Finding solutions within managed careAfter two meetings, NorthernBridges staff and its members, local and state government officials and care providers are taking steps to work together to solve problems.
By: Shelley Nelson, Superior Telegram
After two meetings, NorthernBridges staff and its members, local and state government officials and care providers are taking steps to work together to solve problems.
The meetings are giving stakeholders in Family Care an opportunity to address concerns and NorthernBridges a chance to address issues as the managed care organization works to meet goals defined by the state.
After all, NorthernBridges was developed to reduce costs and eliminate waiting lists for people in need of long-term care. In the five years since the managed care organization took over long-term care for 11 counties in northern Wisconsin, there have been bumps along the way — bumps that have left care providers struggling to meet budgets and provide quality care to care that makes no sense to families of long-term care patients.
It is a concern when a nurse comes in, asks how someone is doing and they respond “fine” and if they have any concerns and they say “no,” said Judy Pahos, guardian of a sister with Downs Syndrome. She said the pat answers likely to be given to questions like that are inadequate for evaluating the level of care that may be needed.
“My concern — and I’ve had it since day one — is we have Alzheimer and dementia,” said Pam Clark, co-owner of Harmony Houses assisted living facilities in the village of Superior. She said turnover in the managed care organization is a concern. “There is no consistency … and they (patients) get very fearful and it’s a trigger for unwanted behaviors.”
Clark said it doesn’t help when residents are evaluated there are several people who come to the site.
Because of the various measures being evaluated — social, medical, screening and behavioral, NorthernBridges chief operating officer, Rita Mueller, said it’s not unusual that managers in the various specialties would all be present during the 6-month, annual or change of condition evaluations the organization is required to perform. However, she said, one of the things the organization is working toward is involving care providers in those assessments.
Among the issues identified is the tool used to determine the care rates for individuals.
“My perception of this rate setting tool is very different than being a very even field type of thing,” said Gene Chuzles, director of the Challenge Center, which operates several community-based residential units for people with disabilities. “This tool establishes a fixed range; it doesn’t necessarily pay for the services that are required … we’re still getting reductions without any clear justification.”
He said the agency has sustained about an 18 percent reduction in residential services and cut between 25 and 30 positions.
“The biggest impact is we can no longer provide the services we used to provide— at least of that level,” Chuzles said.
That was a concern for Pahos, who joined forces with other guardians to fight a decision to replace staff with a door alarm at her sister’s community-based home run by the Challenge Center. The families succeeded in keeping staff on site overnight.
“You put these people in charge of looking after their loved ones,” said Douglas County Board Supervisor Pat Ryan. “And they’re the ones being punished.”
Ryan questioned the administrative costs for running NorthernBridges and the impact that has on the care people receive.
Mueller said NorthernBridges is under the 5.7 percent administrative costs allowed for the managed care organizations operations and about 81 percent of all revenue taken in goes to member care.
There are a number of issues that need to be resolved, said Vince Maro, Family Care regional manager for the Wisconsin Department of Health Services, which oversees the Family Care program.
And the group plans to meet again at 11:30 a.m. May 10 in Room 204 of the Government Center.