FAQs

Matrix, which is a Care Management system unique to Inclusa. 

As of this time, we are awaiting clarification from DHS on communication to members as we proceed to transition.  It is not clear at this time what messages members will receive between the August 15, 2019 date of certification and January 1, 2020.  Inclusa expansion leads are in communication with DHS officials and have posed this and a series of related questions.  As we gain clarity, we will share the information with Care WI employees. 

This is still to be determined and will likely be based on the number of enrollments.   

Typically, at least one Member Support Manager supports an office.  There have been instances, where a drop-in office with assigned staff is supported by an MSM in another Inclusa office.   

Member Support Managers (MSM’s) are the main support for IDT.  Each MSM supports a unit serving 250-300 members and 12-15 staff.  Unit meetings occur twice per month and are generally in person. These meetings are a critical part of  Inclusa’s strategy to  ensure that IDT receive accurate and timely information.  Included are updates on the following subjects: new or revised policies/procedures, organizational information, provider relations, discussion of local issues and general brainstorming.    MSM’s support to IDT is tailored to the needs of the teams at any given time. Generally, MSM have regular 1:1 meetings with IDT, as well as case consultations with teams. Our goal is to provide teams with the information and support they need to effectively manage workload and provide excellent customer service to our members and other stakeholders.  

This varies according to the membership of the county; we do have county specific teams when there is membership to support this approach.  We make every effort to assign caseloads that minimize travel and allow teams to know the communities they work in.  

Typical caseloads are 1:36 for Community Resource Coordinators (Care Managers) and 1:72 for Health and Wellness Coordinators (Nurses).  Mental Health Teams, which are in the larger offices, have slightly lower caseloads.   

The RFP identifies the 1/1/20 start date, DHS would need to amend that for individuals to begin supports with Inclusa prior to then.   

Inclusa uses a dedicated Certified Screen Specialist (CSS) model to complete all Long-Term Care Functional Screens. The ratio we use at Inclusa is 1 CSS to 250 members.     

 The CSS at Inclusa work professionally by representing Inclusa in the community, reaching out to collateral sources, accessing medical records, sending letters to members, and managing their own calendars for work assignment completion.  The CSS are required to attend one screening unit meeting per month and will meet with their supporting manager at least monthly or more often as appropriate for the individual. 

 CSS are all certified Long-Term Care Functional Screeners and work from various locations within Inclusa’s service regions to complete all screens in the most efficient, accurate, and cost–effective manner based on the location of the member and the screen’s due date.  The LTCFS Managers and Liaison are also certified screeners and work collaboratively to provide screen assignments, support and oversight for CSS screen quality and timeliness. 

The expectation for workload of a CSS is generally to complete and calculate 25-35 screens per month.  This number may vary depending on the coverage area, travel time, and other circumstances.  The numbers each CSS completes and the area that each CSS covers ensures that we have the appropriate number of CSS to meet the needs of the screening unit.  Screeners in the metropolitan areas where travel is less and screens can be grouped more easily per trip, will likely complete more screens per month than a screener covering a larger area and is not able to group as many screens in one trip.  

Annual Screen assignments are provided to the CSS 2 months ahead of the month the screen is due giving ample time to the CSS to schedule and complete the screens.   Change in Condition screens are assigned as request are made by IDT staff.  These requests have varying due dates depending on their priority and are blended into the CSS monthly assignments according to their due date as they are assigned.   The LTCFS Managers keep master spreadsheets and run reports to ensure all screens are completed. 

Inclusa has written Best Practice guidelines and a CSS handbook to assist with the completion of the screening process.   The LTCFS Managers and Liaison are available every work day to answer questions and provide support and guidance. 

We will begin reaching back out to those that expressed interest in the next couple of weeks to schedule interviews. As always, you can contact us with additional questions along the way. We are certainly here to support you!