Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

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.


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.


Previous Section Previous Section         Contents         Next Section Next Section


The information on this page is archived and provided for reference purposes only.

AHRQ Advancing Excellence in Health Care