wisconsin partnership program
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Wisconsin Partnership Program. Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004. Wisconsin Has Implemented Health/ Long-Term Care Programs That:. - PowerPoint PPT PresentationTRANSCRIPT
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Wisconsin Partnership Program
Steven J. Landkamer
Program ManagerWisconsin Dept. of Health & Family Services
July 14, 2004
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Wisconsin Has Implemented Health/ Long-Term Care
Programs That: Provide Comprehensive Health & Long-term
Care to People Who Meet Nursing Home Admission Criteria & are Medicaid Eligible;
Allow Consumers to Retain Choice of Primary Care Physician;
Maximize the Ability of Consumers to Live in Their Own Home & Participate in Community Life.
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Wisconsin Has Implemented Health/ Long-Term Care
Programs That: Improve Functional & Clinical Outcomes; Engage Members in the Decision Making Process
About Their Own Care; Minimize Reliance on Institutional Care; Reduce Costs by Lowering the Need for Acute
Care Intervention by Providing Consistent Primary Care.
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The People Served Are:
Medicaid Eligible or Dual Eligible for Medicare and Medicaid
Diagnosed With an Average of 12.7 Different Conditions
Taking 13.7 Different Medications on Average
In Need of Skilled Nursing Intervention
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Wisconsin Has Implemented Two Programs Fully Integrate Medicare
and Medicaid Services
Program of All-Inclusive Care for the Elderly (PACE)
The Wisconsin Partnership Program
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Key Distinctions BetweenPartnership & PACE
PACE Members: Attend a Day Center & Receive Most Services
There; Receive Care by the On-site PACE Physician; Are Elderly. Must Be Residents of a Large Urban Areas
Capable of Supporting a PACE Site.
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Key Distinctions BetweenPartnership & PACE
Partnership Members: Select a Primary Care Physician From a
Contracted Provider Network; Receive Most Services in Their Home; Can Be Frail Elderly or Have a Physical Disability; The Partnership Nurse Practitioner Serves As
Team’s Primary Care Representative & Accompanies the Member to Most MD Appointments;
Partnership Works in Both an Urban & Rural Setting.
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Funding forPartnership & PACE
Both Medicare and Medicaid Benefits are Capitated and Paid to the Contractor
The Medicare Capititation is the Rate Book Multiplied by a 2.39 Risk Adjuster. (90%in 2004)
Risk Adjusted Rate Based on CMS-HCC and Frailty Adjuster (10%in 2004)
The Same Rate Setting Methodology is Used for Both PACE and Partnership
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Funding forPartnership & PACE
Medicaid Capitation is Calculated by Discounting a Blended Average Cost for Nursing Home Care and Home and Community Bases Waiver Programs Costs.
Rates are Risk Adjusted for Age, Medicaid Only or Dual Eligible Status, and Level of Care.
The Rates for Elderly and People with Physical Disabilities Differ Significantly.
The PACE and Partnership Rates Differ Slightly Based on Case Mix
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PMPM Comparison--Average WPP & January 1999 Waiver Population
$2,000
$2,200
$2,400
$2,600
$2,800
$3,000
$3,200
Pe
r M
em
be
r P
er
Mo
nth
(P
MP
M)
1999Waiver WPP
1999Waiver $2,304 $2,579 $2,809 $2,999
WPP $2,435 $2,554 $2,801 $2,940
1999 2000 2001 2002
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How Partnership Works
Wisconsin Contracts with 4 Community Based Organizations to Provide Partnership Managed Care.
Elder Care of WisconsinCommunity Living AllianceCommunity Care OrganizationCommunity Health Partnership
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How Partnership Works
Wisconsin Partnership ProgramQuarterly Census Growth
1/1/97-3/31/04
375583593236283935152
40536456555245 49 49 50
16441607
1469
128012181144
992939899782
726671545
1378
0
200
400
600
800
1000
1200
1400
1600
1800
# o
f M
em
be
rs
Net per Quarter
Cummulative
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How Partnership Works
Partnership Organizations are at Full Risk for All Health and Long-Term Care Outcomes.
Both Medicare and Medicaid Capitation Payments are Made to the Organizations.
The Partnership Organizations Subcontract with Various Providers including Primary Care Physicians and Hospitals and Pay Them on a Fee-For-Service Basis
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How Partnership Works
Care is Coordinated Through an Interdisciplinary Team which includes: The Member Primary Care Physician (PCP) Nurse Practitioner (NP) Registered Nurse (RN) Social Worker
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How Partnership Works The NP Meets with the PCP to Establish a
Collaborative Practice Agreement that Often Leads to the Delegation of Primary Care to the NP.
The NP Acts as the Liaison Between the PCP, the Member and the Remainder of the Team.
RNs Provide Both Care Management and Skilled Nursing Care.
Social Workers Provide both Psychosocial and other Supportive Services as Necessary
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How Partnership Works Provides Prevention Services to Minimize the
Need for Inpatient and Emergency Room Care.
Provides Community Based, Supportive Services to Minimize the Need for Nursing Home Care.
Accompanies the Member to Physician Visits and “Translates” Physician Recommendation for the Benefit of the Member and the Team.
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How Partnership Works
Assures that Member Concerns and Preferences are Understood.
Assures Follow Through with Physician Recommendations.
Promotes Quality of Life by Supporting Member Specified Outcome.
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Measuring Outcomes of the Partnership Program
The Department of Health and Family Services is using several methods, both traditional and innovative, to measure quality & effectiveness: 14 Member Outcomes Based on Member’s Input about
his/her Quality of Life; Incidence of ACSCs (ambulatory care sensitive
conditions); Utilization of Inpatient Hospital & Nursing Home Care
Before & After Partnership.
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14 Member Outcomes
Developed by the Council on Quality and Leadership, a national accreditation agency for community disability programs.
Determines whether:members’ desired outcomes are being met, and the support the member needs to achieve the outcome has been put in place by the team.
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Member Outcomes
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Outcomes Present Supports Provided
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Self-Determination & Choice Outcomes
88.6%
78.9% 76.6%
70.9%
88.2% 92.1%
85.7%
72.1%
51.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
People are Treated Fairly People Have Privacy Personal Dignity & Respect
Family Care Outcomes WPP Outcomes PACE Outcomes
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Self-Determination & Choice Supports
87.9%
30.9%
74.7%74.6%
78.8%
86.4%
80.7%
31.4%27.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
People are Treated Fairly People Have Privacy Personal Dignity & Respect
Family Care Supports WPP Supports PACE Supports
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Health Care Outcomes
Staff Compile & Trend Data On Hospitalizations For Ambulatory Care Sensitive Conditions (ACSC):
ACSCs are defined by the Institute of Medicine as conditions for which good access to primary care should reduce the need for hospital admissions.
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Result:Hospital Admission
The Rate of Hospital Admissions for Ambulatory Care Sensitive
Conditions Decreased by 41.1 % from 2000 to 2002.
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Result:Hospital Admission
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Result:Hospital Admission
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Result: Access to Dental Care
Access to Medicaid funded dental care remains difficult in Wisconsin.
For example:17% of home and community-based waiver
programs’ for elderly and people with physical disabilities had dental visits in 2001.
72% of all participants in PACE and Wisconsin Partnership program had dental visits in 2001.
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Result: Health Care Utilization
Using the Hospital Discharge Data Base, Staff are Able to Demonstrate Pre/Post Enrollment Hospital Utilization
Findings Show a Positive Reduction of Inpatient Hospitalization & Nursing Home Use
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Comparing Hospital Use, Same People Before & After Enrollment
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Comparing Nursing Home Use, Same People Before & After Enrollment
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Physician Satisfaction
Survey Completed in April 2004. 40 % of Surveys Returned Statistically Significant 95% Confidence Level
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Physician Satisfaction
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Physician Satisfaction
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Physician Satisfaction
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Areas Needing Improvement
Member, Quality of Life, Outcomes. Further Impact on the Incidence of
Hospitalizations for ACSC. Comprehensive Evaluation. Demonstration of Cost Effectiveness. Provider Satisfaction. Interventions in Cases Where there is Mental
Heath and/or Chemical Dependency Concerns.
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Areas in Need of Improvement
Groups Any Mental HealthDiagnosis
No Mental HealthDiagnosis
AODA Diagnosis,Suspected, & Recovery
145 12.3%
79 6.7%
No AODA Diagnosis399
33.9%555
47.1%
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Areas in Need of Improvement
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Areas in Need of Improvement
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Conclusion
Partnership offers a viable alternative to PACE that can be applied to people with physical disabilities and people who live in a rural setting.
Partnership effectively delivers member-specified outcomes.
Partnership is demonstrating positive health care outcomes.