Wisconsin Family Care Final Evaluation Report
July 2003
Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih
The Lewin Group concluded its three year study of a managed long term care experiment in Wisconsin with the final of four reports summmarizing the implementation of the program and analyses of the initial access, cost and quality outcomes. The Family Care program combines county-run aging and disability resource centers to provide centralized outreach, information, referral and intake, with capitated care management organizations to coordinate the delivery of and payment for services. Unique features of the program include: a single point of entry for three target populations -- older frail adults, non-elderly adults with physical disabilities, and adults with developmental disabilities; a risk-adjusted capitated payment system for Medicaid long term care services; the institution of interdisciplinary care management teams that, in addition to long-term care, consider acute and primary care needs and strive to balance consumer preference and cost; and development of a quality assurance and improvement system that improves upon the traditional process measures by seeking direct input from members.
Our independent study conducted for the Wisconsin Legislative Audit Bureau concluded that:
The program substantially met the goals of: 1) increasing choice with a broader range of providers, more residential alternatives, and the option for members to direct their own care; 2) expanding access by eliminating waiting lists for services in the five counties piloting the full program; and 3) improving quality through a focus on social outcomes.
The program has yet to demonstrate improved quality related to an individual's health using claims-based measures, in part due to the time period of our analyses, and the need for more time to fulfill the promise of better care management.
Despite the potential for the capitated rate to inhibit spending, existing enrollees did not experience a decline in service levels during the first year of the program.
It is too early to draw conclusions regarding the program's ability to create a cost-effective system for the future. Early evidence indicated that the Family Care counties had increases in spending similar to comparison areas and that spending on new enrollees offset savings associated with lower per capita spending increases and reduced use of institutions.
The Wisconsin experience can provide valuable lessons related to single entry points, infrastructure, governance, information technology, care management, service integration, provider development, consumer direction and quality assurance/improvement for other states considering changes to their long term care systems.