long-term care integration in san mateo county
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Long-Term Care Long-Term Care IntegrationIntegration
in San Mateo Countyin San Mateo County
Jean FraserJean Fraser
Maya AltmanMaya Altman
March 10, 2011March 10, 2011
Long-Term Care Integration Long-Term Care Integration Core ConceptsCore Concepts
►Emphasize home and community-based services to allow individuals to remain in community settings
►Consolidate preventive, primary, acute, Long-Term Care, and Home- and Community-Based services and funding
►Allow more local control and flexibility►Eliminate administrative duplication
and complexity
Core Concepts (continued)Core Concepts (continued)
►Enhance assessment, care planning, and medical management
►Establish smooth and appropriate transitions between levels of care
►Reinvest savings back into San Mateo County community
►Improve service delivery and access to care
Goals: Long-Term Care Goals: Long-Term Care IntegrationIntegration
►Person-centered care►Improved health &
quality of life►Greater access to home and
community-based services►Lower number of premature
nursing home placements
Current SituationCurrent Situation
80 year old Living alone
Multiple chronic health problemsDeclining at homeSocially isolated
Chronic lack of support leads to hospitalization
Discharge to nursing home
No coordinated care
Person unable to reside at home alone
Result
Lack of long-term planning
Lives in an institution
Very expensive care
Barriers
Future of Long-Term CareFuture of Long-Term Care
80 year old Living alone
Multiple chronic health problemsDeclining at homeSocially isolated
Primary care providers connect with case manager for long-term care assessment
Services selected based on need and long-term care plan
Support provided in the home
Result
Improved health
Lives in most integrated setting
More cost efficient
Why now?Why now?
San Mateo County is facing a San Mateo County is facing a huge increase inhuge increase inolder adults. older adults.
Minus a fully coordinatedMinus a fully coordinatedsystem, more people will system, more people will fall through the cracks.fall through the cracks.
Work Toward Long-Term Care Work Toward Long-Term Care Integration in San Mateo CountyIntegration in San Mateo County
YearYear MilestonesMilestones1980s 1980s and and 1990s1990s
• San Mateo County consolidation of HCBS in Health San Mateo County consolidation of HCBS in Health System System
• Creation of Commissions on Aging and DisabilitiesCreation of Commissions on Aging and Disabilities• SMC, HPSM, and SMC Hospital Consortium propose LTCI SMC, HPSM, and SMC Hospital Consortium propose LTCI • IHSS Public Authority Advisory CommitteeIHSS Public Authority Advisory Committee
20032003 • SMC selected as pilot for Uniform Assessment ToolSMC selected as pilot for Uniform Assessment Tool• County hospital Senior Care Center Opens (Ron Robinson County hospital Senior Care Center Opens (Ron Robinson
SCC)SCC)
20062006 • HPSM Medicare CareAdvantage operations beginHPSM Medicare CareAdvantage operations begin• CareAdvantage subcontract with SMC Behavioral Health CareAdvantage subcontract with SMC Behavioral Health
and and Recovery ServicesRecovery Services
20082008 • Partnership with CalOptima in Orange County to advocate Partnership with CalOptima in Orange County to advocate for LTCI in both countiesfor LTCI in both counties
20102010 • LTC institutional benefit added to HPSMLTC institutional benefit added to HPSM• HPSM initiates clinical care management in nursing HPSM initiates clinical care management in nursing
facilitiesfacilities
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HPSM serves 95,000 people through six programs.
59,000 members
42% of whom areseniors and disabled
8,000 of whom areSpecial Needs Plan members
California
San MateoCounty
HPSM Medicaid
CareAdvantage (Special Needs Plan)
• 8,000 enrollees (60% of those eligible)• Member benefits
– Dental and vision care– Transportation for medically related services– Subcontract with County Behavioral Health
• Customer service– Staff dedicated to and expert in serving older and disabled
members– Staff fluent in Spanish, Chinese, Tagalog, and Russian– Help for members in navigating the Medicaid / Medicare
maze– Assistance in maintaining Medi-Cal status
• <1,000 people “saved” from losing Medi-Cal in past year• Work with Legal Aid to help people with share of cost
CareAdvantage (con.)
• Care management– Identification of members at high risk– In home physician visits– Help with managing medications– Care transitions between hospital and home– Connecting members to medical homes– Interdisciplinary care coordination teams– Case conferences with County Behavioral
Health and Aging and Adult Services / IHSS– Clinical management in long term care
facilities
Medicaid Funded ServicesAcute Medical / Ancillary Care
(HPSM/County)
Institutional Long Term Care
(HPSM as of Feb 2010)
Home & Community Based
Services (Many operated by
County/FFS)
Outpatient/Clinic Based Primary Care
Distinct Part Skilled Nursing Facilities
In-Home Supportive Services (IHSS)
Specialty Medical Care/ County Mental Health Services
Freestanding Nursing Homes
Multipurpose Senior Services Program (MSSP)
Ancillary Services (Lab, pharmacy, radiology, durable medical equipment)
Caveat: Reimbursement only with LTC aid code
Hospice, Adult Day Health Care, Adult Day Care, Alzheimer’s Day Care Resource Centers
Inpatient Services
Services combined into LTCIServices combined into LTCI
Skilled Nursing
PACE
MSSP
In-Home Care
Adult Day CareNutrition
Mental Health Alcohol & Other Drug
Skilled Nursing
Model for LTCIComponent Options
Population • All adult Seniors and Persons with Disabilities (SPDs)
Medical Criteria • Eligible for nursing home level of care• At risk for nursing home level of care in the near term
Coverage • Dual eligible enrolled in CareAdvantage• Medicaid only• Dual eligible not enrolled in CareAdvantage
Assessment • Uniform assessment tool for all integrated services
Model for LTCI—ContinuedComponent Options
Acute Services • All Medicaid primary and acute care• All Medicare primary and acute care for duals in
CareAdvantage
Long Term Care • Medicaid nursing facility services• Medicare nursing facility services for CareAdvantage duals
HCBS • All Medicaid HCBS: Adult day health care Personal care (IHSS) MSSP
• “In Lieu” Services, e.g.:Services in assisted livingServices in Board and Care
Expanded TransportationHome modifications
Model for LTCI—Continued
Component Options
Medical Home • Primary Care Medical Home (enhanced primary care)
Interdisciplinary Team
• Member specific teams• Member is part of the team• Personal care worker may be part of the team
Individual Care Plan • Address physical as well as psychosocial needs• Accessible by all• Member involved in development of plan
Case Management • Case management based on individual care plan
Model for LTCI—ContinuedComponent Options
Community Services • Leverage existing San Mateo County Health System and community resources
• Integrate services already available
Enhanced Data • Single initiative to track and trend interventions / outcomes
Public Authority • Contract with Public Authority for personal care services
Stakeholders • Program oversight by local stakeholders
What Will Be Different?What Will Be Different?
NowNow LTCILTCIOne place to go for helpOne place to go for help
One uniform assessment for all One uniform assessment for all servicesservices
Variety of options available with Variety of options available with focus on keeping people in the focus on keeping people in the most home-like environmentmost home-like environment
System for MD and community System for MD and community agencies to refer patients who agencies to refer patients who need help before they decline & need help before they decline & need hospital careneed hospital care
Patient is the decision-makerPatient is the decision-maker
Questions?Questions?
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