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Family Care transition continues

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news New Richmond, 54017

New Richmond Wisconsin 127 South Knowles Avenue 54017

When the managed care organization for northwest Wisconsin went belly up last year, the future was a bit uncertain for the clients with disabilities that the organization served.

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As the transition from Community Health Partners (CHP) to the new MCO for this five-county region, Southwest Family Care Alliance, falls into place, some of the anxiety about the future has lessened.

Teri Buros, director of Southwest Family Care Alliance (SFCA), attended a meeting of the St. Croix County Council on Aging and Disabilities Thursday, Jan. 17, to provide an update on the progress being made in St. Croix, Pierce, Dunn, Chippewa and Eau Claire counties since Jan. 1.

Taking over this region has been a real challenge for the small organization, Buros admitted, but the long-term financial health of the managed care organization appears bright.

Managed care organizations contract with the Wisconsin Department of Health to coordinate care for people with disabilities and the frail elderly. The MCOs determine rates that will be paid to providers, such as group homes and occupational workshops, on behalf of client members.

In recent months, the state has cut funding for services which fall under the Family Care and Family Care Partnership programs. State officials have directed MCOs to become more efficient while still providing a high level of care for people with disabilities or the frail elderly.

The result has often been declining reimbursement rates and reduced services for clients.

CHP had provided MCO services to the five-county region for some time but closed its operation Dec. 31, 2012 due to financial instability.

"I'm not exactly sure what happened there," Buros told the council.

The contract to serve the region's Family Care and Family Care Partnership clients was eventually awarded to SFCA, which had been serving eight rural counties in southwest Wisconsin.

Buros said the MCO wasn't anticipating that it would be awarded the contract to serve all of the approximately 2,700 clients in this area. And SFCA had just 75 days to hire employees, work out office details and begin serving members by Jan. 1, 2013.

"Priority one was continuity of care," she told the council. SFCA worked quickly to talk with group homes, care providers and other service providers to make sure that each member's care was not disrupted while things get sorted out.

Buros said SFCA made an immediate commitment to providers that rates would remain stable for the next year, so facilities and organizations could work on their budgets.

Buros said the MCO is committed to meeting "face to face" with every client member in the coming weeks to get a better handle on each person's needs.

Next month, SFCA will be touching base with all care providers to ensure they are getting paid what's due them.

Buros said service providers have experienced delays in reimbursement payments in recent months, causing financial stress for many businesses. They're leery that SCFA will actually come through with their promises and stabilize the Family Care system in these parts.

"That good will is critical," Buros said. "People are going to get their money next month, come hell or high water."

In the coming months, SFCA will be tackling issues such as western Wisconsin representation on the managed care organization's governing board. The MCO will also get a better handle on the overall financial condition of the Family Care program in the region.

The biggest question facing Buros and SFCA is how the new organization will be different from the failed CHP.

By combining two MCOs into one, Buros said administrative overhead is considerably less. She also noted that SFCA has hired a smaller cadre of employees to manage the cases for members. SFCA has hired 166 people, while CHP had 366 employees previously.

"We saved $6 million right off the top," Buros said.

Buros said the company has the same number of care managers as before, just not as many administrators and supervisors.

"Our goal is to not change the quality of care for members," she said. "We just need to become more efficient."

Even with the savings, Buros admitted that this region is still under funded. She said she expects SFCA to lose money over the next year or two as the transition is finalized and rates to providers are equalized.

The Department of Health has entered into a risk sharing agreement to SFCA to limit financial exposure should the money mess be worse than they anticipate.

Buros said, however, that she expects everything to work out well in the end.

"We need time to do this," she said. "But our intent is that we're here to stay."

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