Family Care Options for Long Term Care 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 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 What is Family Care? Aging and Disability Resource Centers A flexible long-term care benefit Care Management Organization Aging and Disability Resource Centers One-stop shopping for information about LTC Information and assistance Functional eligibility screening Choice counseling 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 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 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 State's Role Set capitated rate Oversee eligibility and enrollment process Assure quality in the care provided Assessment of Quality in Family Care Our Challenges: Produce valued outcomes for people served Foster quality assurance and quality improvement in the redesigned system 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 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 What Did We Measure? Outcomes - What do members say is important to them? Supports - How responsive is CMO to members' preferences? Four Possible Scores 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. 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. 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. Family Care Website www.dhfs.state.wi.us/LTCare