Family Care Partnership ProgramSummary
The Family Care Partnership Program is an integrated program of health
and long-term care designed to improve access and quality while achieving
cost savings. Acute and long-term support services are coordinated across
care settings using an inter-disciplinary team comprised of a physician,
nurse practitioner and social worker or independent living coordinator.
Combining the benefits of the Medicaid/Medicare systems into one
program through an 1115/222 dual waiver helps to avoid fragmentation and
duplication of services--challenges inherent in the dual fee-for-service
system. Combining the benefits of both systems reduces costs related to
duplication of services, and permits better coordination and improved
quality of services to participants.
By choosing a system of capitation over fee-for-service, the
Partnership Program proposes to achieve the cost savings and flexibility
traditionally achieved in managed care programs, while ensuring that
quality is not sacrificed for cost. Research conducted will ensure
consumer-defined indicators of quality care and service delivery are
carefully incorporated into the Partnership Program.
Two Innovative Models of Care
The Partnership Program consists of two innovative models of
care, one for the elderly, and one for people with developmental or physical disabilities.
Service delivery in the Partnership Program model is home-based and
involves the consumer in care planning and decision-making. Managed Care
Organizations (MCOs) are facilitated in developing the
capacity to integrate the provision of acute care services with the
long-term support services MCOs traditionally provide.
Consumer choice is a cornerstone of the Partnership Program.
Consumer choice has been shown to be a critical factor in the degree of
satisfaction which elderly or younger persons with disabilities experience
with their health and long-term care. Individuals enrolled in the
Partnership Program are offered a choice of care, choice of setting, and
choice of the manner in which service is delivered. Participants are
supported in their choice to receive community-based care in their homes.
Participants are also able to choose their primary care physician within
very broad parameters. Competent and trained participants have the option
of selecting and directing the work of personal care workers.
Participants in the Partnership Program must be Medicaid-eligible, or
dually eligible for Medicaid and Medicare, and meet nursing home level of
care criteria. Participation in the Partnership Program is voluntary, and
participants may disenroll at any time. MCOs may not disenroll
participants except under stringent protocols approved by the Wisconsin
Department of Health Services.
The Partnership Program uses the cost containment features
of a managed care system to integrate Medicare and Medicaid funding
streams and service delivery systems for acute and long-term services.
Managed care systems offer the opportunity to provide flexible service
plans and benefits to meet individual needs.
The Primary Objectives of the Partnership Program are to:
Control health care costs among elderly and physically disabled
people who meet nursing home admission criteria. By capitating
(pre-paying the set Medicare and Medicaid funding for all services,
regardless of actual cost) and integrating long-term support and acute
care through a managed care system, the Partnership Program will
demonstrate that health care costs for a high cost population can be
controlled. Capitation of Medicare and Medicaid funds helps prevent
cost shifting and increases the incentive to provide preventive care.
The comprehensive range of services available under the
Partnership Program further reduces the incentive to shift costs.
The managed care delivery system will result in an integrated plan for
individuals enrolled in the Partnership Program that will limit the
use of high cost institutions and specialty services, as well as
reduce administrative costs. Data collected during the demonstration
will be used to develop improved risk adjusters for special
populations, enabling more valid and reliable cost estimates.
The Partnership Program’s inter-disciplinary team model ensures that
care is coordinated across systems that currently operate in parallel.
The team coordinates all aspects of care and focuses at the weakest
point—the point of intersection—where the health care system most
often breaks down. The team coordinates transitions between service
providers. The inter-disciplinary team is knowledgeable about all
aspects of the participant’s care plan and can prevent two or more
different systems from prescribing duplicative or contradictory
treatments. The consumer’s involvement in the team and participation
in decision-making supports a high degree of consumer satisfaction.
Improve health outcomes through the delivery of integrated
preventive care. Many elderly and people with disabilities suffer from
secondary illnesses brought on by their disability or chronic
condition that can be prevented and/or minimized by coordinated care.
Capitating the Medicare and Medicaid funding streams increases the
incentive for the inter-disciplinary team to make cost-effective
decisions. The incentive to shift costs is eliminated. Unnecessary
hospitalizations and institutional care can be reduced by greater
focus on preventive services and consumer education and support of
chronic conditions. Participants experience improved health outcomes.
Increase the role of the participant in decision-making. The
Partnership Program creates visible and important roles for
participants in planning their care and services. Consumer involvement
in care planning shifts the responsibility for making cost-effective
decisions from an impersonal administrative organization that
primarily controls costs, to a team that is simultaneously responsible
for ensuring quality and managing costs. Beneficiaries are educated as
to their role, not only in the development of their own plan of care,
but in the development of that care plan in relation to other
beneficiaries. Participant education includes not only health
education, but education regarding choices in the context of a managed
Increase quality through the development and use of
consumer-defined measures of quality. The financial incentives are
realized only to the extent that individuals enrolled in the
Partnership Program continue to participate in the program over time.
However, participants in the Partnership Program are
volunteers and can disenroll from the program with relative ease.
Thus, the Partnership Program must continue to provide a high quality
service package that fosters the consumer satisfaction necessary to
retain enrolled individuals over time. The Partnership Program will
demonstrate that consumers who participate in defining measures used
to determine the quality of their care, will be more satisfied with
their quality of care and will be less likely to disenroll.
Demonstrate that Managed Care Organizations (MCOs) can provide a
comprehensive range of long-term support and acute health care to a
nursing home level of care population of elderly and people with
disabilities. The infrastructure developed by the
Partnership Program will assist MCOs in
developing their capacity to meet the financial and organizational
requirements to provide acute health care as well as community-based
long-term support in a managed care, risk-based environment.
Implementation and Organization to Accomplish Objectives
The Department of Health Services contracts with MCOs to implement the Partnership Program.
These organizations in turn subcontract with hospitals, clinics, HMOs and
other providers to ensure a comprehensive network of acute and long-term
care. The Program began serving individuals in January 1996 as a Medicaid
Pre-Paid Health Plan (PHP). The funds were capitated and a graduated
risk-sharing plan was in effect. Wisconsin received a Medicaid/Medicare
waiver from the Federal Health Care Financing Administration (Centers for
Medicare and Medicaid Services) and began full Medicaid/Medicare
capitation in January 1999.
The Wisconsin Department of Health Services is the State
Medicaid Agency. The Managed Care Section in the Office of Family Care
Expansion is responsible for the design and development of the
Partnership Program. Staff at the Department are experienced in administering
community-based programs, and have designed and administered many
nationally acclaimed human service programs. The Department has a history
of collaborating with internal and external partners to develop and study
new managed care models in Wisconsin, including PACE (1989), Independent
Care (1994), Partnership Program (1994), and Family Care (1998).
Partnership Managed Care Organizations
The first site of the Partnership Program for Elderly People was Elder
Care of Dane County, a community-based, not-for-profit organization that
provides services to elderly people in Dane County, Wisconsin. The
Community Care Organization in Milwaukee, a full risk comprehensive PACE
site, was the second Partnership site serving the elderly.
The Community Living Alliance in Madison, Wisconsin became the first
site of the Partnership Program for persons with physical disabilities. An
additional site was selected at the end of 1995, the Community Health
Partnership, Inc. in Eau Claire.
Pooling the Resources of Managed Care Organizations
The managed care organizations involved in the Partnership Program
are collaborating on functions that are common to each organization. Risk
management is one example. The member organizations have pooled their
resources to provide stop-loss protection. A management information
system, claims processing system and clinical protocols are also being
On September 27, 2001, the Partnership Program received a
grant from the Robert Wood Johnson Foundation to support Partnership’s
participation in the Foundation’s Medicare/Medicaid Integration Program.
For additional information regarding the Partnership Program, contact:
Wisconsin Department of Health Services
Division of Long Term Care
Office of Family Care Expansion
One West Wilson Street, Room 518
PO Box 7851
Madison, WI 53707-7851
Office of Family Care Expansion
Division of Long-Term Care
Department of Health Services
State of Wisconsin
In Partnership with:
|U.S. Centers for
Medicare & Medicaid Services
Care Wisconsin Health Plan, Inc.
Community Care Health Plan, Inc.
Independent Care Health Plan
Dane County Department of Human Services
Eau Claire County Department of Human Services
Milwaukee County Department of Aging
University of Wisconsin-Madison
Office of the Commissioner of Insurance
Made possible by a grant from:
The Robert Wood Johnson Foundation
January 10, 2013