Wisconsin's Managed Long-Term Care Model

Article excerpt

Among, the current array of managed long-term care (LTC) programs, the Wisconsin Family Care Program (WFCP) may be the most instructive model involving aging-network programs. WFCP is administered by county service agencies in aging in the five project counties. The Milwaukee County agency is also the area agency on aging, administering programs mandated by the federal Older Americans Act. Although most states do not organize and administer their aging and LTC services through county governments, many do. For those that do not, WFCP offers many lessons useful in formulating versions of managed LTC programs.

Two important components of WFCP are the following:

Resource Centers. WFCP'S resource centers serve as single points of entry into the LTC system, providing information, counseling and access to all relevant services, along with information on providers, preventive healthcare and earlyintervention services. The resource centers are designed to serve not only Medicaid-eligible consumers, but also private-pay consumers and their families.

Care Management Organizations (CMOs). Key to the success of WFCP are its care management organizations. CMOs are county-based managed care organizations that receive capitated payments for all LTC services, including nursing home care. The capitation rate includes Medicaid, state and county funds consolidated into single monthly payments averaging about $1,800 a month per member. The capitation rate constitutes a strong incentive to keep consumers in the community by minimizing nursing home care costs and to create a seamless system in which individuals' needs dictate the services provided. The CMOs have also been able to eliminate waiting lists for eligible people in each of the five counties WFCP serves.

A comprehensive evaluation of WFCP released in 2005 demonstrated the program's relative cost effectiveness. During the two-year study period (20032004), average individual monthly Medicaid costs for WFCP members outside the metropolitan Milwaukee area were $452 lower than costs for their comparison group, who were not in the managed LTC program. Also, costs for members of the Milwaukee CMO were $5 lower than for their comparison group. …