Over the past year, considerable resources have been devoted to creating various options to redesign the current long term care (LTC) delivery "system." Most observers agree the problems inherent in this system include:

• Consumer choices are limited.
• Public dollars are not always spent cost-effectively.
• Persons with the greatest LTC needs may be denied services.
• LTC programs and funds are fragmented and often times have conflicting policies/requirements.
• Quality assurance mechanisms throughout the LTC spectrum are inadequate and inconsistent.
• LTC policy changes are often made without sufficient supporting research and data analyses.

Given the limitations and disadvantages of the current long term care system, the Wisconsin Association of Homes and Services for the Aging (WAHSA) strongly advocates for a redesigned delivery system which "maximizes an individual's choice of services, providers, and care settings as long as such care is necessary and meets a minimum level of quality standards and is cost-effective."1 Further, the future delivery system should integrate acute and primary care, long term care, and supportive services in order to provide, finance, and manage the health and long term care needs of clients.2

As a way to begin to address the above cited problems, the Wisconsin Association of Homes and Services for the Aging (WAHSA) has considered three models or programs to initiate changes to the present system. As will be discussed in this paper, each of these models assumes certain common program changes, particularly in the areas of comprehensive assessments, single point of entry, quality assurance mechanisms, and cost-effective allocation of public dollars. The targeted populations to be served by these models or programs would include elderly and disabled persons.

• LTC Voucher Program
  Under this model, persons who qualify for public LTC funding would be awarded a "voucher" which could be utilized to purchase care and services. The value of the voucher would be determined according to the findings of the person's comprehensive assessment. This assessment would establish a set capitated rate reflective of the individual's LTC needs. The voucher could then be used directly by the person (or his/her family or guardian) to purchase care and services or the person could elect to pool the voucher with other clients under a managed care arrangement.

• LTC Managed Care Organization (MCO) Program
  Under this program, the Department of Health and Family Services (DHFS) would utilize MCOs to purchase LTC and services for publicly funded clients. The State's primary role under this option would be to establish capitation rates by level of care/service need and to perform quality assurance monitoring. The capitation rates awarded to the MCO would be determined by the comprehensive assessment. This model is the more traditional risk-based approach and incorporates a strong case management emphasis.

• Current System Modifications Program
  WAHSA proposes a number of modifications to the current LTC system. For some, these changes would be the only ones necessary to fundamentally improve an already strong Wisconsin LTC system. Others, however, support these changes as a way to transition from our present system to the redesigned system of the future. This program proposes vehicles to reduce excess institutional capacity, consolidate multiple LTC programs, build better data collection and analysis systems, and more cost-effectively allocate scarce public funds.

WAHSA recommends that the Department's immediate redesign efforts concentrate on developing the LTC Voucher Program and initiating the program changes contained in the Current Modifications Program. The LTC Managed Care Organization Program could be implemented in response to the Voucher Program, but it would not need to be the dominant vehicle to manage or deliver LTC in the future.