FlexCare
FlexCare
Section I: Summary
Using a case management model to serve nursing-home-eligible Medicaid recipients
FlexCare - Salt Lake City, Utah
Under most state Medicaid programs, patients who need long-term care are at risk of losing their benefits if they move out of nursing homes. But in Utah, the state health department initiated a five-year managed care demonstration project in 2000 that provides Medicaid patients the option of living in alternative settings that offer greater independence.
Called FlexCare, the program allows people with long-term care needs to move out of nursing homes into less restrictive environments such as assisted living, residential care, or their own home. FlexCare also lets patients move seamlessly among different levels of care as their medical needs change over time.
Section II: Statement of purpose
While other states have opened up assisted living options to Medicaid patients with long-term-care needs, FlexCare is “pretty unique” in the country because it not only offers patients a full array of living situations, it also provides intensive case management, says project director Don Fennimore.
Each FlexCare enrollee is paired with a case management team consisting of a nurse and a social worker, and each team carries an average caseload of only 35 patients, which allows them to keep close track of their patients’ needs, says Fennimore.
The team coordinates services with the patient’s primary care physicians, specialists, home health, mental health and other providers. The nurse typically accompanies the patient to doctor visits, while the social worker communicates with the patient and his/her family and assists with financial and other needs. Together they serve as advocates for the patient as the patient’s needs and living arrangements change over time.
FlexCare is currently open to eligible adults in Salt Lake, Davis or Tooele counties. To qualify, enrollees must be either in a nursing home for at least 90 days and medically eligible for long-term-care services under Medicaid; in a nursing home on a Medicare stay and medically eligible for long-term-care services under Medicaid; or hospitalized and medically eligible for long-term-care services under Medicaid upon discharge.
About 360 patients – or roughly 18% of the nursing-home-eligible Medicaid population in the three counties – are enrolled in FlexCare. The target penetration rate is about 30%-35%, says Fennimore.
FlexCare is essentially a long-term-care HMO under Medicaid in Utah. Through its case management model, the program is able to offer enrollees a full range of services and living arrangements at a cost that is about 5% lower than the average nursing home rate, says Fennimore. The program pays FlexCare a daily rate for each enrollee and FlexCare becomes the payer for all services provided to that enrollee, including their room-and-board, case management, home health services, physical therapy, mental health services, durable medical equipment, etc.
Section III: Outcomes
FlexCare is run by a division of Valley Mental Health, a public, nonprofit corporation that is the Medicaid mental health provider for Salt Lake County. The small profit margin Valley Mental Health reaps from FlexCare is reinvested in the program’s infrastructure, says Fennimore.
For example, FlexCare created a psychiatric assisted-living facility for patients who need both psychiatric services and some level of custodial care but prefer more independence than they would have in a nursing home. In the FlexCare facility, “they’re getting focused psychiatric care, which they’re not going to get in a nursing home,” says Fennimore. “And it’s designed to maximize their independence and privacy.”
FlexCare has also developed specialty housing units for younger physically handicapped patients. The housing units provide a handicapped-accessible cooking area and a roll-in shower in each apartment, a pool of personal care attendants, and a peer group for residents. The level of care in these facilities can be tailored to the needs of each individual resident, which is not the case in nursing homes.
Given the success of FlexCare, others areas of Utah are considering, or have begun implementing, similar case management programs for long-term care Medicaid patients. Weber County, north of Salt Lake City, started a program in October 2003. Also, a similar project may get started in a five-county area of southern Utah.
Contact information
For more information, contact:
Don Fennimore
State Health Department, Valley Mental Health
Salt Lake City Utah
Phone: 801-263-7100
DonF@vmh.com
http://www.vmh.com/