Wisconsin Partnership Program

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

• Member of Care Management Team along with a
• Participant
• Nurse Practitioner (NP)
• Registered Nurse (RN)
• Social Worker
• Service Coordinator.
• Collaborator in Care Plan Development.

3
How do Physicians Become Involved?

• Elder Care has an Agreement with Each Large
  Physician Group.
• All Primary and Specialty Physicians Covered
  Under One Agreement.
• 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?

• PCP Becomes Involved in One of Two Ways
• Brought to the Model by a Potential Participant
• Physician Contacts Elder Care to Become Involved
  in the Program.
• Initial Meeting to Provide Information and Assess
  Interest.

5
How Do the PCP and Care Team Relate?

• 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?

• Typically the NP
• Provides Initial History and Physical
• Provides Periodic Re-evaluation of Medical
  Status
• Provides Evaluation of Episodic Illnesses in the
  Members Home
• Attends All Participant Visits to the PCP.

7
How Do the PCP and Care Team Relate?

• Ensures that Health Maintenance Standards are
  Offered and Accessible
• Assumes Leadership in Collaborating with
  Appropriate Providers
• Orders Diagnostic or Therapeutic Interventions
• Communicates with the PCP to Keep Him/Her
  Informed of Medical Status.

8
How Do the PCP and Care Team Relate?

• The RN Provides
• Health Assessment and Response to Illnesses and
  Medication
• In-home Assessment to Identify Functional
  Limitations and Adaptations
• Skilled Nursing Services
• Oversee the Provision of Personal Care and
  Evaluate the Effectiveness of Care.

9
How Do the PCP and Care Team Relate?

• Team Manages Care on an Ongoing Basis and
  Communicates and Seeks Input from PCP as
  Appropriate.
• Care Team Serves as Resource for the PCP.

10
Supporting Physicians in Managing Care

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

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Supporting Physicians in Managing Care

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

12
Supporting Physicians in Managing Care

• 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?

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

14
The Results
15
The Results
16
The Results
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How are Physicians Paid?

• Elder Care of Wisconsin www.elderc.org
• Wisconsin Partnership Program www.
  dhfs.wisconsin.gov/WIpartnership

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More Information

• Elder Care of Wisconsin www.elderc.org
• Wisconsin Partnership Program www.
  dhfs.wisconsin.gov/WIpartnership