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Executive Summary
In October of 1996, the Coalition of Wisconsin Aging Groups (CWAG), with the cooperation of the Bureau of Long-Term Support and the Office of Strategic Finance, held six regional long-term care conferences. The audience for these sessions included county employees, elected officials and consumer members of the long-term support planning committees as well as county long-term support staff and citizen advocates.
There were three main objectives for the conferences. First, to provide current information about the long-term care redesign initiative being undertaken by the Dept. of Health and Family Services. Second, to work with committee members and staff to study how they could be more effective in utilizing all community resources in their counties. Finally, to learn from these groups what the state should be looking for when they define the quality outcomes they want built into the newly redesigned system.
The morning was devoted to briefing the general session on the long-term care redesign, then breakout sessions with staff to learn how to better use their committees and a session for consumers and advocates on effective advocacy for long-term care. The final session was for long-term support planning committee members to assess their success in using community resources to maximize long-term care services in their county.
The afternoon sessions were designed to gather information from the participants, on desired quality outcomes for the redesigned system. Using a form provided by the Office of Strategic Finance (Appendix A), participants were asked to list the outcome indicators and measures that should be built into the new system for consumers, providers and managed care organizations.
As part of the exercise, participants were asked to rate the importance of what they had written using a rating of 5 to 1 (five as very significant and 1 very insignificant) also provided by the Office of Strategic Finance (Appendix B). They could list as many 5's or 4's, etc. that they wanted. Finally, they shared their results in a round-robin discussion. There was not enough time to have the group rank the complete results.
At the end of the sessions, participants turned in their worksheets and this report is a summary of the almost 200 three-page worksheets that were turned in plus some of the discussion points recorded in the reporting sessions. It should be noted that the groups seemed to be most comfortable defining outcomes for the consumers and providers but some had a great deal of difficulty defining outcomes and measures for managed care organizations. They weren't quite sure of the definition of a managed care organization, even after it was explained to them. Their sense was that by defining the desired outcomes for the consumer and provider, the outcome measures for the managed care organization would be whether they achieved the outcomes for the two groups they are charged with overseeing. This reluctance caused a lower number of completed worksheets for the managed care organization than for the other two.
When all of the results were tabulated, there were certain categories that became apparent. These broad topics were: Consumer, Provider, Care Manager, Single Entry Point, Health Care, Financing, Rights & Grievances, Quality, Accountability, Training and Contract Issues. The report has been organized first by the three broad categories outlined in the handout (Appendix A) and then, when appropriate, under these sub-categories. The sub- groupings are those of the author and not the participants, but help substantially with the overall reading of the report.
There was a general assumption that the state would implement a new data collection system. With the new technology available and current systems software already in place, the technology already exists for good database management and information sharing. There is also existing software that allows for electronic reporting, billing and reimbursement. Several participants stressed that the state should adapt existing software rather than try to develop its own system.
COP and the COP values used in all of the COP related programs were strongly supported and any new program should be build from this successful program. In fact, there was some confusion why the state was talking about a new system when they already have a good system in place that could be modified and improved.
Some of the desired outcomes are listed below, by category. The complete list of outcomes, with explanations are in the body of the report.
Consumers
- Consumers should have choices in where they live, who provides services and when and how the services are provided.
- System should foster independence.
- System should be consumer-centered and consumer-driven.
- Consumers, their families and friends and their possessions should be treated with respect.
- System must strongly support caregivers.
- People of all ages should be in the least restrictive environment possible.
- Safety, security and trust are essential for the consumer's well being.
Providers
- Providers should have a proven track record in long-term care service provision.
- Providers should have strong quality standards.
- Care plans should be consumer-centered.
- Providers should offer a broad array of flexible services.
- Providers should be allowed to build relationships with consumers and their families.
- Continuity of care is essential.
- Providers should have a clearly identified "customer service department".
- Providers should be culturally and spiritually sensitive when developing plans and services.
Care Managers
- Care managers should be advocates for the consumers, be able to respond rapidly and be accessible to consumers and family members.
- Care managers should serve as a link between the health care system and consumers.
- Care managers should have realistic case loads, adequate time allowed to work with consumers and use a universal assessment tool.
Single Entry Point
- SEP should be a public entity accountable to tax payers, especially if this is where eligibility is going to be determined.
- SEP should be easy to access and user friendly.
- SEP should have the ability to rapidly respond, especially in emergencies.
- Staff should respect the privacy of individuals and have knowledge of local community resources.
- Mental and physical health must be considered in doing the assessments and care plans.
Funding and Eligibility
- Eliminate waiting lists, don't cap individual services and emphasize cost-effectiveness.
- Put emphasis on prevention and early intervention.
- There should be a sliding-fee schedule with cost-sharing.
- Consolidate money and let it "follow the person".
- Services should be affordable and uniform for both public and private consumers.
Managed Care Organization
There is a great deal of information in this report mainly from consumers and line workers. The sessions were well attended and their thoughts and experiences were clearly articulated both in the written materials they handed in and in the round robin discussions. It is hoped that as the Dept. of Health and Family Services continues to work on long-term care reform, they will continue take into consideration the voices of those in the field and those receiving services.
- Consumer satisfaction is essential for quality assurance.
- There must be a formal grievance procedure in place.
- Complaints must be handled in a timely manner.
- There must be strong abuse protection built into the system.
- COP Values must be part of the long-term care system in Wisconsin.
- System must be publicly accountable.
- Consumers and local government representatives should be part of the policy making boards of the MCO.
- Training should be mandatory for all levels of the organization.
To receive this publication in its entirety, call, write or e-mail: Coalition of Wisconsin Aging Groups 5900 Monona Drive - Suite 400 Madison, WI 53716 608-224-0660 1-800-488-2596 (toll free)
E-mail: cwag@midplains.net
Last updated: August 15, 1997
By: Gail Schwersenska