Wisconsin Communitybased Care in Wisconsin

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Wisconsin Community-based Care in Wisconsin

• Began state funded Community Options Program
  (COP) in 1981
• COP waiver for elders in 1985
• Waiver for Community Integration Program in 1983
• Waiver for Brain-injured in 1995

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Long Term Care System Redesign

• Concerns about access, complexity and
  institutional bias
• Process involving hundreds of consumer family
  members, providers, and advocates
• Proposed a new Medicaid managed long-term care
  model

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What is Family Care?

• Aging and Disability Resource Centers
• A flexible long-term care benefit
• Care Management Organization

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Aging and Disability Resource Centers

• One-stop shopping for information about LTC
• Information and assistance
• Functional eligibility screening
• Choice counseling

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A Flexible Long-Term Care Benefit

• Traditional waiver services including care
  management, community support, home
  modifications, nutrition, supportive home care,
  transportation
• Traditional state plan services related to LTC
  including nursing facilities, therapies,
  medical equipment and medical supplies

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Care Management Organization

• Receives a capitated rate for each member
  enrolled
• Enrollment is voluntary, but waiver services are
  only available through CMO
• Must accept all eligible individuals
• elders, persons with physical or developmental
  disabilities
• functional limitations requiring long-term care
• financially eligible

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Care Management Requirements

• Interdisciplinary team - social worker, nurse,
  other health professionals, caregiver, member
• Assessment that determines what is needed to meet
  the outcomes the member prefers
• Manage all health care services including acute
  and primary care
• Apply methods for meeting needs and preferences
  in most cost-effective manner

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States Role

• Set capitated rate
• Oversee eligibility and enrollment process
• Assure quality in the care provided

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Assessment of Quality in Family Care

• Our Challenges
• Produce valued outcomes for people served
• Foster quality assurance and quality improvement
  in the redesigned system

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Approaches to Assessing Quality

• Traditional Model
• Compliance
• Professional norms
• Governmental regulations
• Standards of care
• Program processes
• Uniformity
• Standardization

• New Model
• Outcomes
• Clinical
• Functional
• Personal
• Individualized processes
• What works for the person

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Family Care Outcomes
Self-determination and Choice People are treated
fairly People have privacy People have personal
dignity and respect People choose their
services People choose their daily routine People
achieve their employment objectives People are
satisfied with services
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Family Care Outcomes
Community Integration People choose where and
with whom they live People participate in the
life of the community People remain connected to
informal support networks
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Family Care Outcomes
Health and Safety People are free from abuse and
neglect People have the best possible
health People are safe People experience
continuity and security
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Strategy for Measuring Personal Outcomes

• 14 Family Care consumer outcomes
• Interview Family Care members
• Use tested information collection
  decision-making methods by The Council on Quality
  and Leadership
• Produce valid reliable measurements of outcomes

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What Did We Measure?

• Outcomes - What do members say is important to
  them?
• Supports - How responsive is CMO to members
  preferences?

What Will Results Tell Us?
The extent to which CMO members are achieving
personal outcomes from services and supports
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Four Possible Scores
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People choose where and with whom they live.

• Control of decisions regarding a living
  situation, is important in all people's lives.
• They should be able to choose their living
  arrangement, location, and if they prefer to live
  with others, their roommates.
• People learn about the range of options by having
  opportunities to see what is available.

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People choose their services.

• Services exist to help people get what they want
  and need.
• People's ability to choose where they shop or do
  business means they are more likely to get what
  they want and need.
• People are offered options for services and
  interventions, and their wishes and preferences
  regarding service selection are respected.

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People have the best possible health.

• Best possible health must be defined in terms
  that are satisfactory to the CMO member.
• The definition of best possible health depends
  on the current health status of the member and
  the possibility of health interventions to
  restore lost capacity, provide stabilization or
  minimize further loss of function.

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Family Care Website

• www.dhfs.state.wi.us/LTCare