value to the member - independent care health plan · icare members can expect to receive help in...

Value to the Member

Friends for Health. Friends for Life.www.icare-wi.org

H2237_IC1122 CMS Accepted

Corporate ManagementThomas Lutzow, PhD, MBAPresident & CEO, Independent Care Health Plan

Liz Bartlett, JDVice President & General Counsel

Linda Ellis, MD, MJMedical Director

Lisa Holden, RN, BSNVice President, Accountable Care

Bill Jensen, MBAVice President

Vinay Pandey, BSVice President & Chief Information Officer

Don Slowik, CPAVice President

Craig Steffes, CPAVice President & Chief Financial Officer

Board of DirectorsHoward L. Garber, PhD Chairman, Independent Care Health Plan Board of Directors President, Centers for Independence, Inc.

Stephen Arnhold, FSA, MAAA, CFAVice President, Actuarial, Humana Inc.

Alex Chou, JD, MBADirector of Corporate Development, Centers for Independence, Inc

Cheri Greenfield-LaTour, MBAVice President of Patient Experience and MSO Development, Humana, Inc.

James Hartwig, JDOfficer and Board Member, Centers for Independence, Inc.

Anita Holloway, MD, MBAMarket Vice President and Medical Officer, Humana, Inc.

Elwood I. Kleaver, Jr., CPAHealth Care Consultant

John Moats, MBA Consulting Leader, HumanaOne and Humana Small Group Division

Daniel Neely, PhD, CPA Associate Professor of Accounting, University of Wisconsin - Milwaukee

Our Value ..................................................1

iCare Core Values ....................................2

Member Profiles ........................................3-9

Dorothy Douglas ....................................3

Anthony St. Louis ....................................4

Ana Rios ..................................................5

Genesis Pena-Delgado .........................6

Agnes Turner ..........................................7

Linda McGhee Qtairi .............................8

Miller Brown ............................................9

The iCare Experience ...............................10

Mission, Purpose, Vision, .........................11 Goals, History

A Different Approach to Care .................12

Quality Through Care Coordination .......13

Diversity ......................................................14

Access to Community Services ..............15

Innovation ..................................................16-25

High Level Care Coordination ..............16

Specialty Services .............................16

Behavioral Health Team ...................17

Medical Disease Management .......19 Team

Re-Admission Prevention .................20 (RAP) Program

Wisconsin Statewide Health .................21 Information Network

TruCare ....................................................22

Nurse Advice Line ..................................23

MarketPOINT ...........................................23

iCare part of studies on best ................24 practices for Medicare, Medicaid

Choice .........................................................26-29

What is the iCare Medicaid SSI ............26 Program?

iCare BadgerCare Plus..........................27

Get to Know the iCare...........................28 Medicare Plan

iCare Family Care Partnership .............29 for Long-Term Care and Acute Care Needs

Results Through Care Coordination .........30

Accomplishments ......................................31

Quality, Choice, Results.............................32

Member Demographics ............................32-33

Membership by Ethnicity ......................32

Membership by Age Group .................32

Initial Assessment Statistics of ..............33 Membership

Membership Growth (1994 - 2013) ......33

Table of Contents

Page

Our members know that if they are in need of someone to talk to when there is no one else around, they can call their care coordinator. Someone from our Care Management team is always on call to make

sure that a member is not alone in their moment of need.

Our Value From the beginning, Independent Care Health Plan (iCare) has been there for those with special needs and limited means, providing access to needed health care services and community resources. Our members value the outstanding care management services offered by iCare, and their ability to reach out to their care coordinators and care teams.

Our members know that if they need someone to turn to, their care coordinator is right there in their corner, ready to assist with providing access to quality health care and community services.

When our members are in need of a champion to ensure that his or her medical, behavioral health or social service needs are met, their iCare care coordinator is just a phone call away.

1

iCare Core Values

Inspire Wellbeing

• Motivate Members to peak health

• Listen to what is important to Members

• Build partners to achieve health outcomes

• Promote wellbeing as a personal habit

Brave New Solutions

• Imagine Member-unique solutions

• Optimize care resources

• Share best practices

• Drive continuous improvement

Radiate Compassion

• Reflect sensitivity to Member preferences

• Withhold judgments that may cloud decisions

• Treat others as if they were me

• Make iCare feel like home

Thrive Together

• Celebrate success of shared responsibility

• Lead even when no one’s looking

• Honor our legacy of integrity

• Be an “Effectiveness Multiplier”

iCare members can expect to receive help in determining which medications to take, when to take them, and combinability with other

medications. A trusted resource is just a phone call away.

Dorothy DouglasDorothy Douglas lost her continuity of care after her doctor changed practices. Dorothy is afflicted with diabetes and mental health issues. Without anyone to help her access the medical services or prescription drugs that she needed, Dorothy experienced six inpatient visits during an 18-month period from March 2007 to November 2008. After becoming a member of our Medicaid Supplemental Security Income (SI) program in September 2008, her high utilization of inpatient services was noted by iCare.

Her care coordinator referred her to the Specialty Services Department, where care manager Michelle Elliott intervened by working diligently to contact Health Care for the Homeless to schedule a behavioral health appointment to update her prescription and ensure continuity of care. Michelle also worked with a Specialty Services Department RN to contact Dorothy’s nurse practitioner, advocating for a refill of her original prescription until she was able to schedule the appointment.

Now, with a regular regimen of care through a nurse practitioner program and monthly medication monitoring by Michelle, Dorothy is living a more stable life and has not had any further inpatient visits. Dorothy knows that she can depend on her care manager, stating, “Michelle helps me, if I have a problem I can call her.” Michelle indicated that Dorothy lives an independent life, and will sometimes call her with questions about accessing specialists or obtaining DME to meet her medical needs. Dorothy later became a member of the iCare Medicare Plan, where she continues to receive the care management that iCare provides, as well as Part D prescription drug services.

Dorothy lives in a modest two-bedroom apartment that she shares with her son on Milwaukee’s north side. Formerly an instructor with the Head Start program from 1995 to 2003, Dorothy is retired, but she is studying to become a medical assistant, attending Bryant and Stratton College through a federal loan and grant.

Quality, Choice, Results

Member Prof i les

3

Anthony St. LouisAnthony St. Louis is a self-taught computer whiz. He finished his studies at South Milwaukee High School and has taken classes at the Milwaukee Area Technical College to study animation. He has been an iCare Medicare Plan member since October 2009. Anthony has a mild heart condition, ADHD, mood disorder and a pervasive developmental disorder, which he keeps stable with medications that he has used since he was 4 years old. His mother, Donna Wheeler, indicated she found out about iCare when she applied for SSI for Anthony after he finished high school. Donna was formerly a medical assistant, but because of a disability she no longer works. Her husband David works full-time

servicing heating, ventilating and air conditioning units.

After working with the State’s Division of Vocational Rehabilitation (DVR) to determine if Anthony could work, Donna indicated, “Nothing worked out, they basically said he was unemployable. I was kind of disappointed, I had been supporting Tony for two years and it’s expensive, especially when I’m on disability, so that’s when I applied for SSI and Social Security. When we got the SSI, Tony was automatically enrolled into iCare. At that time I didn’t know a lot about iCare until Maggie explained everything to me.” Maggie is Anthony’s care coordinator.

All iCare Medicaid/SSI and Medicare Plan members have their own care coordinator to help them access health and community services. Donna likes to mention the money she saves with iCare’s Over-the-Counter (OTC) Medication and prescription drug benefit programs. “I do take advantage of those OTC drugs; it can be very helpful with band aids and all kinds of things we can get from that.” The OTC benefit allows iCare Medicare Plan and Partnership members to purchase OTC medications that are home-delivered.

Donna would like Anthony to be able to live on his own or in a group setting. Maggie informed her of a community resource to help her search for a group-home setting for Anthony. Donna also knows that after he moves out on his own, his care coordinator can point him in the right direction for filling his prescriptions, accessing medical care and finding social services.

With iCare, living life to the fullest is an important goal. Not only do we keep your child from falling though the cracks, we provide the safety net on which your family can depend as you plan for the future.

Friends for Health. Friends for Life.

Sometimes it can take as long as a week for a doctor’s office to return a phone call, but with iCare, members can expect to talk to their care

coordinator right away.

Ana RiosHaving been struck by an errant taxi cab that left her disabled and unable to stand for long periods of time, a friend recommended that Ana Rios join iCare because of the comprehensive services that we provide. Ana has been an iCare Medicaid SSI member since March 2006. Unfortunately, the accident that left Ana disabled was not the last time that she had to visit a hospital emergency room. Within a two-year period she used ER services four times for chest pain, abdominal pain, eye problems and an ankle injury. Ana’s care coordinator educated her on the use of urgent care to help ensure appropriate use of healthcare services, and she has not used ER services since. Originally from Puerto Rico, Ana has lived in the United States since she was a little girl, moving to Milwaukee in 1991.

Ana has a bilingual care coordinator who also assists with scheduling appointments and interpreter services when she sees her therapist and psychologist. Ana was once assaulted and her assailant broke her fingers, requiring her to have surgery on her hand. She now has regular rehabilitative therapy for her hand and attends counseling for the mental trauma caused from the assault. Ana credits open communication with her care coordinator for keeping her from preventable inpatient and ER visits. Ana thanked her care coordinator for his constant reminders on preventive health measures, including breast self-exams, which helped her to find a small lump in her breast. Fortunately, tests indicated the lump was only a cyst. In all of these situations, Ana says, “As long as God is on my side I march forward.”

Ana indicated that she is very satisfied with her providers, interpreters and her care coordinator. Because of her counseling, she says she has the confidence to take walks again and be more independent. She likes to take walks in Walkers Square Park on Milwaukee’s south side.

Before her accident Ana worked at La Causa, a social services agency that provides shelter, education and emotional support for neglected and abused children. She resides on Milwaukee’s south side with her cat Paulina in a two-bedroom upper flat. Ana has six children and 19 grandchildren. She likes to help out in the community by donating items to the church, saying that the community has been good to her. Her philosophy, “You need to get along with everyone, even your enemies.”


Member Prof i les

5

Genesis Pena-DelgadoVictoria Delgado, Ildefonso Pena and their daughter Genesis Pena-Delgado, live in a house perched on a winding street on the south side of Milwaukee. Their daughter Genesis became an iCare member in January 2009, and is presently in the iCare Family Care Partnership program. Genesis was diagnosed with epilepsy at the age of three and has mild mental retardation.

Having attended Pulaski High School’s special education program, Genesis has since transitioned

from her classes and lives with her parents, where her father took on the responsibility of providing full-time care.

Originally from Puerto Rico, Ildefonso and Victoria moved to the United States in 2001 and do not speak English. Independent Care provides free Spanish translation services to ensure that they understand the benefits for which they are entitled and to maintain consistent communication in caring for Genesis.

When describing Genesis’s care manager, Victoria stated, “She helps a lot, she coordinates a lot, is always willing, and when I leave a message, she always gets back to me.” In keeping with iCare’s role to promote healthier living, Genesis’s care manager provided her with a referral to Columbia St. Marys for physical and occupational therapy sessions. When Genesis’s safety helmet didn’t fit, her care manager arranged to obtain a new one. Genesis’s care manager proved instrumental in ensuring that she remained active by helping her to enroll in recreational programs sponsored by the Milwaukee Recreation Division, where she could participate in crafts, pool activities, and field trips to the zoo and museum. Victoria indicated that Genesis is very much into crafts, loves to go shopping and is always occupied with something.

Victoria also expressed how pleased she was with iCare services, especially in monitoring the medications being used by Genesis. She described a visit to a doctor where she believed the physician was unresponsive to her concerns regarding a medication that was affecting Genesis’s liver. On her next appointment she was accompanied by Karen, a Partnership team nurse, where it was agreed that the doctor would reduce the dosage and then discontinue using it. “She went with me and he listened. That’s why I give thanks to Karen, and she is going with me on my next appointment,” Victoria exclaimed.

At iCare, we don’t just provide services, we act as your advocate and guide in managing your medical, social and mental health needs. You will get to know our voices and faces, and we will quickly get to know yours. We are in your corner at all times and make ourselves easily accessible through frequent home visits and phone updates.


Going through a three hundred page provider directory can be confusing at times. Our members can call their care coordinator to help them find

the right doctor for their needs.

Agnes TurnerAgnes likes to compose poetry to sway people to change their attitudes and behaviors, explaining, “It’s hard out there.” She knows from experience, having contracted post-Polio syndrome at an early age, she walked on crutches for 33 years and now uses a scooter to get around. “I was never able to do too much,” she said. She has endured the stares and whispers of people who are not like her, which has made her hesitant to interact with others, but defiantly she says, “You have to be strong, keep your head to the sky.” She said her doctor told her she was the strongest woman he knew.

Agnes has been in iCare’s Medicaid SSI program from the beginning when it started in 1994. She says that iCare has helped her to be independent. Her care coordinator stated, “One of the things I most admire about Ms. Turner is her ability to be proactive. When she was in need of a scooter she contacted me for assistance. When she had problems with the scooter’s battery, she never hesitated to follow up with me or Home Care Medical. I used to be scared to go places, but with my scooter I can get groceries and take out the garbage.”

Besides writing poetry, Agnes said she has been crocheting since she was 24 years-old, but that she has to take medication for her carpal tunnel syndrome first. She likes to read, having read the Bible eight times, she said that she finds something new every time. Agnes also likes to garden, sew, and cook her specialty meal of spaghetti with meat sauce.

Like the majority of iCare members, Agnes appreciates the benefits of membership, where help and information is just a phone call away. “I love iCare. If I have problems, I call my care coordinator and she helps me. When I am upset I can call her, and her voice just calms me down.”


Member Prof i les

7

Linda McGhee QtairiIndependent Care Medicare Plan member Linda Qtairi became an advocate for iCare because of the assistance provided by her care coordinator to help her recover from a stroke, stating, “I thought it would be a good thing to convince people to join iCare.” Linda has been with iCare since 2003 and if anyone can vouch for the benefits and services offered by the Plan, it would be her. After she became eligible for SSI benefits, she joined iCare. “When I had surgery, I needed a nurse at home because of an infection. The nurse had to come in and bandage me every day,” describing the help she received from iCare, noting that some health insurance does not provide that type of coverage.

Linda’s care coordinator is Paulette Lee. When Linda joined iCare, Paulette provided her with

education on the role of a primary care provider, and proper use of urgent care clinics and emergency room services. She noted that Linda was motivated to participate in preventive care routines, including obtaining her flu shot and scheduling for a mammogram and pap/pelvic exam. Linda also needed glasses and Paulette provided information on which providers offered this service.

When Paulette completed Linda’s assessment, she noted that she expected her transition into iCare to go smoothly. She stated, “I have worked directly with Linda to answer questions or resolve problems with her medications or dental services. Linda takes her health care seriously and has participated in health related incentive programming offered by iCare.”

Linda likes the services provided by Paulette stating, “My care coordinator is beautiful to me, she set me up with a dentist. Any problems I don’t understand, I call her and she explains it to the fullest. We get a good deal with our medications. I was with another plan with higher co-pays. For people with low incomes, iCare’s Medicare Plan makes it easier to pay for your medications.”


Dental care is a high priority for iCare members, and care coordinators play a major role in locating dental providers with experience in helping

people with special needs.

Miller BrownOne can describe Miller Brown as a gentle giant, standing at over 6 feet and 210 pounds, this Vietnam War veteran from Tennessee has been with iCare since 2003. He spends some of his spare time at Career Youth Development (CYD), a community based organization that provides counseling services for people fighting alcohol or other drug addictions. Noting that young people tend to act out their frustrations in a negative way, he tries to set an example at CYD by channeling his everyday frustrations into social activities such as playing cards, pool or dominoes, which he says, “Keeps me from acting out.” He graduated from CYD’s program in December 2008.

Miller is in the iCare Family Care Partnership program, where most of his medical and long-term care needs are covered by iCare. He said he tried other insurance, “It didn’t work too good, every time I went to the doctor it came out of my pocket. Every time I had to pay for medicine, I payed more than I do now.” Miller is afflicted with osteoarthritis, which causes pain in his back and ankles.

When Miller first joined iCare in 2003, he was in the Medicaid SSI program and his care coordinator was Connie Kafka. He credited Connie with helping him to obtain the proper treatment that he needed. “My care coordinator always tells me where I can go to get something done. Since I got iCare, I got the right doctor that cares for me.” In 2012 Miller enrolled in the iCare Family Care Partnership program, and now has an entire care team to help him access medical and long-term care services.

Miller likes to tell people about iCare’s benefits and services. He said, “Since someone tries to help me, I wanted to help someone else get what they need.” Connie had this to say about her former charge, “He has always had motivation to move forward and insight into recognizing things or people who were holding him back. In working with Mr. Brown through the years, I know that he works on a daily basis to achieve his goals. When he does not know something, he asks for the information and follows through. He is truly a motivated individual and works to motivate others as well.”


Member Prof i les

9

The iCare ExperienceSince 1994 Independent Care Health Plan (iCare) has provided quality health care benefits to eastern Wisconsin’s low income and special needs population. Over the years we have experienced tremendous growth as we continue in our goal of delivering efficient and effective health care services to our members through care coordination. We are proud of our accomplishments and look forward to continued success in a future where quality health care benefits, optimum provider access and choice, and knowledge of community resources creates strong, solid results for our members.

Independent Care offers a comprehensive health and social services program for people ages 19 and older with special needs, who receive both Medicaid and Supplemental Security Income (SSI) benefits. With over 8,000 members in the iCare Medicaid SSI program, iCare is one of the largest providers of health care services for people with special needs in the state of Wisconsin.

In 2007 we introduced our Medicare Advantage Special Needs Plan, the iCare Medicare Plan HMO SNP. It is a managed care plan for people who dually qualify for Medicaid and Medicare. Members participating in this plan benefit from the same model of care as provided under our Medicaid SSI program but qualify for extra benefits covered under Medicare.

We also offer the iCare BadgerCare Plus program for low-income childless adults, parents, pregnant women and children. The program covers basic health care services, including primary and preventive care, as well as prescription drugs.

Finally, in 2010 we added the iCare Family Care Partnership HMO SNP program to our portfolio. Our Partnership program serves people with physical and developmental disabilities and frail elders. The program is designed to enable people with have long-term care needs receive care within their home environment, where experience demonstrates better outcomes in comparison to nursing homes. There are also significant cost savings involved when a person can avoid institutionalization.

We are taking the necessary steps to ensure iCare’s future growth and availability for our members. We will continue the expansion of our care coordination model throughout our service area to ensure that those with unique and complex medical, behavioral and human service needs have access to quality health care services.

1994 - Joint venture between MCFI and Humana forms iCare. Focus:

Providing access to care for those with special needs.

*Dec. 1994 - 925 members

Dec. 1995 - 2,320 members

1996 - Emphasis on guiding members to social service

programs.

Dec. 1996 - 2,441 membersDec. 1997 - 3,170 members

1998 - Focus on evaluation of care coordination model and

deliverables. Move to fully capitated risk model.

Timeline

* Enrollment figures taken from Executive Monthly Enrollment Reports

MissionTo secure the wellness of persons with complex medical and behavioral conditions, respecting their dignity and the values of caring stakeholders.

PurposeTo measurably improve the health of iCare members through personalized, sustained and integrated care coordination.

VisionIndependent Care is the national leader for advanced managed care programs that serve people with complex health and social needs.

GoalsIndependent Care is grounded in the premise that quality health care can be provided effectively and efficiently through care coordination. We strive to empower our members to participate actively in self-care management, which ultimately leads to a higher quality of life. Together with providers and community resources we achieve strong, solid medical, behavioral and social outcomes, ensuring results are recognized for individuals with special needs now and into the future.

HistoryFormed in 1994, iCare was a joint venture between a for-profit health care company, Humana Wisconsin Health Organization (WHO), and a non profit, the Milwaukee Center for Independence. The two distinct organiza tions resolved to create a program allow-ing for improved quality and access to care for indivi d uals in the Medicaid market. The result is a partnership that integrates managed care with social services.

Today, iCare provides medical, dental, behavioral health, vision and prescription drug coverage through care coordination. Care coordination recognizes that medical, behavioral and social needs must be met in order to improve an individual’s quality of life. Benefits also include health outreach, treatment information and follow-up and assistance in choosing providers.


1999 - Focus on evaluation of care coordination model and

deliverables.


2000 - Development of a comprehensive quality improvement program.


2001 - Defining care coordination process. Refined assessment tool.


Timeline

11

iCare care coordinators build trust with their members, where they become comfortable in talking about anything. This sharing of

information helps ensure that members are prepared for meaningful doctor visits.

A Different Approach to CareIndependent Care was one of the first managed care organizations to recognize that in serving people with complex medical needs, we have to address social and mental health issues in order to treat the medical condition. Since 1994 we have been providing health care services for people with special needs, creating a member-centered model of care, with a focus on “whole person” management.

Members of iCare receive baseline as well as yearly health assessments to develop a member-centered plan of care specifically for their needs. We also offer programs where members can benefit from different levels of care, and their needs are addressed accord-ing to the severity of their condition. Most importantly, we place an emphasis on preventive care and persis-tent follow-up with our members. This may involve a phone call to remind a member of his/her doctor’s appointment to scheduling transportation for them to get there.

This personal focus on care has enabled us to maintain steady member satisfaction rates over a long period of time. In our “whole person” approach to care, we also point our members in the right direction to access community services that they might not have known were available to them.

2002 - Move to an integrated multi-disciplinary model of care

approach, with emphasis on behavioral change. Based upon iCare calculations, new model of

care provided significant savings to the State.


2003 - Intervention strategies developed. Defined care coordina-tion performance model. Member

satisfaction over 97%.*

* iCare annual member satisfaction survey.


Timeline

If a member finds that they cannot obtain proper care from their doctor, they can count on their care coordinator to be an advocate on their

behalf. Members have extra clout with iCare.

Q u a l i t y Through Care Coordination

Delivering quality health care services to individuals with physical, mental or emotional disabilities is often challeng-ing. Many of our members have more than one disability, including problems with substance abuse and mental illness. In addition, medical care for people with special needs has often lacked preventive and chronic care management, combined with the expertise needed to manage multiple medications.

A study release by The National Minority Quality Forum (The Forum) suggested that low-consuming Medicare FFS beneficiaries with chronic diseases are more costly to the program because they are more likely to under-manage

their disease, resulting in acute events that require costly emergency room visits and hospitalizations. Gary Puckrein, PhD, President/CEO of the Forum stated;

“If we can identify these patients, who are under-managing their chronic condition put-ting them at high-risk for disease complications, we can intervene to help these individ-uals manage their disease more effectively, and, ultimately, reduce overall health care costs.”

This is where iCare’s multiple levels of care coordination prevail. Independent Care uti-lizes a care coordination model that helps caregivers when addressing disease process issues, identifying and obtaining treatment for modifiable illnesses, avoiding futile inter-ventions, improving outcomes and quality of care, and encouraging client participa-tion in self-health management. As iCare collaborates with physician offices in helping to ensure that members are compliant, we can work as a team with caregivers and care providers to benefit the people we are serving.

When someone becomes a member of our iCare Medicaid SSI or iCare Medicare Plan they are assigned a care coordinator or care manager according to their condition.

2004 - Enhanced care planning and intervention management

process. State and iCare negotiate a severity adjusted rate to reflect

member risk. Member satisfaction over 97%.*


2005 - State SSI expansion and introduction of competitors.

Mandatory enrollment. Staff level adjustment to service growing

membership. Member satisfaction

stands at 96.9%.*


Timeline

13

Care coordinators and care managers iden-tify health care needs by performing initial and yearly assessments. They clarify needs and goals and support efforts toward self-care manage-ment. Members are empowered to participate in self-care. Nurse case managers work with iCare staff and members with more complex medical, behavioral or social needs. A care co-ordinator or care manager will continue to work with the member while the nurse case manager provides assistance. Nurse case man-agers are registered nurses with years of experience in primary and specialty care.

Some members benefit from a higher level of care management involvement. If a member is struggling with mental health issues or substance abuse, iCare’s intervention specialist and psychiatric social worker may provide support for behavioral change and assistance locating community resources. Our health outreach works with members with special needs and assists them in accessing preventive services.

iCare Partnership members are a part of an assigned care team consisting of a social services coordinator, a registered nurse, a nurse practitioner and a wide network of providers. The Partnership Care Team conducts initial and six-month assessments to develop a member-centered plan. In the process, needs and goals are discussed and members’ families are encouraged to participate in preparing a member-centered plan that includes self-management of the member’s condition. The care team will teach, model and prompt activities that promote healthier living.

Diversity

Independent Care has several multilingual care co-ordinators. Wisconsin has a diverse population, with thousands of residents who do not consider English their primary language. Our multilingual care coordi-nators speak fluently in languages such as Spanish and Hmong. This allows us to effectively coordinate the health care of these individuals with less confusion and better understanding of benefits and services.

We also provide over-the-phone interpreter services for those members who do not speak English. This service can be accessed by calling our Customer Service department.

2006 - Signed contract with CMS to offer Medicare Advantage Special Needs Plan. Milwaukee Major Tom Barrett nominates iCare for the Inc.

Magazine “Inner City 100” award, which profiles fast growing inner-

city companies like iCare.


2007 - Launched iCare Medicare Plan in Milwaukee County. Sub-mitted bid to Milwaukee County

Department of Aging to become a Care Management Unit (CMU) for

Family Care.


Timeline

All non-English speaking members are directed to network physicians who understand their culture. One reason people choose iCare is that our provider network includes pri-mary and specialty care providers who practice in areas where our members live and spend time. Our Network Development staff works hard to sign quality providers that focus on members’ needs and expectations.

In addition to a multilingual staff, iCare also provides a TDD phone number for the hearing-impaired. Special services also are available for those who are blind or have limited vision.

Access to Community ServicesIndependent Care is unique and innovative in its approach to community services that can help someone achieve a higher quality of life. This approach is what sets the program apart from other managed care plans and traditional Medicaid/Medicare programs. Care coordina-tors assist in finding support groups, locating affordable housing, food and clothing, and suggest opportunities for social interaction.

Independent Care works with durable medical equipment companies, social service agencies, home care providers and advocacy groups. We also collaborate with organizations and providers to ensure adequate services for people who are disabled in facilities and other venues. We perform this function through a variety of mediums, starting with our care coordinators and care teams, but also utilizing social media to provide information on preventive health and community resources that can benefit people with disabilities.

2008 - Expanded iCare Medicaid SSI service area into Kenosha, Ozaukee, Racine, Sheboygan,

Washington and Waukesha counties.


2009 - Launched iCare BadgerCare Plus. Completion of office suite

expansion in Schiltz Park.

Dec. 2009 - 18,519 members

2010 - Launched the iCare Family Care Partnership program in

Milwaukee County.

Dec. 2010 - 15,654 members

Timeline

15

When a member is having trouble getting their prescriptions filled, their iCare care coordinator will step in for them and resolve the issue.

InnovationWith the passage of the Affordable Care Act, care coordination is a hot topic with major health plans hailing it as a way to reduce health care spending. Since 1994 iCare has been at the forefront in advocating a care coordination model for manag-ing chronic health conditions. The State of Wisconsin’s Medicaid SSI managed care program expansion implemented in 2005 utilizes a similar care coordination model that was pioneered by iCare. Independent Care’s innovative approach to providing quality care coordination is reflective of the people and resources dedicated to improving the lives of our members.

High Level Care Coordination

Specialty ServicesIndependent Care’s Specialty Services Department provides the highest level of care available through our care coordination model. Led by Marlena Anderson, a registered nurse with seven years of experience at iCare, Specialty Services performs multiple functions through a variety of programs including:

• Discharge planning (Medical admissions)• Utilization review (Behavioral health)• Medical and behavioral health disease management (DM)• Outpatient BH “Gatekeeping”• ReAdmission Prevention (RAP)

As outlined by Anderson, Specialty Services receives internal referrals from care coordi-nators for members who have demonstrated the need for a higher level of intervention and guidance in navigating the health care system. Anderson indicated that in both the Medical and Behavioral Health Disease Management programs, Specialty Services staff function as resources for members and their caregivers while empowering them, through education and encouragement, to assume an active role in the manage-ment of their disease. The department works to ensure that members are adequately treated at the appropriate level of care with the goal of reducing avoidable disease related admissions and ER visits. With lower case loads, Specialty Services staff are able to develop targeted care plans with the members, conduct home and facility visits as

2011 - Expanded iCare Medicare Plan service area to Brown, Manito-

woc, Outagamie, Walworth, Wau-paca and Winnebago counties.

Dec. 2011 - 15,594 members

2012 - Expanded iCare Medicaid SSI/BadgerCare Plus Core Plan

service area to Brown, Manitowoc, Outagamie, Walworth, Waupaca

and Winnebago counties.

2012 - Expanded iCare Family Care Partnership service area into

Kenosha and Racine counties.

Dec. 2012 - 15,407 members

Timeline

Specialty Services Department Manager Marlena Anderson, RN

needed, and collaborate with providers more frequently. The multidisciplinary teams meet weekly to discuss missed opportunities, to receive feedback and guidance, and to update each other about interventions that have proven effective.

Behavioral Health TeamOnce a week Specialty Services’ Behavioral Health (BH) Team meet to go over member caseloads or staffings, which outlines the member’s diagnoses, last contact date with iCare, high risk criteria, dates of inpatient stays and outpatient visits, prescription drugs prescribed, and the treatment plan/goal. The BH Team is led by Care Manager Eleni Voulgaris, who has over 9 years of experience at iCare. The team is charged with inpa-tient and outpatient utilization review, crisis intervention and BH disease management. The team is composed of registered nurses, care managers, a psychiatric social worker and an intervention specialist. Voulgaris outlined how the team interacts with iCare’s network of caregivers;

“The BH Team works collaboratively with providers, targeted case managers and community support workers to assure the best overall treatment for the member. The BH Team is able to provide information such as emergency room and hospital visits, medication profiles (including medications from other providers), and com-pleted examinations in clinics and with other treating providers. This helps minimize duplication of services, over prescribing of medications, and alerts providers to member needs.”

During the morning meeting, four to six staffings print-outs are circulated to discuss the specifics of each member’s condition. The staffings reveal that the members who are recommended for this level of care are usually afflicted with a multitude of chronic be-havioral health and medical conditions; ranging from diabetes, congestive heart failure and asthma to alcohol dependence, depression, opiate addiction and schizophrenia.

Top 10 Mental Health Conditions of iCare Members

2013 - Expanded iCare Medicare Plan service area to Dane, Oconto

and Shawano counties.

2013 - Expanded Medicaid SSI service area into Calumet, Dane,

Dodge, Door, Fond du Lac,

Jefferson, Kewaunee, and Marinette counties.

Dec. 2013 - 15,039 members

March 2014 - Opened enrollment to Dane County Medicaid SSI and

dual-eligible beneficiaries.

April 2014 - Opened Madison office location for local care

coordination and community outreach.

Timeline0% 10% 20% 30%

Depressive DisorderAnxiety Disorder

Bi-PolarAlcohol Abuse/Dependence

Schizoaffective DisorderAltered Mental Status

Drug AbuseParanoid Schizophrenia

PsychosisEpisodic Mood Disorder

34%18%

12%9.7%

6.4%6.2%

5.6%5.1%

4.5%3.5%

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I nnovat ion

Many of these members are hard to contact and do not follow their plan of care. The team describes a constant struggle to get members to their doctor appointments or to take their medications to address their illness.

After each staffings review, questions emerge from the team; is the member in compliance with their medication regimen or their plan of care — is their doctor aware that another physician has prescribed a particular medica-tion — has the member been responsive to outreach from their care manager? Recom-mendations from the team include tips on how

to get a member to see their doctor — an unscheduled home visit to check on a mem-ber’s living condition — follow-up with a doctor to obtain clarification on a prescription — sometimes a member simply needs encouragement. BH Team Care Manager Michelle Elliot described how she interacts with one of her members stating;

“My role is like a cheerleader. There are times when due to an individual’s mental health they isolate and don’t have anyone to point out to them how hard they’ve worked or what they’ve accomplished. I’ve seen people who have accom-plished a lot, especially when given the barriers that they face, and it’s a great ex-perience to be able to point out to someone how far they’ve come and give real life examples. A lot of times the member is actually surprised and never looked at it from that perspective.”

Members are assigned to the BH Team when referred from their care coordinator. The criteria for assigning a member to the team includes;

• Three or more BH hospital stays within the last 6 months• Having missed 3 consecutive BH follow-ups in the last 6 months• Three months of failed medication compliance• Member has had 15 or more AODA/BH emergency room visits in the last 12 months• Member has an active disease process and has refused to see their provider for over a year

The BH Team’s plan of action after a member has been assigned requires that the psychi-atric social worker (AODA) or the intervention specialist (BH) and team RN take ownership of the case. These team staff will work intensively with the member for 90 days, following up by:

• Contacting the member within 72 hours of being assigned• Initiating a minimum of weekly interventions• Completing a specialty assessment within 7 days• Face to face contact with the member within 14 days• Staffings meetings with the team for additional recommendations and discussion of progress

BH staffing meeting with RN Care Manager Kristin Gillan (left) and Care Manager Michelle Elliot.

If after 90 days the member has progressed to a less intensive level of care, they are reassigned to their original care coordinator, with recommendations for future outreach. If the member is in need of further assistance, they are transferred to a team care manager where intervention is continued; including monitoring appointments, medications, and collaborating with service providers. Each member is serviced by team staff according to their care stratification level, with the goal of reducing inpatient stays and emergency room visits, as well as ensuring medication compliance and access to providers and community services.

Medical Disease Management TeamMembers in iCare’s Medicaid SSI and Medicare Plan programs have an average of up to 6 medical and/or mental health conditions. The Specialty Services Department’s Medical Disease Management (MDM) Team is available for those members afflicted with chronic medical conditions that require more intensive interaction to ensure compliance with a plan of care, require medication management, or need education on their disease state. Staffed by a registered nurse and two care managers, the MDM Team receives referrals from a member’s CC or from the Re-Admission Prevention (RAP) Team. Referrals are reviewed by the team RN, who uses the following criteria to determine if a member should be elevated to a higher level of care:

• Three or more hospital stays in a 6 month period• Non-compliance (follow-up, meds)

MDM staffings meeting with Care Managers Davette Baker (left) and Denise Dable.

Top 10 Diagnoses of iCare Members Unspecified Essential Hypertension

Diabetes Type II

Hyperlipidemia

Lumbago

Chest Pain

Tobacco Use Disorder

Esophageal Reflux

Depressive Disorder

Pain in Limbs

Asthma0% 10% 20% 30% 40% 50%

19

I nnovat ion

• Member has an active disease process and has refused to see their provider over a one year period

• Disease related knowledge deficit, outstanding needs

After a member has been assigned to the MDM Team with a referral from their CC, the next steps for the team include; transfer staff-ing, scheduling of an assessment/home visit within 14 days, staffing review for additional recommendations and discussion of progress, referrals for needed services and intensive case management. Case closure for mem-bers referred to the team occurs when the member has demonstrated compliance with the plan of care, inpatient stays and ER visits are reduced, or difficulty in contacting the member precludes further attempts at inter-vention.

In the case where a member is referred by the Re-Admission Prevention Team, the member receives 60 days of intensive education on their disease process and a home visit if needed. The team conducts staffing meetings for additional recommendations and discussion of progress, where it is decided if the member requires ongoing disease management or has progressed to the point where they can be returned to their CC.

Care Manager Denise Dable provided an example of how her team intervenes when a member is non-compliant with their plan of care;

“A dual-eligible woman enrolled in both our Medicare SNP and Medicaid SSI pro-gram was recorded to have had 11 hospitalizations within a 9 month period. She has numerous co-morbid diseases including diabetes, CHF, and chronic pain and was transferred to Specialty Services for completion of an assessment to determine her needs. The CM and RNCM were instrumental in getting her set up with daily medication management and education on the importance of attending provid-er appointments, taking medications as prescribed, and the benefits of a healthy diet. Now she has a very positive relationship with her care manager and also with her primary care provider, with whom she attends regular appointments and fol-lows the plan of care. The results are evidenced by a drastic reduction in hospital-izations during the past two years; with only two in 2013 and three in 2012.”

Re-Admission Prevention (RAP) ProgramSpecialty Services is home to iCare’s Re-Admission Prevention (RAP) program, which focuses on preventing avoidable inpatient readmissions within the 30-day contiguous period following hospital discharge. This program is targeted toward members in the iCare Medicare Plan. All diagnosed conditions are targeted to prevent avoidable re-admissions.

Discharge Planning RN Barbara Ludke (left) and Disease Management RN Kezza Frye during staffings review.

When a member is admitted to the hospital, discharge planner RNs review their clinical in-formation and use a Readmission Risk Assess-ment tool to see how likely a member is to readmit. The RAP program provides members with an RN and CM after discharge for either an in-home or telephonic assessment based on the members readmission risk score.

During the assessment members receive on-the-spot education about their disease process. Communication with the primary provider is initiated for needed services, durable medical equipment, reconciliation of medications and intervention assistance. A new care plan is then devised with specific interventions assigned to either a CM or RN. Care plan interventions and frequency of interventions are scheduled and the member remains in the program until education and compliance are complete and no readmissions occur.

RAP Follow-up Process• Home visits completed within 72 hrs of discharge notification• Hospital follow-up completed within 48 hrs of discharge notification• PCP visit scheduled within 7-14 days of discharge• Care Plan sent to provider within 72 hrs of discharge notification • Telephonic contact based on risk level

Specialty Services Manager Marlena An-derson stated that the goals of the pro-gram are: safe transition from hospital to home; stabilization within the home; care plan sharing with the members’ providers between transition settings; and education on their illness.

More specifically, the RAP Team aims for members to complete a 30-day period without a readmission. If the team meets this goal, the member is returned to their care coordinator or stays with the RAP Team for additional case management. If a member is readmittedbefore the 30 days are complete, the entire process begins anew. Since the program’s initiation iCare has seen a measurable drop in the readmission rate for members.

Wisconsin Statewide Health Information NetworkTo better facilitate the exchange of health information between providers and our care management team, iCare will participate in the Wisconsin Statewide Health Informa-tion Network (WISHIN). It will oversee the implementation of a statewide health infor-mation network and health information exchange services in Wisconsin. It is one of the

(l-r) RAP Team Nurse Practitioner Laurel Marek, CM Davette Baker and Disharge Planning RN Joyce Thao

RAP Team CM Joanna Porterfield (left) and CM Josie Marquez.

21

I nnovat ion

nation’s leading efforts to improve health care through regional electronic information exchange.

Health information exchange technology will sup-port the flow of health information among physician practices, hospitals, labs, managed care organiza-tions and others, allowing for delivery of health infor-mation at the point of contact, providing safer, more efficient, patient-centered care. More than simply a data system, WISHIN will support emergency room (ER) coordination that allows a physician to retrieve a patient’s information quickly, speed the delivery of appropriate care, and avoid unnecessary duplica-tive testing, medical errors and extra costs.

It will also assist in arranging follow-up care. Inde-pendent Care will provide care coordination con-tact details and related clinical information to the exchange. This information will assist hospital case managers, with the goal of reducing ER admissions and obtaining medical homes for iCare members. Our unique ability to combine social services with a results-oriented health plan helps providers to effectively manage care for challenged members. We help our providers identify the needs of people who use the ER and multiple other health resources, and assist them to develop a planned program of care.

TruCareiCare members benefit from a cutting edge model of care, where modern technology as embodied in our TruCare system can easily coordinate their care and help to im-prove outcomes. The TruCare system can assist care coordinators in assessing member needs to determine which disease management programs and resources they would most benefit from. It can help care coordinators address various conditions and modify care plans based on a member’s specific needs. The TruCare system automatically monitors how a member follows their plan of care, identifies gaps in care, departures from established medical practices or whether various combinations of medicines are safe to use. TruCare can also provide predictive modeling, assessing whether a depar-ture in a plan of care will result in future hospitalization. This allows iCare’s care manage-ment team to address how a member follows their plan of care before hospitalization is required.

With the ability to coordinate care with the iCare care management team, as well as external referral channels such as a county case worker or a group home house par-ent, TruCare can create “virtual communities,” where clinical staff and outside health services providers can log into TruCare using a lap-top computer to check on a mem-ber’s plan of care. Users of the TruCare system have access to a single, prioritized view of required activities to help members follow their plan of care. Tasks are automatically populated from the care plan, and from the users themselves. Data can be exchanged in real-time with eligibility, claims, pharmacy, predictive modeling and lab systems, creating a true personal health summary.

Nurse Advice LineStaying healthy starts by asking questions and getting up-to-date information. When iCare members need answers the iCare Nurse Advice Line is available 24 hours-a-day/7 days-a-week.

The Nurse Advice Line service also provides an Audio Health Library that provides access to hundreds of pre-recorded messages on an array of health care topics ranging from the common cold to heart disease. Each message is about three to five minutes long. Members can access hundreds of health care topics with the touch of a button.

MarketPOINTWe have partnered with Humana MarketPOINT insurance agents, who are immersed in iCare’s whole-person model of outreach. Our no-pressure approach ensures that iCare is a good fit for a person’s particular medical, behavioral health and social service needs. Our MarketPOINT agents will walk a prospective member through the process, from finding out which prescription drugs are covered to insuring that a doctor is in our network. Our helpful agents will make sure that a prospective member is qualified for the iCare Medicare Plan, visit their home to help with the paperwork, and leave infor-mation about the benefits and services available through iCare.

After the paperwork is submitted by the MarketPOINT agent and eligibility is confirmed, the member can expect a phone call from an iCare representative welcoming them to the plan, where they will also have the opportunity to ask questions about the next step in accessing iCare’s benefits and services.

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I nnovat ion

Independent Care Health Plan, known as iCare, was among the first health plans to focus on one of the most complicated and costly segments of the population: people eligible for both Medicare and Medicaid because they are disabled or aged and impoverished.

The federal and state governments spend a combined $300 billion a year on health care for the more than 9 million people eligible for the two programs.

The group accounts for about 38% of Medicare and Medicaid’s total costs.

Wisconsin is among the few states that have long contracted with health insurers such as iCare to manage their complex care. Now more states are doing the same, with the hope of provid-ing better care, control-ling costs and enabling people to remain in their homes rather than nursing homes.

ICare is getting some attention as a result.

The company was one of eight managed care organizations and health plans nationwide select-ed for a study to help de-

termine the best practices for assessing what is mostimportant to the individ-ual, and communicating those goals to the people involved in his or her care.

The study is being done by the National Commit-tee for Quality Assurance, which develops measures for evaluating health insurance plans on quality and value.

“Part of what we are trying to do is learn from their experience,” said Jessica Briefer French, a senior consultant for re-search forNCQA.

Separately, iCare was one of seven organiza-tions selected for a proj-ect to identify and test new strategies that im-prove and integrate med-ical and behavioral care and long-term support services, such as home care, for people covered by both Medicare and Medicaid.

The seven organizations —known as the PRIDE Consortium, for Promoting Integrated Care for Dual Eligibles — were selectedfor their expertise in pro-viding care for people in the two programs.

The project is an initiative of the Center for Health Care Strategies, a health policy resource center in Hamilton, N.J., and issupported by a grant from the Commonwealth Fund, a foundation in New York that funds health policy research.

ICare, which is owned by Humana Inc. and the Milwaukee Center for Independence, manages the care of some of the most vulnerable people covered by Medicare and Medicaid.

They include people with physical or developmen-tal disabilities, such as cerebral palsy and DownSyndrome; people with severe mental illness; and people who are elderly and require specialized care to remain in their homes.

The interest in iCare stems partly from more states turning to specialized health plans and man-aged care organizations to provide integrated care and to lower costs.

iCare part of studies on best practices for Medicare, MedicaidBy Guy Boulton of the Journal SentinelMarch 13, 2014

From the Milwaukee Journal Sentinel:

The trend concerns some advocates, who have questioned whether the organizations have the expertise needed to pro-vide care for people with complex health problems and limited resources. Advocates also worry that the health plans and organizations will stint on providing care to control costs and to generate profits.

Nationally, the success stories are few, and where there have been successes, the programs have remained small, Bruce Vladeck, a senior adviser at Nexera Con-sulting, said last year at the annual conference of the Council on Health Care Economics and Policy.

The challenge in provid-ing integrated care to people covered by Medi-care and Medicaid, how-ever, is long-standing and widely acknowledged. The federal government oversees Medicare while states oversee Medicaid. And the two programs have different benefits, different billing codes and different regulations.

“We’ve created our own complexity that is un-necessary,” said Thomas Lutzow, chief executive officer of iCare.

The Affordable Care Act created an office in the Centers for Medicare and

Medicaid Services to cre-ate demonstration pro-

jects designed to improve the coordination be-tween the two programs.

ICare, formed in 1994, was an outgrowth of a demonstration program funded by the federal government.

The study by the National Committee for Quality Assurance will focus on 400 people who are in the

Family Care Partnership program, one of the state programs designed to help keep people in their homes rather than in nurs-ing homes.

The committee plans to develop a set of stan-dards for integrated care as well as for determin-ing people’s goals and developing care plans for them.

“To develop standards, they have to know how it is done,” said Bill Jensen, an iCare vice president. Developing individual care plans, he said, is part science and part art.“It is very much at the heart of what we do,” Jensen said.

ICare uses a “resource allocation decision tool” — a detailed question-naire or decision-support tool — developed by the state to help determine

people’s goals and develop a plan for their care.

The care plans must be highly personalized because the medical care and support ser-vices needed by people whose care is managed by organizations such as iCare varies widely.

Their personal goals also vary. The goal of one person may be to con-tinue playing cards with his or her friends on Friday night, Lutzow said, while someone else may want to continue singing in the church choir. At the same time, someone with ce-rebral palsy might have much different goals.

The question, Lutzow said, is how someone can continue to live a pur-poseful life. “You have to be excited about living,” he said.

25

I nnovat ion

Choice The choice to join one of iCare’s programs is often related to benefits, costs and social assistance. We provide a choice of programs tailored to a member’s specific needs.

What is the iCare Medicaid SSI Program?iCare was started in 1994 as a federal demonstration project, the program served as a pilot for the Department of Health Services expansion of Medicaid SSI managed care throughout the State of Wisconsin.

iCare’s Medicaid SSI program is a complete health care services program for people with physical, developmental or emotional disabilities.

What are some of the services covered by the Medicaid SSI Program?

• Ambulatory Surgery Centers• Doctor visits• Dental• Emergency care• Hearing services• Hospital services• Mental health and substance abuse treatment• Medical equipment• Transportation for doctor’s visits • A personal care coordinator to help manage your care.

We provide the same coverage as Medicaid SSI. When you are an iCare member, there are no co-pays or deductibles for your medical or mental health services. Your medications are covered by the State. When you fill your prescriptions, you will be responsible for a co-pay.

iCare’s Medicaid SSI service area covers Brown, Dane, Dodge, Door, Fond du Lac, Jef-ferson, Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca and Winnebago counties.

Who Is Eligible for Medicaid SSI HMO Enrollment?• Must be 19 years of age or older • Receive Medicaid and Supplemental Security Income (SSI) or SSI-related benefits • Have a Forward or ForwardHealth ID Card• Medicare beneficiaries or those enrolled in a Medicare HMO are also eligible, as

long as they receive Medicaid or SSI benefits

To get more information on your SSI Medicaid HMO options, including iCare – Call the State’s HMO Enrollment Specialist at 1-800-291-2002.

27

iCare BadgerCare PlusThe BadgerCare Plus program is a State program that covers health care services, including preventive care and prescription drugs. iCare is a participating BadgerCare Plus HMO.

What are some of the services covered by the BadgerCare Plus Program?• Ambulatory Surgery Centers• Chiropractic services• Dental• Dialysis/kidney-related services• Disposable medical supplies• Doctor visits (office visits, surgical procedures, radiology and lab services)• Durable medical equipment• Emergency ambulance rides• Emergency room visits• Health screenings for children• Hearing services• Home health & hospice services• Hospital services (including inpatient and outpatient visits)• Mental health services• Nursing home services• Physical, occupational and speech therapy• Podiatry• Reproductive Health and Family Planning services• Routine Vision services• Substance abuse services by a physician• Transportation for doctor’s visits

These covered services may change. You should always check with your provider to see if the ser-vice you want is covered and if there are any limits on that service. Some services covered under the BadgerCare Plus program will have a co-payment between $0.50 and $3.00. Co-payment amounts are based on income.

iCare’s BadgerCare Plus service area covers Brown, Door, Fond du Lac, Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca and Winnebago counties.

Who Qualifies for BadgerCare Plus?• Childless adults with incomes at or below 100% of the Federal Poverty Level• Parents and caretakers at or below 100% of the Federal Poverty Level • Pregnant women with incomes at or below 306% of the Federal Poverty Level • Children (ages 17 and younger) with household incomes at or below 300% of the

Federal Poverty Level• Transitional medical assistance individuals, also known as members on extensions, with incomes

over 100 percent of the Federal Poverty Level. To get more information on your BadgerCare Plus HMO options, including iCare – Call the State’s HMO Enrollment Specialist at 1-800-291-2002.

Choice

Get to Know the iCare Medicare Plan

The iCare Medicare Plan (HMO SNP) is a Coordinated Care plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in the iCare Medicare Plan depends on contract renewal. The iCare Medicare Plan is a Medicare Special Needs Plan, which means its benefits are designed for people with special health care needs. This plan is available to anyone who has both Medical Assistance from the State and Medicare.

With assistance from Medicaid, members pay less for some of their Medicare health care services. Medicaid may provide other benefits by covering health care services that are not usually covered under Medicare. Members may also receive Extra Help from Medicare to pay for the costs of their Medicare Part D prescription drugs.

The iCare Medicare Plan offers complete coverage for doctor and dental visits, emergency care, hospital services, mental health and substance abuse treatment, medical equipment and other services mostly at no cost to members. Members must enroll in a full Medicaid HMO plan (including iCare’s or another plan) to receive full benefit coverage. Premiums, co-pays, coinsurance and deductibles may vary based on the level of Extra Help that a member receives. Please contact the plan for details.

Who is Eligible for the iCare Medicare Plan?

• Must be eligible for Medicare and Medicaid benefits or eligible for Medicare and Medicare cost-sharing assistance under Medicaid

• Must have both Medicare Part A and Part B• Cannot have End Stage Renal Disease (exceptions may apply)• Must enroll in a full Medicaid HMO to receive full benefit coverage. Can remain in

Medicaid Fee-For-Service, but may be subject to small copays• Must live in our service area of Brown, Calumet, Dane, Kenosha, Kewaunee,

Manitowoc, Marinette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Sauk, Shawano, Sheboygan, Walworth, Washington, Waukesha, Waupaca, or Winnebago counties.

How to Sign UpPeople can enroll in the iCare Medicare Plan at any time! Simply complete our enrollment application and after eligibility has been determined, we will send a membership packet explaining how to access iCare Medicare Plan benefits.

People can also enroll by calling one of our licensed insurance agents at 1-855-839-0918. For more information about the iCare Medicare Plan call Customer Service at 1-800-777-4376 (TTY: 1-800-947-3529), 8:00 a.m. to 8:00 p.m., 7 days-a-week.

iCare Family Care Partnership for Long-Term Care and Acute Care Needs Our Family Care Partnership Plan is a health and long-term care (LTC) program that fully integrates all aspects of care. It is designed to meet the long-term care needs of frail older adults and people who have physical or developmental disabilities. Partnership combines Medicare, Medicaid, dental, prescription drugs and home/community-based LTC services.

Eligibility Requirements

• Live in Dane, Kenosha, Milwaukee, or Racine counties• People with physical/developmental disabilities (18 years of age or older)• In Dane County only people with physical disabilities (18 years of age or older)• Frail elderly adults 60 years of age or older• Must be eligible for Medicaid• Must have LTC service needs as determined by the state of Wisconsin LTC Functional screen• Must not have End Stage Renal Disease (exceptions apply)

How to Sign Up for PartnershipContact the Aging & Disability Resource Center (ADRC) in your county to find assis-tance in reviewing options and enrolling in the Partnership program. Membership is vol-untary and members can disenroll at any time. For more information about long-term care options available in your county contact the ADRC. The ADRC can also assist you with information about eligibility and enrollment.

ADRC Contact Information

• ADRC of Dane County: 1-608-240-7400, 1-855-417-6892, (TTY: Wisconsin Relay 711)• ADRC of Kenosha County: 262-605-6646, 1-800-472-8008 (TTY: 262-605-6663)• Milwaukee Aging Resource Center (for residents of Milwaukee County who are 60

years of age or older): 866-229-9695 (TDD: 414-289-8591)• Milwaukee Disability Resource Center (for residents of Milwaukee County under

60 years of age): 414-289-6660 (TTY/TDD: 414-289-8559)• ADRC of Racine County: 262-833-8777, 1-866-219-1043 (TTY: Wisconsin relay 711)

The iCare Family Care Partnership (HMO SNP) is a Coordinated Care plan with a Medi-care contract and a contract with the Wisconsin Medicaid program. Enrollment in the iCare Partnership program depends on contract renewal. This plan is available to any-one who is 18 years of age or older, and who has both Medicaid and long-term care service needs as determined by the State of Wisconsin. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year.

29

Choice

R e s u l t s Through Care CoordinationNo matter what program a person chooses, they will always have access to a dedicated care co-ordinator or care team to help them access their medical, mental health and social service needs. A care coordinator or care team is available to:

• Answer questions• Help to visit a doctor• Help to manage prescription drugs• Help find community services• Speak with about personal health concerns

Independent Care will provide the most appro-priate care for a member’s needs. We will take extra steps to ensure that members obtain the services they need when they need it.

Care coordinators will encourage members to get the care they need in order to cre-ate better outcomes and results. The concept works. A few of our members serve as role models for their peers by serving on iCare committees and promoting iCare to people that can benefit from the program. Their success can be attributed to iCare’s expertise in care coordination and the social and community service benefits it in-cludes.

Helpful Customer ServiceIn addition to a dedicated care coordinator, iCare Customer Service is a member’s link to everything they want to know about iCare. You can contact Customer Service at 1-800-777-4376 (TTY: 1-800-947-3529), 8 a.m. to 8 p.m., 7 days-a-week.

Independent Care’s Customer Service department is the first line of contact in accessing covered services. If a member is in need of interpreter services at their next doctor’s appointment, our Customer Service staff will arrange that for them. If a member needs help locating a provider, Customer Service will provide assistance. With iCare, members know that there is someone on their side to ensure that they are getting the health

care and community services that they need. The emphasis on maintaining one’s health through care coordination helps to foster better results for our members.

Accomplishments

• Awards of Excellence. A Special Honoree Award in the 1996 U.S. Depart-ment of Health and Human Services’ “Models that Work” competition, which reflects our commitment to improving the health status of under-served and vulnerable populations.

• Winner of the Small Business Times’ 2004 Health Care Heroes Award in the Corporate Achievement in Health Care category.

• Recipient of the 2006 and 2007 Metropolitan Milwaukee Association of Commerce’s (MMAC) Future 50 Award. Presented to the fifty fastest- growing companies in the Milwaukee metropolitan region.

• Recognized by Inc. Magazine as a 2007 and 2008 Inc. 5000 Award winner, one of the 5,000 fastest-growing private companies in America.

• Recognized by the Initiative for a Competitive Milwaukee as a 2007 Inner City Growth Award winner, highlighting iCare’s success in operating in Milwaukee’s central city and contributing to its economic rebirth.

• Winner of the Small Business Times’ 2007 Health Care Heroes Award in the Community Service category.

• 2009 Business Journal - Top Milwaukee Workplaces

• 2009, 2011, 2012 Sterling Awards - Outstanding Employer

• 2009 - 2014 American Heart Association Start! Fit Friendly Company Award

• 2010 Milwaukee Employment Services Network – Distinguished Employer

• 2010 - 2011, 2014 Milwaukee Journal Sentinel - Top 100 Workplaces

• 2012 - 2013 Business Journal - Milwaukee’s Healthiest Employers

31

Quality, Choice, ResultsIndependent Care’s scope of capabili-ties reaches throughout our service area and touches not only those with special needs, but also their families.

This Value to the Member is published for all of the organizations, groups and providers that act as advocates for those with physical, mental or emotional disabilities. It is our hope that you will encourage your patients, clients and family members who are eligible for a program like iCare to give it a try. It could mean the difference in the quality of life for someone who is impor-tant to you.

For more information about long-term care options available to you contact the Aging & Disability Resource Centers. The Resource Center can also assist you with information about eligibility and enrollment.

For more information about iCare call 1-800-777-4376 (TTY: 1-800-947-3529) 8:00 a.m. to 8:00 p.m., 7 days-a-week.

Member DemographicsMembership by Ethnicity Membership by Age GroupEthnicity Medicaid SSI Medicare Dual

Age Medicaid SSI Medicare Dual

0

5,000

3,000

19,000

1,000

7,000

9,000

11,000

13,000

15,000

17,000

1994 95 96 97 0198 99 00 02 03 04 05 06 1007 08 09 11 12 13

Membership Growth (1994 - 2014)

Initial Assessment Statistics of Membership (2013)

Member Demographics

18,519

9,942

925

20,000

15,039

21,371

332014

The iCare Family Care Partnership (HMO SNP) and the iCare Medicare Plan (HMO SNP) are Coordinated Care Plans with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in the iCare Family CarePartnership (HMO SNP) and the iCare Medicare Plan (HMO SNP) depends upon contract renewal. The iCare Medicare Plan is available to anyone who has both Medical Assistance from the State and Medicare. The iCare Partnership program is available to anyone who has both Medical Assistance from the State and Medicare and functionally eligible as determined by the State of Wisconsin Long-Term Care Functional Screen. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, of each year. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. You must use plan providers except in emergent or urgent care situations. If your preferred provider is not in our plan, we will seek to include them in our network. If you obtain routine care from out-of-network providers, without first contacting your Team and getting prior authorization, neither Medicare, Wisconsin Medicaid or iCare Partnership will pay for these services. You must use network pharmacies to access your prescription drug benefit, except under non routine circumstances when you cannot reasonably use network pharmacies, quantity limitations and restrictions may apply. For full information on the iCare Medicare Plan and iCare Family Care Partnership (e.g., routine physical exam, pharmacy, eyeglasses, dental) benefits, call our Customer Service department from 8:00 a.m. to 8:00 p.m., 7 days-a-week, at 1-800-777-4376 (TTY: 1-800-947-3529). For more information about Medicare benefits and services, including general information regarding the health or Part D benefit, contact 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov; TTY users should call 1-887-486-2048, 24 hours-a-day, 7 days-a-week. For more information about Wisconsin Medicaid benefits call the Department of Health Services at 1-800-362-3002 (TTY: 1-888-701-1251) or visit www.dhs.wisconsin.gov/Medicaid. You can also write to, Independent Care Health Plan, 1555 N. RiverCenter Drive, Suite 206, Milwaukee, WI 53212. For more information about long-term care options available to you in contact the Aging & Disability Resource Centers. The Resource Center can also assist you with information about eligibility and enrollment. If you have special needs, this document is available in different formats or languages. Call iCare at 1-800-777-4376, TTY users should call 1-800-947-3529.

1555 N. RiverCenter Dr. Suite 206Milwaukee, WI 53212

1-800-777-4376, 414-223-4847Fax: 414-231-1092

TTY 1-800-947-3529 or 7-1-1, Voice:1-800-947-6644 or 7-1-18:00 a.m. to 8:00 p.m., 7 days-a-week

www.icare-wi.org

© 2015 Independent Care Health Plan

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