransportationXXXXXX

Supportive Home CareSupportive Home CareXXXXXXCase ManagementCase ManagementXXXXXXResidential CareResidential CareXXXXXXHome ModificationsHome ModificationsXXXXXXHome Delivered MealsHome Delivered MealsXXXXXX

Day Service or RespiteDay Service or RespiteCardCardXXXXNursing Home CareNursing Home CareCardCardXXXXPhysical, Speech, OTPhysical, Speech, OTCardCardXXXX

Home Health, Personal Home Health, Personal CareCare

CardCardXXXXDME/DMSDME/DMSCardCardCardCardXXMedicationsMedicationsCardCardCardCardXX

Physician/Hospital Physician/Hospital ServicesServices

Current MA Current MA WaiverWaiverFamily CareFamily CarePartnershipPartnershipCovered ServicesCovered Services

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Does Family Care Save Money?Does Family Care Save Money?

Independent assessment of four of the five Independent assessment of four of the five original Family Care Pilots found:original Family Care Pilots found:

Average savings of $452 per monthAverage savings of $452 per month

Reduced use of nursing homesReduced use of nursing homes

Persons maintained Health and functioningPersons maintained Health and functioning

Assembly Committee of Medicaid ReformAssembly Committee of Medicaid Reform

Department of Health and Family ServicesDepartment of Health and Family Services

February 8, 2006February 8, 2006

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How Money is Saved?How Money is Saved?

Reduced hospital costsReduced hospital costs

Reduced nursing home useReduced nursing home use

Focus on outcomes; needs Focus on outcomes; needs vsvs wantswants

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What is the Family CareWhat is the Family CarePartnership Program?Partnership Program?

Combines health and longCombines health and long--

term care services for elderlyterm care services for elderly

and people with disabilities.and people with disabilities.

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Who is Eligible for Partnership?Who is Eligible for Partnership?

FINANCIAL • Be Medicaid-eligible,

FUNCTIONAL

TARGET GROUP

• Be otherwise eligible to receive services in a nursing home.

• Be one of the following:- 65 years or older- 18+ years with a physical disability- 18+ years with a developmental

disability

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Partnership TeamPartnership Team

Partnership Team includesPartnership Team includes-- Primary Care PhysicianPrimary Care Physician-- Nurse PractitionerNurse Practitioner-- Registered NurseRegistered Nurse-- Licensed Social WorkerLicensed Social Worker-- Member, Significant OthersMember, Significant Others

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How Does PartnershipHow Does PartnershipWork?Work?

Team provides or arranges all servicesTeam provides or arranges all services

-- Goal: To assist participant in living in the Goal: To assist participant in living in the community for as long as possiblecommunity for as long as possible

Medical CareMedical Care-- Medical care is includedMedical care is included-- Member contacts Team to make appointments for Member contacts Team to make appointments for

routine, urgent and outroutine, urgent and out--ofof--area carearea careException: Emergency careException: Emergency care

-- Primary Care Provider makes referrals to network Primary Care Provider makes referrals to network specialists when neededspecialists when needed

-- Members present their ID card to network Members present their ID card to network providers to receive servicesproviders to receive services

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Family Care is a better fit when:Family Care is a better fit when: Member prefers control over convenienceMember prefers control over convenience

-- Member maintains greater responsibility in Member maintains greater responsibility in coordinating own carecoordinating own care

One stop shop for all services One stop shop for all services –– longlong--term term care care andand medical care medical care –– is less importantis less important-- Retaining existing physician(s) is importantRetaining existing physician(s) is important-- Physicians who have agreed to contract with Physicians who have agreed to contract with

the MCO are not those the member would like the MCO are not those the member would like to seeto see

Absence of chronic, complex diseaseAbsence of chronic, complex disease Medication management is not indicatedMedication management is not indicated

Why Choose One or The Other?

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Partnership is a better fitPartnership is a better fitwhen:when:

Participant prefers convenience over Participant prefers convenience over controlcontrol-- Participant maintains less responsibility in Participant maintains less responsibility in

coordinating carecoordinating care

One stop shop of all services One stop shop of all services –– longlong--term term care care andand medical care medical care –– is importantis important-- Retaining existing physician(s) is not as Retaining existing physician(s) is not as

importantimportant-- Physicians who are willing to contract with the Physicians who are willing to contract with the

MCO are acceptableMCO are acceptable

Presence of chronic, complex diseasePresence of chronic, complex disease Medication management is indicatedMedication management is indicated

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What about SelfWhat about SelfDirected Supports?Directed Supports?

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SelfSelf--Directed Supports OptionDirected Supports Option

Option available for all Community Care Option available for all Community Care programs (Family Care & Partnership)programs (Family Care & Partnership)

-- Empowers you to arrange, purchase and direct Empowers you to arrange, purchase and direct some of your own longsome of your own long--term care servicesterm care services

-- Gives you greater control and flexibilityGives you greater control and flexibility

Option available through state wide Self Option available through state wide Self Directed Supports program called IRIS Directed Supports program called IRIS (Include, Respect, I Self(Include, Respect, I Self--Direct)Direct)-- Empowers you to arrange, purchase, and direct Empowers you to arrange, purchase, and direct

allall of your long term care servicesof your long term care services

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In order for Family Care or In order for Family Care or

Partnership to be offered in an Partnership to be offered in an

area, there must first be an area, there must first be an

operating Aging and Disability operating Aging and Disability

Resource Center (ADRC)Resource Center (ADRC)

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Aging & Disability Resource Centers Aging & Disability Resource Centers and Longand Long--Term Care ReformTerm Care Reform

A single sourceA single source for the general public to get for the general public to get objective and reliable information about a broad objective and reliable information about a broad range of community resources of interest to range of community resources of interest to elderly people and people with disabilities.elderly people and people with disabilities.

Service is provided at no costService is provided at no cost and without regard and without regard to income and assets.to income and assets.

Help people conserveHelp people conserve their personal resources, their personal resources, health and independence.health and independence.

Reduce the demandReduce the demand for public funding for long for public funding for long term care by delaying or preventing the need.term care by delaying or preventing the need.

Growth of aging and disabled populationGrowth of aging and disabled population means means that more people will need assistance.that more people will need assistance.

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Aging & Disability Resource Center Serving Aging & Disability Resource Center Serving Calumet, Outagamie and Waupaca countiesCalumet, Outagamie and Waupaca counties

Go ToGo Towww.www.youradrcresourceyouradrcresource.org.org

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Aging & Disability Resource Center Serving Aging & Disability Resource Center Serving Calumet, Outagamie and Waupaca CountiesCalumet, Outagamie and Waupaca Counties

Waupaca CountyWaupaca County

BranchBranch

811 Harding Street811 Harding Street

Waupaca, WI 54981Waupaca, WI 54981

715715--258258--64006400

11--866866--739739--23722372

www.co.waupaca.wi.uswww.co.waupaca.wi.us

Outagamie CountyOutagamie County

BranchBranch

401 S. Elm Street401 S. Elm Street

Appleton, WI 54911Appleton, WI 54911

920920--832832--51785178

11--866866--739739--23722372

www.co.outagamie.wi.uswww.co.outagamie.wi.us

Calumet CountyCalumet County

BranchBranch

206 Court Street206 Court Street

Chilton, WI 53014Chilton, WI 53014

920920--849849--14511451

11--866866--739739--23722372

www.co.calumet.wi.uswww.co.calumet.wi.us

WWW.yourADRCresource.org

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The ADRC serves people in Calumet, The ADRC serves people in Calumet, Outagamie, and Waupaca Counties who Outagamie, and Waupaca Counties who meet one or more of the following:meet one or more of the following:

Are over age 60Are over age 60

Have a developmental disabilityHave a developmental disability

Have a physical disabilityHave a physical disability

Have mental health issuesHave mental health issues

Have substance abuse issuesHave substance abuse issues

Are young adults with disabilities who are transitioning to Are young adults with disabilities who are transitioning to

adulthood and related servicesadulthood and related services

Are families, caregivers, or advocates for any of these Are families, caregivers, or advocates for any of these

individualsindividuals

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What does the ADRC do?What does the ADRC do?ADRC helps to:ADRC helps to: Sort out issues and answer questionsSort out issues and answer questions Identify options to make choices and maximize Identify options to make choices and maximize

independenceindependence Identify informal supports and location of gapsIdentify informal supports and location of gaps Determine eligibility for public fundingDetermine eligibility for public funding Explain programs and services that are available in their Explain programs and services that are available in their

own communitiesown communities

ADRC will assist with:ADRC will assist with: Applications for public benefitsApplications for public benefits Signing up for government programsSigning up for government programs

For those with greater needs, ADRC will help to encourage an For those with greater needs, ADRC will help to encourage an even more ineven more in--depth interview to help identify care and other depth interview to help identify care and other support needs.support needs.

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Plan for the FuturePlan for the Future

Transition from individualTransition from individualCountyCounty Managed ProgramsManaged Programs

totoManaged Care OrganizationManaged Care OrganizationCovering Several CountiesCovering Several Counties

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Role of the Managed CareRole of the Managed CareOrganization (MCO)Organization (MCO)

Partners with counties in dayPartners with counties in day--toto--day day provision of longprovision of long--term care servicesterm care services

Tailors the delivery of care to eligible Tailors the delivery of care to eligible recipients based on their needsrecipients based on their needs

Contracts with quality providers of serviceContracts with quality providers of service Contracts with the state to provide Contracts with the state to provide

consistent level of long term careconsistent level of long term care Bears financial riskBears financial risk

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Role of the State ofRole of the State ofWisconsinWisconsin

Provides statewide fiscal, regulatory Provides statewide fiscal, regulatory and quality oversightand quality oversight-- Managed Care OrganizationManaged Care Organization

-- ADRCsADRCs

Legislative changes to accommodate Legislative changes to accommodate reform reform -- FundingFunding-- Statutory changesStatutory changes

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Role of CountiesRole of Counties

Provides local oversight through the Provides local oversight through the ADRC Consortia Advisory Committee, ADRC Consortia Advisory Committee, regional Long Term Care Council, regional Long Term Care Council, Operations Council, and local Advisory Operations Council, and local Advisory CommitteeCommittee

Operates Aging and Disability Resource Operates Aging and Disability Resource Centers (Centers (ADRCsADRCs))

Encourages crossEncourages cross--county collaboration county collaboration for efficiencies and best practicesfor efficiencies and best practices

County Boards must approve County Boards must approve participation in redesigned systemparticipation in redesigned system

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Calumet, Outagamie & Waupaca Counties Calumet, Outagamie & Waupaca Counties have partnered with Community Care have partnered with Community Care

to work toward becoming the MCO in this areato work toward becoming the MCO in this area

Community Care isCommunity Care is-- A pioneer in communityA pioneer in community--based longbased long--term careterm care

-- Nationally recognized for model of integrated careNationally recognized for model of integrated care

-- A nonA non--profit organization with over 30 years of profit organization with over 30 years of experience in experience in caring for atcaring for at--risk Wisconsin residentsrisk Wisconsin residents

-- Currently serving more than 4000 adults with longCurrently serving more than 4000 adults with long--term term care needscare needs

-- An agency with a high degree of member satisfactionAn agency with a high degree of member satisfaction

FFamiliar places. amiliar places. CCaring faces.aring faces.

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Our shared goalsOur shared goals

To empower adults with health and longTo empower adults with health and long--term term care needs to remain independent as long as care needs to remain independent as long as possiblepossible

To improve the quality of life for all people in our To improve the quality of life for all people in our communitiescommunities

To work together to end waiting lists for longTo work together to end waiting lists for long--term care servicesterm care services

To ensure that people understand their choices To ensure that people understand their choices and are matched with the best program for them and are matched with the best program for them (Family Care, Family Care Partnership, IRIS, or (Family Care, Family Care Partnership, IRIS, or Medicaid fee for service)Medicaid fee for service)

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KEY ELEMENTS OF PROPOSEDKEY ELEMENTS OF PROPOSEDMODELMODEL

Community Care is MCO with state contractCommunity Care is MCO with state contract

Community Care provides Partnership & Community Care provides Partnership & Family CareFamily Care

Representative of each county on Representative of each county on Community Care BoardCommunity Care Board

Local input through Advisory Committees Local input through Advisory Committees and Operations Counciland Operations Council

Counties may contract for care Counties may contract for care management and/or other key servicesmanagement and/or other key services

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Who Will be Impacted ByWho Will be Impacted ByImplementation of ProposedImplementation of Proposed

Model?Model? ConsumersConsumers

-- Current COP, CIP recipients will be offered the opportunity to sCurrent COP, CIP recipients will be offered the opportunity to select elect Family Care, Partnership, IRIS, or remain in Medicaid fee for seFamily Care, Partnership, IRIS, or remain in Medicaid fee for servicervice

-- For those counties with wait lists, the wait lists will be gone For those counties with wait lists, the wait lists will be gone in 24 in 24 monthsmonths

ProvidersProviders-- Current providers will be offered the opportunity to contract wiCurrent providers will be offered the opportunity to contract with th

Community Care to continue to provide servicesCommunity Care to continue to provide services

CountiesCounties-- After the transition period, counties will no longer offer long After the transition period, counties will no longer offer long term term

support programs; COP & CIP will go awaysupport programs; COP & CIP will go away-- Counties will continue to sponsor the ADRC, mental health Counties will continue to sponsor the ADRC, mental health

programs, adult protective services, and programs for childrenprograms, adult protective services, and programs for children

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What can you do toWhat can you do toensure success?ensure success?

Get InformedGet InformedProvide inputProvide inputProvide feedbackProvide feedbackStay informedStay informed