- Associated Press - Friday, April 22, 2016

MADISON, Wis. (AP) - The Department of Health Services projects it will save at least $300 million over the next six years with an overhaul of Wisconsin’s long-term care programs, according to an agency document released Friday.

The estimate comes as the department seeks Joint Finance Committee approval on a plan detailing changes to Family Care and IRIS, which provide long-term care to more than 55,000 Wisconsin residents. Under the new system, insurance companies will oversee both medical care and long-term care like bathing, cleaning and cooking.

But legislators, clients and advocates have been pressing for more details before the plan is approved and sent to the federal government for review.

“The whole thing lacks specificity,” said Rep. Kathleen Bernier, a Republican from Chippewa Falls who sits on the Committee on Aging and Long-Term Care.

The DHS’ two-page document provides some additional details on financial estimates and consumer care, though some stakeholders’ questions were still unanswered.

Under the proposed system, medical care and long-term care would both be overseen by insurance companies who apply to become integrated health agencies, or IHAs. The state would be divided into three zones, and each zone would be served by three IHAs selected through a competitive bidding process.

DHS says the changes, which were included in the 2016-2017 budget, aim to cut costs as Wisconsin’s population ages and the demand for services increases. Average enrollment is expected to grow by 37 percent in the next decade, according to the department.

The new, more holistic model will keep members healthier and thereby reduce the need for services, DHS said. Programs in other states have seen savings of about 11 percent in switching from fee-for-service models to managed care, the department said, though it used a more conservative estimate of 7 percent savings due to potential unknown factors.

Using that estimate, DHS said the total savings will come to at least $300 million over the next six years compared to the current program - about $1,000 in savings per Family Care member, per year, by the sixth year of the program.

Joint Finance Committee Co-Chair Rep. John Nygren said the committee will work with the Legislative Fiscal Bureau to verify how accurate those estimates are. Nygren said he aims to schedule a finance committee meeting within the next month to give ample time for the federal process to play out before the next state budget.

“I think this is something we need to act on fairly quickly,” Nygren said.

Advocates and those who use the program say the changes might not be as detrimental as they initially feared, but they are concerned about some of the unknowns, including how thousands of people will be transitioned to the new program and whether IHAs will work as closely with clients as managed care organizations currently do.

“Honestly, I do feel like my daily life and my ability to be independent is literally hanging in the balance,” said Stephanie Helle, a 29-year-old with a brittle bone disease who uses in-home visits twice daily for bathing, dressing, exercise and cleaning.

Advocates also raised concerns about having only three zones, with the potential for smaller providers to end up going out of business. DHS says the zones offer large enough populations to minimize risk of financial instability.

Lynn Breedlove, co-chair of the Wisconsin Long-Term Care Coalition, said there’s a better map now than there was at the end of the budget session, but they won’t really know how good or bad the program is until it’s been in place for a few years.

“One of the big concerns is the fear of the unknown,” he said.

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Follow Bryna Godar on Twitter at https://twitter.com/bgodar


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