WHA’s Post-Acute Work Group Examines Proposed HMO/Hospital Collaboration Strategies, Complex Patient Discharges

February 27, 2020

WHA’s Post-Acute Care Work Group welcomed several guests to its Feb. 21 meeting at the WHA headquarters in Madison. Susan Seibert, deputy director, Bureau of Benefits Management in the Division of Medicaid Services, Wisconsin Department of Health Services (DHS) reviewed a draft collaboration plan created by DHS in response to input from WHA’s Post-Acute Work Group. The plan proposes steps to improve collaboration between BadgerCare Plus and Medicaid SSI HMOs and Wisconsin hospitals regarding discharge planning or transitioning members to other settings. These include improving HMO-hospital communication, especially in times of transition when time is of the essence for action on prior authorization requests; opportunities for involvement in HMO contract administrator meetings to discuss and resolve issues of concern; and a regular process for DHS review of HMO policies that relate to BadgerCare member care transitions and discharge planning, and authorization processes for services in post-acute settings. Work group members suggested revisions to the plan and Seibert will take back to DHS the work group’s comments. A plan to communicate the collaboration plan’s provisions to hospitals and HMOs will be developed once the plan is finalized.

Judy Baskins, former chief of clinical integration for Palmetto Health in Columbia, South Carolina, and Tom Brown, former president and CEO of Lutheran Homes of South Carolina, gave a presentation to the work group describing a pilot program they developed in South Carolina for post-acute care for complex hospital patients and its eventual statewide implementation. Through a process that involved the health system, skilled nursing facilities and the state Medicaid agency, a complex care program was developed that assesses Medicaid-eligible individuals in the hospital who no longer require hospitalization but need nursing home-level care. The patients in the program must have multiple complex needs. The program offers an enhanced rate to the nursing facilities when admitting these patients.

The final guests of the day were members of the Network for Innovation in Senior Care. The Network is a consortium of 16 organizations working across 24 Wisconsin counties, providing residential support and services for both rehabilitative and longterm care. One of the issues the Network is engaged in is transitions of care from senior living settings to the hospital and back. This problem encompasses both the flow of information between settings and the capacity of post-acute settings to provide care for patients with multiple and complex co-morbidities, which include patients with extreme obesity, skin grafts, tracheostomies, ventilators and other conditions.

Issues discussed included the impact of “Medicaid pending” status on patient transitions, which can occur when a patient delays providing information required to determine Medicaid eligibility; a post-acute Medicaid rate that doesn’t cover the cost of caring for a complex patient; and the steps that some hospitals are taking to care for patients who can’t be discharged, including construction of a special facility to house these patients. The work group will continue to communicate with the Network on issues of common concern in post-acute care.

Contact WHA Vice President, Policy Development Laura Rose for information on the Post-Acute Care Work Group.


This story originally appeared in the February 27, 2020 edition of WHA Newsletter