1 Wisconsin Partnership Program Sharon Larson Provider Relations and Contracting Manager Elder Care of Wisconsin & Steven J. Landkamer Wisconsin Dept. of Health & Family Services July 14, 2004

2 The Role of Primary Care Physicians ã Member of Care Management Team along with a: ã Participant; ã Nurse Practitioner (NP); ã Registered Nurse (RN); ã Social Worker; ã Service Coordinator. ã Collaborator in Care Plan Development.

3 How do Physicians Become Involved? ã Elder Care has an Agreement with Each Large Physician Group. ã All Primary and Specialty Physicians Covered Under One Agreement. ã Model is Most Effective if the Primary Care Physician (PCP) is Invested in the Model and is Willing to Collaborate.

4 How do Physicians Become Involved? ã PCP Becomes Involved in One of Two Ways: ã Brought to the Model by a Potential Participant; ã Physician Contacts Elder Care to Become Involved in the Program. ã Initial Meeting to Provide Information and Assess Interest.

5 How Do the PCP and Care Team Relate? ã If the PCP is Interested in Participating in Partnership, the Team Nurse Practitioner Meets with the PCP to Establish a Collaborative Relationship.

6 How Do the PCP and Care Team Relate? ã Typically the NP: ã Provides Initial History and Physical; ã Provides Periodic Re-evaluation of Medical Status; ã Provides Evaluation of Episodic Illnesses in the Member’s Home; ã Attends All Participant Visits to the PCP.

7 How Do the PCP and Care Team Relate? ã Ensures that Health Maintenance Standards are Offered and Accessible; ã Assumes Leadership in Collaborating with Appropriate Providers; ã Orders Diagnostic or Therapeutic Interventions; ã Communicates with the PCP to Keep Him/Her Informed of Medical Status.

8 How Do the PCP and Care Team Relate? ã The RN Provides: ã Health Assessment and Response to Illnesses and Medication; ã In-home Assessment to Identify Functional Limitations and Adaptations; ã Skilled Nursing Services; ã Oversee the Provision of Personal Care and Evaluate the Effectiveness of Care.

9 How Do the PCP and Care Team Relate? ã Team Manages Care on an Ongoing Basis and Communicates and Seeks Input from PCP as Appropriate. ã Care Team Serves as Resource for the PCP.

10 Supporting Physicians in Managing Care ã The NP Attends All Participant Visits to the PCP. ã The NP Communicates Changes in Condition and Changes in Care Plan and Seeks Advice as Needed. ã The NP or RN Provides Home Visits.

11 Supporting Physicians in Managing Care ã Provide Visits in Nursing Homes and Hospitals and Coordinates Discharge and Post-Institutional Care with Discharge Planners. ã The NP and the RN Work with the Participant and Pharmacy to Assist with Medication Compliance.

12 Supporting Physicians in Managing Care ã The Care Team Acts as the First Point of Contact for the Participant, 24/7, Reducing Phone Calls to the PCP or the On-call Physician.

13 How are Physicians Paid? ã PCPs and Specialty Physicians are Paid Fee-For-Service. ã Partnership Sites are at Liberty to Negotiate with Providers to Assure Access and Quality. ã In General Physician are Paid as Traditional Medicare Pays.

14 The Results

15 The Results

16 The Results

17 How are Physicians Paid? ã Elder Care of Wisconsin: ã Wisconsin Partnership Program: www. dhfs.wisconsin.gov/WIpartnership

18 More Information â Elder Care of Wisconsin: â Wisconsin Partnership Program: www. dhfs.wisconsin.gov/WIpartnership