Transition to Reform in Wisconsin

Donna McDowell, Director

Bureau of Aging & Disability Resources Department of Health Services

D. McDowell 1

D. McDowell 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 MedicareLTC Consumers have 4-7 chronic conditions

and co-occurring disabilities

D. McDowell 3

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

D. McDowell 4

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

D. McDowell 5

Self-Management Is Important

Fatigue

Depression

Pain

Emotion

Stress

Disease

D. McDowell 6

Chronic Disease Self- Mgt

July 2010

Trainers/Leaders

'

$

Washburn

Burnett

DouglasBayfield

Sawyer

AshlandIron

Vilas

Oneida1 MT 2 LL

Price

Polk Barron Rusk

Chippewa1 MT1 LL

St. Croix Dunn

Taylor

LincolnLanglade1 LL

Forest Florence

Marinette

OcontoClarkMarathon

Shawano

WoodPortage Waupaca

Menominee

Door

Kewaunee1 MT 6 LL

Brown

Pierce

Pepin

Buffalo Tremp-ealeau

Eau Claire2 MT 5 LL

La Crosse

MonroeJuneau

Adams

Waushara

Outagamie

Manitowoc

Sheboygan

1 LL

SaukVernon

Crawford

Richland

Grant

Iowa

LafayetteGreen Rock Walworth

Kenosha

Racine 9 LL

Washington5 LL

OzaukeeColumbia

Dane

Jefferson

Dodge

Milwaukee

Fond du Lac5 LL

Marquette

Winnebago

Jackson

T-Trainer (TT), Master Trainer, Lay Leader

Master Trainer (MT)

Lay Leader (LL)

Master Trainer & Lay Leader

1 MT2 LL

2 MT 16 LL3 SLL

1 LL

2 LL

1 MT 1 TT13 LL

1 LL

1 TT1 MT6 LL

2 LL

1 MT2 LL

1 MT 3 LL

8 MT 58 LL 5 SLL MT 13 SLL

2 LL

1 MT

1 MT2 LL

3 LL

1 LL

2 LL

2 LL

12LL

1 MT4 LL

4 LL 2 MT

4 LL

1 MT 6 LL

Waukesha

2 MT 4 LL

1 LL

Calumet

1 LL

2 LL

1MT

1 MT

1MT2 LL

3 MT3 LL

1 MT7 LL

2 MT25 LL

2 LL

2 LL

9 LL

2 LL

2 L

1 LL2 LL

1LL

5 LL

Oneida Nation2 MT 5 LL

Green Lake

1 MT 4 LL

Statewide CDSMP262 Lay Leaders

16 Spanish Leaders5 Spanish MT

41 Master Trainers2 T-Trainer

D. McDowell 7

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

D. McDowell 8

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

D. McDowell 9

Stepping OnJuly 2010

Counties with Trainers/Leaders

'

$

Washburn

Burnett

DouglasBayfield

Sawyer

AshlandIron

Vilas

OneidaPrice

Polk Barron Rusk

ChippewaSt. Croix Dunn

Taylor

LincolnLanglade

Forest Florence

Marinette

OcontoClarkMarathon

Shawano

Wood Portage Waupaca

Menominee

Door

KewauneeBrown

Pierce

Pepin

Buffalo Tremp-ealeau

Eau Claire

La Crosse

MonroeJuneau

Adams

Waushara

Outagamie

Manitowoc

Sheboygan

SaukVernon

Crawford

Richland

Grant

Iowa

LafayetteGreen Rock Walworth

Kenosha

Racine

WashingtonOzaukeeColumbia

DaneJefferson

Dodge

Waukesha

Milwaukee

1 LFond du Lac

Marquette

Green-Lake

WinnebagoCalumet

Jackson

Lead Trainer (LT), Master Trainer (MT), & Leader/Peer Leader (L/PL)

Master Trainer & Leader/Peer Leader (MT/L/PL)

1LT 18L 1 PL1 L

1 LT3 L3 PL

1 L4 PL

Statewide162 Leaders

37 Peer Leaders 1 Master Trainers4 Lead Trainer

5 L

1 MT9 L 2 PL

3 L

3 L 4 PL

Leader/Peer Leader (L/PL)

Master Trainer (MT)

6 L1 PL

2 L3 PL

8 L

4L 1PL 1LT

1 PL

4 L

1 LT 5 L

5 L

11 L

4 L 1 PL

10 L

3 L4 PL

4 L 4 PL

1 L

2 L 1 PL

1 L4 L

2 L

7 L 1 PL

3 L

1 PL 2L

6L 1PL

1L 1PL

2L 2 L 2L2 L

1 L

1 L 1 PL

4L

4 L

4L

2PL

D. McDowell 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)

D. McDowell 11

Partnership/PACE

• DD 586

• ELDERLY 2,703

• PD 1,120

• Total: 4,423

Unknown** 1 5

D. McDowell 12

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

D. McDowell 13

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

D. McDowell 14

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

D. McDowell 15

D. McDowell 16

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

D. McDowell 17

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

D. McDowell 18

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