Community Care is dedicated to providing quality care to those we serve. Our member-centered programs strive to improve the quality of life for frail older adults and adults with physical, intellectual or developmental disabilities by helping them live as independently as possible for as long as possible within their communities.

The Quality Management Department at Community Care monitors the organization’s efforts to ensure the most optimal care is provided to the members we serve. Annually, a Quality Plan is developed and monitored that includes improvement initiatives and Community Care specific healthcare data. Please view our 2021 Quality Work Plan to learn about our improvement projects. For more information on specific areas of the Quality Plan, please explore our Quality Wheel below.

Members play an important role in providing information back to the organization regarding the effectiveness of services provided and/or suggestions for improvements. If any members or their legal decision makers would be interested in participating OR learning more about the member advisory committee, please contact the Community Care Quality Department.

Monitoring of Annual and Semi-Annual Health Assessments

• Community Care is contracted with the Department of Health Services to ensure you receive a head to toe health assessment by your Care Team.The health assessments along with your physical, social, and functional health goals are then carried over into your Member Centered Care Plan.Any risks to your overall health and safety are also monitored through this process as well and positive outcomes are worked into your assessments and care plan.The Quality Department monitors this process and reviews that all member health needs are being addressed.
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Care Management for Vulnerable High Risk Members (VHRM)

• Community Care is ensuring that any member that meets this criteria has been identified. Each member’s care plan includes the supports and interventions necessary to manage risks. Care Managers visit members more frequently in the member’s home to ensure they are safe and healthy.
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Member Satisfaction

Community Care is committed to providing the highest level of member satisfaction and reducing rates of voluntary dis-enrollments. Our satisfaction levels are measured by responses from members and/or caregivers to annual surveys. We are Extremely Pleased to be your Managed Care Organization!

• How often do you get the help you need from your Community Care team? (Remember, even if you don’t need help from us very often, how often do you get the help from us when you do need it?
  If it isn’t EXTREMELY OFTEN, please let your Care Team know.
• How involved are you in making decisions about your care plan?
  If it isn’t EXTREMELY, please let your Care Team know.
• How much does your Care Plan include the things that are important to you?
  If it isn’t A GREAT DEAL, please let your Care Team know.
• How well do the services you receive meet your needs?
  If it isn’t EXTREMELY, please let your Care Team know. 
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Member Incidents

• Community Care is required to report incidents to the State of Wisconsin in a timely manner. Incidents can be member falls with injuries, abuse, financial exploitation, medication events, missing persons, contact with law enforcement and/or restrictive measures. It is important that Community Care is informed of any member incident so that proper follow up can be provided.
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Appeals

• When a decision has been made to deny, reduce or terminate a service that a member is receiving, the member has the right to appeal that decision. Community Care is committed to ensuring that all appeals are processed in a timely manner and that resolutions are reached.
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Grievances

• Members have the right to report concerns, or grievances, regarding any action or inaction of Community Care that the member perceives as negatively impacting the member. There are multiple ways to file a grievance but members are encouraged to talk with their care management team as a first resource when they are dissatisfied. Community Care is expected to be responsive to concerns raised by members and grievances are addressed quickly to find a solution to the concern.
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Service Delivery

• This includes ensuring that background checks have been completed for all staff, that staff who help our members have the proper education and training, and that Community Care is in compliance with regulations.
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Competitive Integrated Employment:

• Community Care wants to assist any member that desires to work. We are coordinating efforts with a network of community providers, agencies, care management teams and the State of Wisconsin to interview members regarding their desire to work, interest surveys and referrals to appropriate service providers. Community Care understands that having fulfilling employment is beneficial for each member’s health and well-being.
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Satisfaction levels along with other Managed Care Organization rankings are posted on the Wisconsin Department of Health services website and can  be seen at:  www.dhs.wisconsin.gov   (In the search box enter the program desired.  Example:  Family Care MCO Scorecard, Partnership MCO Scorecard, or PACE MCO Scorecard)

Please direct any feedback to the Quality Management department at the following email address: [email protected]