san diego long term care integration project (ltcip) november 9, 2005 ltcip planning committee
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San Diego Long Term Care Integration Project (LTCIP)
November 9, 2005
LTCIP Planning Committee
San Diego County Board of Supervisors&
State Office of Long Term Care
Jean Shepard, DirectorCounty of San Diego, Health & Human Services
Agency, (HHSA)
Advisory Group:Goal: Make final decisions and
recommendations for inclusion in the plan.
Planning Committee:Goal: Guide the LTCIP planning process.
Suspended Workgroups pending need for further action/decision-making
Suspended Workgroups pending need for further action/decision-making
Health Plan Partners Workgroup
Health Plan Partners Workgroup Finance/Data
Workgroup
Finance/DataWorkgroup Options Workgroup
Options Workgroup
Internet• Facilitates
communication• Provides broad public
education
Pamela B. Smith, Project DirectorEvalyn Greb, Project ManagerAging & Independence Services
Lead County Agency
MH & SAWorkgroup
MH & SAWorkgroup
Explore use of the Healthy SanDiego model for potentialService delivery system for LTCIP.
Determine the financialfeasibility of the proposedLTCIP for San Diego County.
Make recommendations to Planning Committee re: inclusion of mentalhealth and substance abuse services in LTCIP.
LTCI Strategies:1) Network of Care2) Physician Strategy3) Healthy San Diego Plus Ad Hoc workgroups:Care Management, Provider NetworkDevelopment, Cultural Responsiveness
Governance-Case Management-Info/Technology-Quality Assurance-Scope of Services-Workforce Issues-Developmental Disabilities-Community Network Development
Community EducationWorkgroup
Community EducationWorkgroup
Explore use of public health education models that promote improved chronic care management for LTCIP
Long Term Care Integration Project
Organizational Chart & Decision Tree April 2005
Client Referral Patterns
Why the Interest in ALTCI?
• Unintended consumer consequences• Cost shifting in both directions• Important public financing considerations• An opportunity to do better with limited resources • Managed/Integrated Care implications• Aging of the population/Chronic Care Imperative
Journal of the American Geriatrics Society, Feb. 1997
In-HomeServices
DayHealthCare
AcuteHospital
TransitSkilledNursingFacility
MedicalSpecialty
MealsService
PrimaryCare
MRS.C.
Ideal System
Mrs. C & Care
Manager
Special Needs Plans
• Institutional Beneficiaries (In or expected reside ther >90 days; Community NHC)• Dually Eligible (subsets of duals OK)• Beneficaries with Chronic Conditions (untested to be evaluated on case by case;
e.g. disease specific, plan focuses)
Lumpers vs. Splitters!
CMS Guidance to Integrating
Medicare/Medicaid
• Models: - Buy-In Wraparound - Capitated
Wraparound - Three-Party
Integrated- Plan-Level
Integrated
• Key Considerations:- Enrollment- Operations- Benefits- Payments- Appeals - Part D
Implementation
Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Improved Outcomes
DeliverySystemDesign
DecisionSupport
ClinicalInformation
Systems
Self-Management
Support
Health System
Resources and Policies
Community
Health Care Organization
Chronic Care Model
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
A PS D
A P
S D
D S
P A
A P
S D
AP
S D
A P
S D
D S
P A
A P
S D
AP
SD
A P
S D
D S
P A
Community Resources and Policy
Self-Manage-ment Support
Delivery System Design
Clinical Information
Systems
Develop Strategies for Each Component of the CCM
Overall Aim: Implement the CCM for a specific Dual Eligible/Chronic Care Population
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
AP
S D
A P
S D
D S
P A
Organiz-ation of health care
Decision Support
Core Building Blocks
- Targeting Beneficiaries: Risk vs. Reward - Case Management / Care Coordination
- Integrating Information - Quality Methods and Measures- Primary Care / Chronic Care Management
Bringing Medicare
and MassHealth Together
Senior Care Options
What Works?
Centralized Enrollee Record 24/7 Access to Nurse Case Manager Joint CMS-state Medicare-style monitoring “Extra” benefits, i.e. vision, dental, hearing,
podiatry services to encourage enrollments Rates sufficient for start-up phase “Real” people to support automated
enrollment, screening, and reporting requirements
Exciting Outcomes
High enrollment in underserved, diverse neighborhoods (SCOs hire residents to do marketing/customer service)
Initial resistance by Aging industry slowly shifting to new AAA-SCO business
MMA transition to SNP MA-PD option as fast track to formal Medicare status
Enthusiastic, high-profile bi-partisan support within state government
Wisconsin Partnership ProgramWisconsin Partnership Program
Charting the Future for Special Charting the Future for Special Needs Plans: Needs Plans:
2005 Leadership Forum2005 Leadership Forum
Fairfax, VirginiaFairfax, VirginiaNancy CrawfordNancy Crawford
November 2005November 2005
OutcomesOutcomes
OutcomesOutcomes
Results of Provider Results of Provider Satisfaction SurveySatisfaction Survey
64.1%
91.3%
81.5%
55.7%
7.0%10.9%
3.4% 2.7%
41.6%
5.4%7.6%
28.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Satisfied AppropriateReimbursement
Satisfied AmountPaperwork
Satisfied Amount PhoneWork
Access to Out-of-NetworkProviders
Almost Always & Usually Sometimes & Rarely No Opinion
Medi-Cal Redesign Revisited
• Mandatory Medi-Cal Managed Care for Aged, Blind, and Disabled (ABDs) clients in all current managed care counties
• Implement Acute and LTC Integration Projects in Contra Costa, Orange, and San Diego to test innovative approached for enabling more individuals to receive care in setting that maximize community integration.
San Diego Stakeholder LTCIP Vision for Elderly & Disabled
• Develop “system” that:– provides continuum of health, social and
support services that “wrap around consumer” w/prevention & early intervention focus
– pools associated (categorical) funding– is consumer driven and responsive– expands access to/options for care– Utilizes existing providers
Stakeholder Vision (continued)
– Fairly compensates all providers w/rate structure developed locally
– Engages MD as pivotal team member– Decreases fragmentation/duplication w/single
point of entry, single plan of care– Improves quality & is budget neutral– Implements Olmstead Decision locally– Maximizes federal and state funding
ALTCI Building Blocks
• Stakeholder Process• Community Education and Outreach• Care Coordination Improvement• Community Network Development• Community & Cultural Responsiveness• Personal Care Workforce Support• Integrated IT Development • Primary Care Teams/Physician support• Quality Monitoring and Measurement
Health San Diego Plus
• MediCal Aged, Blind, and Disabled offered voluntary enrollment in LTC Integrated Plan
• Models of care integrated across the health, social, and supportive services continuum:– Private entity to contract with State through RFP with
stakeholder support– Healthy San Diego Health Plus Plans to develop
program details with consultant resources
Community Feedback on Stakeholder Recommendations
• Provider Network
• Care Management
• Community & Cultural Responsiveness
Provider Network Development/ Member Service
Recommendations
– Add geriatric, disability, social service expertise– Define minimum access standards for health and
social services, including personal care services– Define minimum standards for member
services/training of providers across the continuum to meet the individual health and social service needs of aged and disabled members
• Consultants: Scotti Kluess, Carol Zernial
Care Management Recommendations
– Finalize CM model, based on previous work and stakeholder input
– Develop standards and performance measures with State, County & stakeholders for the RFSQ
– Identify CM tools, such as assessment instrument and care plan format
– Identify source and develop community-wide plan for comprehensive training/certification?
• Staff: Brenda Schmitthenner
Community & Cultural Responsiveness
– Recommend plan to involve consumers/ caregivers in decision-making for self-direction, standards for new system of care
– Identify issues of diversity (cultural, physical, cognitive+) in re: access, outreach, education
– Develop minimum requirements and performance measures w/State, County, stakeholders
– Recommend HSD+ training plan and materials to be translated into threshold languages
• Workgroup Facilitator: Jong Won Min, PH.D.
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