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The Wisconsin Partnership Program (WPP)

jessievenegas Jessie Venegas — 12/01/2009

Foresight Links Corporation

This is a voluntary, fully integrated, comprehensive program serving elders and people with physical disabilities who meet the Medicaid criteria for admission to a nursing home. It combines all Medicaid and Medicare acute and long-term care services. The state contracts with four community-based organizations for care coordination. The organizations contract with physicians, hospitals, and other providers to offer a comprehensive benefit package. Patients are allowed to retain their primary care physician if the physician agrees to join the program, and participation in an adult day care program is not required. The main goals of the program are to: • Improve the quality of health care and service delivery while containing costs; • Reduce fragmentation and inefficiency • Encourage self-management. An important feature of the WPP delivery system is the use of interdisciplinary care coordination teams. The teams include a geriatric nurse practitioner (GNP), social worker/social services coordinator, and a registered nurse. The GNP serves as the liaison to primary care physicians. Assessment and care planning is a function shared between the teams and each member. The process includes identifying health and social service needs, services to support members in the context of their own resources and capabilities, and goals regarding work and participation in the community. Each site uses an operation protocol developed by the Department of Health and Family Services, Division of Systems Delivery Development that describes the procedures for teams to work efficiently.

Fragility, pluripathology/polipathology and/or complex chronic diseases







Practices Map



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