san diego long term care integration project ltcip planning committee december 13, 2006
TRANSCRIPT
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San Diego Long Term Care Integration Project
LTCIP Planning Committee
December 13, 2006
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Strategies Developed to Support “Vision”
Network of Care/Aging & Disability Resource Center
Physician Strategy
Healthy San Diego Plus
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Network of Care/ADRC
Activity to-date
Supplemental Grant: Access Center
Focus of next 6 months
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California Endowment & Healthcare Alliance Proposal:
TEAM SAN DIEGO Resources to build a local social network of
chronic care innovators across sectors, setting, and funding by:– Community development of “team
dynamic” through joint provider education– Enhancement of available IT
communication supports for docs, office staff, ancillary and community providers, consumers, caregivers
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Healthy San Diego Plus (HSD+)
Governor’s 2006 Budget proposal: Medicare HMO Wraparound– Medicare Advantage Part D (MAPD) – or – Medicare Special Need Plan (SNP) for “duals” – + Medi-Cal contract for “wraparound” services
(ADHC+SNF) +– Looks like MassSCO, except for 21 yo-64 yo– Runs parallel to, exclusive of, IHSS
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Medicare Special Needs Plans (SNPs) for Dual Eligibles
1. Requires health plans to provide all regular Medicare acute and primary care and coordinates services with Medi-Cal
2. Several plans to start enrolling in San Diego in January 2007, many more at State level
3. Health policy experts predict increased Medi-Cal costs. Why? Medi-Cal not included in cap rate to SNPs
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“HMO Wraparound Demo”
MAPD or “dual” SNP pre-qualified locally– contracts w/DHS (& CMS?)– takes risk, gets actuarially sound cap rates
Plan provides all primary, acute, and HCBS Pooled caps eliminate incentive to cost shift to Medi-Cal Demo provides basis for study w/counties that have only
Medicare SNPs for duals:– Comparing Medi-Cal costs and consumer outcomes– Analyzing impact to IHSS program
State learns impact of new Medicare program on Medicaid costs of enrolled duals in CA
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For more information: See website for background & info:
www.sdltcip.org
– Call or e-mail: [email protected],
858-495-5428 or [email protected],
858-694-3252