The Arc Experience Podcast
The Arc Experience Podcast
Is Wisconsin's Family Care Meeting the Challenge?
If you live in Wisconsin, the term Family Care has a pretty unique meaning. The Family Care program was known nationally as an innovative program when it was created in 1999. More than 20 years later, Wisconsin's version of managed care for people with disabilities and older adults is not without its critics, but it is hard to argue that the program has made a huge difference in thousands of lives, particularly those who spent years on waiting lists. In this episode we have an exclusive sit-down with Inclusa CEO Mark Hilliker who addresses Family Care criticisms, talks about the evolution of managed care and reflects on Wisconsin's pioneer status. Learn why he says, "If you can dream it, you can do it."
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Welcome to the arc experience, featuring the stories of self advocates with disabilities and their families from around Wisconsin. Be inspired. Take action. And now for today's episode,
Speaker 2:Hello and welcome to the arc experience podcast. I am your host, Lisa Pew of the arc Wisconsin. Today. We're talking about something called family care. If you live in Wisconsin, the term family care has a pretty unique meaning. The family care program was known nationally as an innovative program when it was created way back in 1999, it was the state's first attempt to use managed care to help people with disabilities and older adults have the option to live in their own homes and communities with the supports they needed for a good life. Before that many, many people were languishing on long waiting lists, or they were sent to nursing homes to get their care because it really was the only option today's podcast. Guest is a part of that 20 year family care history. Mark Hilliker is the chief executive officer for inclusive. One of the state's largest family care managed care organizations, and is now in 62 counties serving more than 15,000 people. Thanks for joining us, Mark.
Speaker 3:Thanks for having me, Lisa. I had to visit with you today,
Speaker 2:So I didn't mean to AGU Mark, but since you have been around for a long time, our listeners are wondering if you can walk us through a brief history lesson, a family care, like what were things like for people with disabilities and older adults before we had family care in Wisconsin?
Speaker 3:Well, let me start with the, what w what it was like before family care started. Um, I think many people understand that before family care, uh, each Wisconsin County operated a program to support people with disabilities and, and frail elders. And so there were about 72 different ways of providing supports, uh, across the state of Wisconsin. And so, uh, there were, uh, I think ideas about how to support people, um, and maybe in a more collective way that could provide, um, broader, uh, supports and could address issues like long waiting lists. As you mentioned in the preamble to the podcast today, uh, there were literally thousands of people across the state of Wisconsin waiting for services and waiting for years and years sometimes to actually get supports. So, uh, the family care idea was one, uh, that really came about as a way of, of looking at how we might be able to increase both access to services and supports, um, provide high quality care, uh, to, uh, members who would be a part of the program, look at how we might be able to provide some cost efficiencies and also provide choice for people who were in the program. So were kind of the pillars of the family care program as it got started. And in 2001, five counties piloted the family care program. That was really the beginning of the managed care experience in Wisconsin, Portage lacrosse, Richland fond, du Lac, and Milwaukee counties were the five counties that piloted the program to start with. And they did that for eight years. And that experience really led to a better understanding and evaluation of how managed care my work in Wisconsin and toward the end of the pilot process, the state legislature, and the governor agreed that family care expansion across Wisconsin would really be a good idea, uh, in order to support people better in the state. And at that point, uh, there were a number of regional managed care organizations that were formed, um, either out of a pilot, uh, County or, um, separate entities that joined the family care program at that time, and, and started to provide support in regional areas of the state and over the last 12 years or so. Um, that program has expanded to the point where, uh, all 72 counties now are, uh, in the family care program. And what I think is really exciting is as of July, first of this year, um, anybody who's eligible for the family care program when they visit an aging and disability resource center will be enrolled in the program immediately. And so
Speaker 2:That really amazing really.
Speaker 3:Yeah, it really is. And it's, it's really exciting. It's something that we've been working for for a number of years, and to finally have it, uh, be in place this summer, I think is really exciting for, for everybody in the state of Wisconsin.
Speaker 2:You know, when I look back at that history and I see what's happening now across the country, managed care really is the way a lot of States do business for a variety of reasons. And it's kind of, kind of cool to think that Wisconsin was a pioneer because, you know, some people think, you know, managed care is just about saving money, but it really can improve supports for people. And like you said, get a lot of people off really horrible waiting lists.
Speaker 3:And I think, um, you know, what's unique about Wisconsin is that there's been this focus on long-term services and supports. Um, and that's not necessarily the case in many other States in the country where there have been, uh, movements towards managed care, but the focus has really been on acute and primary care, uh, and much of the longterm service and supports, um, practice hasn't evolved as quickly as supports for lung, uh, for acute primary care. So in Wisconsin, we've really had a chance to develop that over the last two decades. And I think, um, we've become a leader in the country in terms of how that support has been provided.
Speaker 2:Yeah, I think, you know, for our listeners who maybe don't understand all the terms and the differences acute primary care would be maybe a managed care system. That's really concerned about people getting their doctor visits and having their, you know, very, very acute health care concerns taken care of, whereas long-term services and supports are, you know, equally, if not, sometimes more important to people where do you live and what do you do during the day, and who are you connected to and all those other markers of health. Right.
Speaker 3:Absolutely.
Speaker 2:So you've been with inclusive, like I said before, for a long time through several name changes, a lot of growth since family care started. Now we're not trying to do, and, you know, a commercial here for inclusive. What I'm wondering if you can tell us a little bit about inclusive's philosophy, like how do you approach care for people with disabilities and older adult?
Speaker 3:Yeah, I think that's a really interesting question. And I think it sort of took me back a little bit in terms of, um, how we've sort of evolved in our thinking over the last dozen years or 20 years or so. And, uh, I think traditionally, uh, long-term services and supports have been provided, um, really focused on people's deficits and challenges in their lives. And they've been really service focused. So what sorts of services can we put in place to address a particular challenge in somebody's life? And I think as we've grown through the, the evolutionary process of the family care program, that thinking has really changed from, uh, from that service focus to one where we're, we've, we, I think coined the term member focused at one time. So really looking at, uh, the member, uh, within the family care program. Um, but as that indicates, there's just, uh, a focus on the member. It's not about the member and the member's whole life. Um, and then it became more of a strength-based approach. So looking at what sorts of capacities do people have to be successful in their lives, what are their interests and their preferences, and how can we leverage those things for success? And from there, I think it's moved to one around person centeredness. So it's really about how do we look at the whole person and try to figure out, um, how can we best support the whole person in that person's interests along with some of the things that they need help with in their day-to-day life. And so that evolution has sort of brought us from one that was really much more of a social service focus to one where we look now at more of a community development. Um, I guess, philosophy, if you will, in terms of how do we leverage all the assets in the community to help you better support everyone in the community. So fostering unity and the common good for all is something that we talk about a lot as being, um, part of developing a vibrant and inclusive community. So where everybody's gifts are welcome and appreciated and valued. And so it's become, I think, a shift in thinking from one that was very much focused on delivering service to one that really looks at how do we help people live more meaningful lives in their communities and how can they be active parts of the community in ways that are really valuable to them. And so that's how we think about the world. Um, and while that's a challenge, I think it's really helped us to open our thinking to what sorts of possibilities exist. Uh, not only for us to do a better job in supporting people, but how can people really explore life's possibilities and understand, uh, what sorts of things they can really do if they, if they can dream it, they can do it. And that's, I think how we think about the world.
Speaker 2:I love that if they can dream it, we can do it. That's wonderful. Hey, we're going to take a really quick break after a word from our sponsor and we'll come back with Mark in a few.
Speaker 4:This podcast episode has been brought to you by old national bank. Old national bank has been recognized by the national organization on disability as a leading disability employer, and one of the best places to work for disability, inclusion, old national fostering, a welcoming workplace where people of all abilities, backgrounds, and skills can work together to accomplish great things.
Speaker 2:Welcome back. You are listening to the arc experience podcast today. We're talking with FamilyCare inclusive CEO, Mark Hilliker. Hey Mark. You and I have talked about this a few times. Sometimes managed care family care gets a bad rap. People think managed care organizations are out there making lots of money skipping on people's services just to make a profit. What do you say to those critics of managed care?
Speaker 3:Well, I think that's something that we've, we've had to deal with over the years, for sure. Um, I think it's an, it's an interesting question because I think there are some dynamics at work that maybe folks don't fully understand. Um, first of all, I think managed care has a bad rap because it largely people see it as being, uh, how do we sort of, uh, reduce the amount of service somebody is actually getting in their lives and or how do we reduce rates in order to save money? And while there are certainly some efficiencies that have been gained through the system and our, our ability to contract for services and, and get the best rates, um, that's really not the only way we look at doing business. And I think if it was then that managed care would have a deservedly bad rap. So I think getting past that to understand that managed care organizations are funded by a, some certain amount of money that, um, the state and the federal government provide to us on a capitated basis, which means for every person that's enrolled in the program, we get a certain number of dollars every month to support them. So regardless of their care needs, we have to manage those dollars across all of our membership. And so there are some people within the program who have significant medical or behavioral or, um, other challenges in their lives that, that, um, cost a lot of money to support. And there are other people who have very few needs. So we try to balance that as much as we can to live within the dollars that are provided and we're stewards of. So it's a, it's a challenge. And for us to look at how do we provide the highest level of support, um, best quality support, and, um, make sure that we're doing that in a way, um, that's as efficient as possible too. So I think, um, oftentimes what's, what's missing. And I think what maybe is, is a next step for the state of Wisconsin is to really look at, um, how does managed care become a broader collaborative effort across not only managed care in the state, but also with providers and with members and other advocates for the program, um, to look at how do we create this next vision for family care? The vision was that was created 20 years ago. We've largely accomplished. So what's next. And how can we create that vision collaboratively in a way that helps people better understand all the dynamics within the system and allows us to create a pathway forward that we can all walk on together. And I think that's really critically important because I don't feel like we have that right now in Wisconsin.
Speaker 2:Right, right. That's a great way to think about it. I mean, thinking about the future, you know, it's hard to think about the future in the context of the current pandemic and you, and I know that the COVID-19 pandemic has been really difficult for people with disabilities and older adults and providers within the family care system. What do you think 2021 will bring in managed care?
Speaker 3:Well, 2020 was certainly a challenging year with the pandemic. And, um, I think what we saw was a, uh, uh, critical exposure to some weaknesses in our systems in terms of how to work, how we're able to support people when something like this happens. Uh, I think we all do a lot of contingency planning, but when we, we don't, I don't think have planned for a pandemic or something that affects systems so broadly. And so what we learned I think is that, um, some of our smaller providers, especially, um, are critically exposed to, uh, financial difficulties when they're not able to deliver the service, um, uh, because of the pandemic and, uh, some of the social distancing requirements and some of the other CDC guidelines that were in place. So, uh, I think we've learned over this last nine months, 10 months, that there are some things we can do to be better prepared for that, um, where we can provide, um, support for providers in a way that will, um, be more meaningful to them when things get very challenging, like they have, and to continue to provide really high quality supports for people in the program. Um, I think that was a, that was a challenge this year, for sure. Um, especially with the already the challenges we had with direct care workforce and the number of people who were actually able to provide direct care. Um, so the pandemic sort of exposed some of those weaknesses. I think, um, we're in a much better place than we were 10 months ago. Um, there's certainly going to continue to experience, uh, the effects of the pandemic, probably at least halfway through this year and maybe a little bit longer. Um, it's really great to see that the vaccines are rolling out. Um, hopefully we can pick up the pace at which people are getting vaccinated. So we can end this this period of time where we've really had a difficult challenge related to the pandemic, but I can tell you, at least I think, um, there've been some things that have happened this year that have been pretty exciting too, in terms of being able to create some flexibilities and our ability to deliver supports to people. And I'm hopeful that we can sustain some of those flexibilities post pandemic. The use of technology, for example, has been something that has really been beneficial, uh, for providers, but also for members, um, in terms of being able to access virtual supports, um, to provide additional, um, security and monitoring at home. Um, when there a person can't be there all the time, but to, to really be able to access tools and resources that help us provide supports in the most effective ways. Uh, I think we've learned a lot this year and those things are, I think really exciting for the future. And I'm, I'm hopeful that collectively we can, we can lobby for those things to maintain, um, their presence in this, in the delivery system once the pandemic ends. Yeah,
Speaker 2:I totally agree. You know, I like to end on a hopeful and optimistic note. Unfortunately, our time together has ended. We'll have to have you back Mark, but I'm wondering if you want to leave our listeners with one thought or something to remember about the long-term services and support system in Wisconsin, what would it be?
Speaker 3:Well, I think what sticks out to me right now the most is just the heroic work that's taken place over the last year, um, with the pandemic in place. And I think we have, uh, a group of providers and direct care workers who are so compassionate and so passionate about the work that they do. Um, they've really stood up and, uh, I think stood out during the pandemic in terms of the length to which they'll go to support people who are at risk and, uh, the family care program supports the most vulnerable people in Wisconsin. I think, I just want to say how grateful I am and how appreciative I am of the work that's that's happened during this time and the support that's been able to be provided to people within the family care program and beyond. Um, I think, you know, we're committed to providing ongoing support as much as we can as an organization. And we really look forward to continuing the collaboration as we work our way through 2021.
Speaker 1:So my hats off to providers and all the direct care workforce, Wisconsin,
Speaker 2:Thank you so much for your support of the arc, Wisconsin. And, uh, we really loved having you today.
Speaker 1:Thank you very much.
Speaker 2:All right. And thank you also to our listeners for listening to the arc experience podcast, we really, really appreciate a review. So make sure you go to Apple podcasts or wherever you listen and leave us a review. It helps us to get more listeners and we will see you next time.
Speaker 1:Today's episode of the art experience was brought to you by the arc Wisconsin, the state's oldest advocacy organization for people with intellectual developmental and their families it's funded in part by the Wisconsin board for people with developmental disabilities. Our theme music called species is the property of[inaudible] and cannot be copied or distributed without permission. It was produced by Eleanor Cheetham, composer and artist with autism.