San Diego Long Term Care Integration Project (LTCIP)

Mental Health & Substance Abuse Working Committee

October 21, 2003

Community Planning Process

Grass-roots effort to improve system of care for long term care consumers and providers

From 50 to 550+ key stakeholders over past 4 years: 10,000+ hours

Agreement to use existing providers, assure fair compensation

Planning within state LTCIP authorization, AB 1040 (form follows funding)

San Diego County Board of Supervisors&

State Office of Long Term Care

Rodger G. Lum, Ph.D, 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 service delivery

model decision

Suspended Workgroups pending service delivery

model decisionHealth Plan Workgroup

Health Plan 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

Mental HealthWorkgroup

Mental HealthWorkgroup

Explore use of the Healthy SanDiego model for potentialService delivery system for LTCIP.

Determine the financialfeasibility of the proposedLTCIP for San Diego County.

Make recommendation to Planning Committee re: inclusion of mentalhealth and substance abuse services in LTCIP.

Incremental LTCI Strategies:1) Network of Care2) Physician Strategy3) Health Plan Pilots

Governance-Case Management-Info/Technology-Quality Assurance-Scope of Services-Workforce Issues-Community Network Development

Developmental DisabilitiesWorkgroup

Developmental DisabilitiesWorkgroup

Make recommendation to PC re: inclusion of persons with developmental disabilities in LTCIP.

Long Term Care Integration Project

Organizational Chart & Decision Tree

8/2003

Legislative Authority

AB 1040 in 1995 (revised in 1998) State Office of LTC:

– provides planning $$– provides “Center” resources– provides liaison with other state programs– approves local activity toward LTCI– will assist in procuring federal waivers

San Diego LTCIP Stakeholder Vision for Elderly & Disabled Develop service delivery “system” that:

– provides continuum of all 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

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

Why change?

Impact of demographics on healthcare Cost containment vs. care management Health & support service fragmentation Categorical admin $$ to service $$ Consumer/outcomes not current focus

Client Referral Patterns

From Vision to Service Delivery Model…

CUSTOMER ACCESS w ith LTCIP

Customer At Home/Community

Care Manager w/ Network of Care

IncomeAsst.

SeniorCntr.

In-homecare

HICAP

MedicalClinic/Health

Care

BloodPressure

Cks

ShoppingAsst. Mental

Health

Transp.

Escort

housingRehab

Intake Worker InformationProvided

From LTCIP Vision to Service Delivery Model… Explore Healthy San Diego due to:

– Access, education, prevention– Advocacy– Cost-effectiveness– Population-based– Existing infrastructure– Stakeholder-designed, BUT

HSD Currently Does NOT…

Tailor the program for chronic care or aged and disabled persons

Provide “wraparound” services Provide chronic care management on a

population basis Receive adequate reimbursement for

chronic care Have much info on “duals”

Where are we now? BOS: “come back with 3 options” Dr. Mark Meiners strategies/looking for

“consortium of funding”:– Network of Care– Physician Strategy – HSD Health Plan Pilots

Administrative Action Plan for FY 2003-04 State Development Grant

Establishment of Mental Health Workgroup

Network of Care Testing with

– consumers and caregivers– community based organizations– other providers, Call Center staff

To develop “continuous quality improvement” program

Measure behavior changes of providers and consumers

Physician Strategy Partner w/physicians vested in chronic care Develop interest/incentive for support of “after

office” services (HCBC) Identify care management resources to

support physicians/office staff to link patients and communicate across systems

Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports

Health Plan Pilots Pilots to do small, voluntary models of care

integrated across the health, social, and supportive services continuum:– Evercare (or any other private healthcare entity) to

contract with State if stakeholders agree (AB43)– Healthy San Diego Health Plans to develop pilot

with consultant resources Stakeholders currently providing feedback on

consultant team’s final report

Mental Health & SA Today Current Medi-Cal carve-out (UBH) Limited Medicare reimbursement LTCIP stakeholders want no carve-outs Mental health and substance abuse problems

under-diagnosed & under-treated Quality of life and cost impact of untreated

mental illness/substance abuse is huge Most state integration projects do not enroll

disabled w/primary MH diagnosis Seniors do not self-identify as having MH &/or

SA issues; don’t use MH Centers/SA services

Mental Health and LTCIP Establishment of Mental Health Workgroup to:

– hear from broad array of stakeholders – focus on consumer as “whole” in system– develop plan specific to San Diego and LTCIP

How do we “mainstream” mental health and substance abuse services for aged and disabled?– parity w/physical health for treatment– age-, disease-specific treatment– delivered as “part of the whole”– viewed within greater context of health

LTCIP Mental Health & Substance Abuse Workgroup Goal: Make recommendation to Planning

Committee on inclusion of mental health and substance abuse programs, populations, and services

Establishment of this Working Committee Importance of consensus (consumers &

providers) on a recommendation Forward recommendation to larger

Workgroup by January 2004