Hi all,

WI is moving to a for-profit managed care model that integrates LTSS, acute, primary and behavioral health under one plan. We are meeting with our State health services as they write the waivers/develop RFPs. They have had these questions. Does anyone have good resources to share:

n  Any specific measures that cross LTSS and medical. (social determinants and how they affect medical). Ari alluded to employment showing better health. Any data on that would be good.

n   data on ways to keep more expensive people in the community. (cost outliers). They didn't' particularly know the percent in WI that are true cost outliers…kept referring to 10-percent but said they didn't know actual percentage. I think you know what percent in TN equate with what percent of costs.

n  evidence/data on factors that could show that over time, amount of resources to high utilizers/outliers/more complex folks could be diminished/reduced using certain strategies, supports, etc.

n  They wanted to know, too, of data showing over time that “scattered site” could lead to lower cost than congregant

n  They wanted sample score cards/report cards that other states use that you think are good.

n  what quality measures can be used to help people be informed for selecting plans.

n  any other data  on whether “any willing provider” was a good thing or if there were other ways to ensure good relationships between providers and IHAs. I think the paper you sent below is good enough for this one.

Thanks!

Beth Swedeen

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