Managed Care & Persons with Disabilities & Chronic Illnesses
Developing Integrated Systems of Care
For the Dually Eligible Population
Presenters: Lee Bezanson, J.D. , R.N., Director of Long-term Care, State of New Hampshire Department of Health and
Human Services.
Mary Rowin, M.B.A., Project Manager, Center for Delivery Systems Development, Wisconsin Department of Health and
Family Services.
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In this session, two State officials described the approaches that their States are pursuing to develop integrated financing
and delivery system models for persons dually eligible for Medicare and Medicaid.
Lee Bezanson began the session by
describing New Hampshire's efforts in the context of a consortium established by the New England States to examine
ways to better integrate services for the dually eligible population. She described the key elements of New Hampshire's
approach, including two capitated alliances (one for acute care, the other for long-term care) linked by a community
network team that provides consumer-directed supports and services. The model is to be piloted in one county within the
State.
Mary Rowin then described the Wisconsin Partnership Program (WPP), a federally approved demonstration program
designed to provide acute and long-term care services to dually eligible people. The key elements of the partnership include an
emphasis on consumer participation and choice and on comprehensive and coordinated care delivered through
community-based organizations on a capitated basis.
In addition to describing the program, Ms. Rowin also shared with
participants the key challenges encountered and lessons learned in developing and implementing the program. From the
contracting organization's perspective, they were:
- How to build the census.
- How to develop a coordinated team role.
- How to direct the physician role in the program.
- How to manage utilization.
- How to reimburse providers.
- How to collect data.
From the State's perspective, they were:
- How to keep a consumer focus when building a new program.
- How to discuss Medicare and Medicaid with the Health Care Financing Administration (HCFA).
- How to plan when you don't have the data.
References
New England States Consortium, Framework for the New England States Demonstration Projects for Dually
Eligible Persons, pp. 1-47.
New England States Consortium, States Project at a Glance as of September 1997.
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