The new Wisconsin Family Care IRIS 2.0 will involve tighter operating margins. The Department of Health Services will contract with Integrated Health Agencies who must manage 1. long term care 2. mental health behavioral 3. and the Medical needs for each individual member.
The Integrated Health Agencies will contract with a Financial Administrator (insurance plan) who will conduct the reimbursement for community providers contracted with the Wisconsin Family Care IRIS 2.0 Program.
Participants will no longer be able to perform their service as they have with past programming within this new delivery vessel. The new Family Care IRIS 2.0 programming will be value based - outcome driven- with reimbursement penalties to better define obsolete practices.
The combination of such an abrupt change, the comprehensive enfolding of multiple separate services, and implementation of labor intense regulatory required tasks will contribute to roll out difficulties. The past MCO's - Managed Care Organizations lacked the fiscal integrity to maintain delivery while meeting regulatory tasks.
Long term participants will find this new Family Care IRIS 2.0 Program overwhelming. Expect the State of Wisconsin to employ a regulatory crawl to help entice delivery providers to contract with the new programming. Regulatory crawl is a strategy to facilitate economic incentives that favor a larger than large provider. An example would be a budget that indicates the company must serve approximately 12 consumers to create the revenue to pay staff needed to meet quality activities and reporting initiatives to conduct business in Wisconsin.
Part of this is expanding the definitions of care , giving new services a residence within this New Family Care IRIS 2.0 which facilitates payment. The program must record evidence of regulation for any aspect of service being performed for reimbursement. This in a sense places pressure on the Medical delivery system to begin to categorize senior care tasks as a medically reimbursable service.
The new Wisconsin Family Care IRIS 2.0 will manifest very predictable changes that are certain to catch invested participants off guard. The goal of Home Care Path is to inform the participating community to view these soon to come disruptions as products of the system.
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