Key Findings from the Family Care Implementation and Outcomes Study Lisa Alecxih February 13, 2004

1 Implementation Report Methods u Site visits to counties with both a CMO and a RC  Fond du Lac, La Crosse, Milwaukee, Portage, and Richland  Once annually from 2000 to 2002 u Telephone communication with DHFS staff u Documentation and data provided by DHFS and CMOs  Provider networks  Enrollment  Contracts  Quality review reports u Provider telephone interviews

2 Cost & Outcomes Methods u Data  Medicaid Management Information System (MMIS)  Human Services Reporting System (HSRS) Long-term Support (LTS) Module  Nursing Facility Minimum Data Set (MDS)  Long-term Care (LTC) Functional Screen  Community Options Program (COP) and DD Functional Screens  Member Outcome Tool u 10/1999-3/2000 (pre); 1/2001-6/2001 (post)  Timeframe dictated by claim lag u Comparison – remainder of state and matched counties

3 Major Implementation Achievements Access u Established nine Resource Centers (RC) u Use single web-based functional screen for all three target groups u Eliminated wait lists in CMO counties Cost u Introduced procedures for institutional diversion u Created five Care Management Organizations (CMO) Quality u Instituted interdisciplinary care management teams u Increased consumer involvement u Developed innovative quality assurance & improvement system

4 Increased CMO Enrollment

5 Elimination of Wait Lists Note: The non-CMO counties include individuals under age 60, while the scale for Milwaukee only includes individuals age 60 and over. The estimates for non-CMO counties and the CMO counties other than Milwaukee prior to the elimination of the wait list include children with physical disabilities or developmental disabilities. Source:The Lewin Group calculations based on DHFS provided wait list data.

6 Resource Centers u Provide a single source for:  easy access to information, referral, and options counseling  access to publicly funded programs for the target populations u Met the challenge of developing/enhancing local information and referral resources u Actively and creatively conducted outreach campaigns u In most cases, met or exceeded target population contacts per eligible standards (8.0 per 1,000)  Elderly – all met, up to 22 per 1,000  Physical Disabilities – all met, 27 to 230 per 1,000  Developmental Disabilities – all but two met (Kenosha and Marathon), up to 36 per 1,000

7 Care Management Organizations u Built upon existing county LTC functions of service brokerage and contracting u Adopted interdisciplinary care management teams that  consider acute and primary care needs, in addition to chronic care  strive to balance consumer preference and cost u Built provider networks u Managed services within the capitated rates u Began to consider a prevention focus

8 New CMO Enrollees Average 40% Less Spending

9 Increased Consumer Involvement u Advisory roles on boards and committees u CMOs established self-directed supports options u Member-centered support planning  shift from providing services to clients to being responsive to customers u Consumer-defined outcomes

10 Issues Encountered u Federal approval and requirements u Failure to initially involve staff of Economic Support units u Disparate information technology systems at the county and state level u CMO struggles to hire ahead of member enrollment u Loss of the independent advocates in Fall 2001 u Freezes on non-Medical Assistance CMO enrollment

11 Preliminary Outcomes u Substantially met the goals of:  increasing choice and access  improving quality through a focus on social outcomes u No decline in service levels for existing enrollees u Too early to draw long-term cost-effectiveness conclusions

12 Pre-Post Spending Results Depend on Measure and Comparison 27% 28% 16% 18% 12% 28% 26% 24% 17% 12% 24%* 0%* 10%* 50%* 9% 0% 10% 20% 30% 40% 50% 60% Fond du LacLa CrosseMilwaukeePortageAll CMOs Percent Change in Spending Pre- to Post-Period CMOCMO w/ CapitationComparison Change in Per Member Per Month Payments for Long Term Care Services from Pre to Post Period

13 Declines in Medicaid Nursing Facility Use Jan-98 May-98 Sep-98 Jan-99 May-99 Sep-99 Jan-00 May-00 Sep-00 Jan-01 May-01 Sep-01 Jan-02 May-02 Sep-02 Jan-03 Medicaid NF Users Per 1,000 County Population MilwaukeeNon-CMO CountiesCMO No Milwaukee

14 Estimate of New Enrollees in Milwaukee Drive Change in Overall Spending

15 Balancing the Family Care Philosophy

16 Key Findings from the Family Care Implementation and Outcomes Study Lisa Alecxih February 13, 2004