Wisconsin Integrated Health Agencies 2 Meet The 2.5 Percent Challenge

With the roll out of Wisconsin's new Family Care IRIS 2.0 the (IHA's) Integrated Health Agencies (insurance plans) will be challenged to assure service with a margin of 2.5 percent.  For this to occur the State will need to support provisions conversion to a value based delivery. 

In 2014 Milliman Inc performed an actuarial analysis of Wisconsin Family Care Long Term Care Services expenditures and capitation rate model.  Since then 2 contracted Care Management Organizations no longer operate due to fiscal (no money) difficulties.  From the existing data the State budgetary committees forecast 5 percent would create unsustainable profits for Integrated Health Agencies. 

The financial structure being brought forward indicates 85 percent of the time Wisconsin capitation payments made to Integrated Health Agencies are expected to be within plus/minus 2.5 percent of the Integrated Health Agencies actual annual service cost for the contracted service.

This communicates the core of establishing (tighter margins) rates within a service agreement.  Acceptable risk then becomes the percentage of program members eligible for service in the absence of adequate provision.

The program is challenged to establish an acceptable (risk tolerance) percentage of program members eligible for help but going through their day with unmet needs. This communicates an essential need for a value based provider network to assure quality and safety.  Lack of provision figures in to the calculation of risk as a participating measure in program success.

Home Care Path is constructing a multisided platform designed to help match families with dementia needs to local support partners who can give the primary care giver a much needed break.

Take a first peek https://www.homecarepathdementiasupport.com/en/infos/about at the open structure designed to strengthen a families access to the help they need in real time.  Families can list their need and support partners can list their availability.  This concise application exists to save families precious time and resources they so desperately need to effectively care for their loved one.