transition to reform in wisconsin donna mcdowell, director bureau of aging & disability...
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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
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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
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Self-Management Is Important
Fatigue
Depression
Pain
Emotion
Stress
Disease
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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
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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
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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)
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Partnership/PACE
• DD 586
• ELDERLY 2,703
• PD 1,120
• Total: 4,423
Unknown** 1 5
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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
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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