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San Diego Long Term Care Integration Project (LTCIP). November 9, 2005 LTCIP Planning Committee. Long Term Care Integration Project Organizational Chart & Decision Tree. San Diego County Board of Supervisors & State Office of Long Term Care. Jean Shepard, Director

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San Diego Long Term Care Integration Project (LTCIP)

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San diego long term care integration project ltcip

San Diego Long Term Care Integration Project (LTCIP)

November 9, 2005

LTCIP Planning Committee


San diego long term care integration project ltcip

Long Term Care Integration Project Organizational Chart & Decision Tree

San Diego County Board of Supervisors

&

State Office of Long Term Care

Jean Shepard,Director

County of San Diego, Health & Human Services Agency, (HHSA)

  • Internet

  • Facilitates communication

  • Provides broad public education

Pamela B. Smith, Project Director

Evalyn Greb, Project Manager

Aging & Independence Services

Lead County Agency

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

Health Plan Partners

Workgroup

Finance/Data

Workgroup

Options Workgroup

MH & SA

Workgroup

Community Education

Workgroup

LTCI Strategies:

1) Network of Care

2) Physician Strategy

3) Healthy San Diego Plus

Ad Hoc workgroups:

Care Management, Provider Network

Development, Cultural Responsiveness

Explore use of public health education models that promote improved chronic care management for LTCIP

Determine the financial

feasibility of the proposed

LTCIP for San Diego County.

Make recommendations to Planning Committee re: inclusion of mental

health and substance abuse services in LTCIP.

Explore use of the Healthy San

Diego model for potential

Service delivery system for

LTCIP.

Governance

-Case Management

-Info/Technology

-Quality Assurance

-Scope of Services

-Workforce Issues

-Developmental Disabilities

-Community Network Development

April 2005

www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/


San diego long term care integration project ltcip

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


San diego long term care integration project ltcip

Ideal System

In-HomeServices

PrimaryCare

AcuteHospital

MealsService

MRS.

C.

DayHealthCare

Transit

Medical

Specialty

SkilledNursingFacility

Mrs. C &

Care

Manager

Journal of the American Geriatrics Society, Feb. 1997


San diego long term care integration project ltcip

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

CMS Guidance to Integrating Medicare/Medicaid


San diego long term care integration project ltcip

Chronic Care Model

Community

Health System

Health Care Organization

Resources and Policies

ClinicalInformationSystems

Self-Management Support

DeliverySystem

Design

Decision

Support

Prepared,

Proactive

Practice Team

Informed,

Activated

Patient

Productive

Interactions

Improved Outcomes


San diego long term care integration project ltcip

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Overall Aim: Implement the CCM for a specific Dual Eligible/Chronic Care Population

Community Resources and Policy

Organiz-ation of health care

Clinical

Information

Systems

Self-

Manage-

ment

Support

Delivery

System

Design

Decision Support

Develop Strategies for Each Component of the CCM


San diego long term care integration project ltcip

Core Building Blocks

Targeting Beneficiaries: Risk vs. Reward

Case Management / Care Coordination

- Integrating Information

Quality Methods and Measures

Primary Care / Chronic Care Management


San diego long term care integration project ltcip

sco

Senior Care Options

Bringing Medicare

and MassHealth Together


What works

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

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 program

Wisconsin Partnership Program

Charting the Future for Special Needs Plans:

2005 Leadership Forum

Fairfax, Virginia

Nancy Crawford

November 2005


Outcomes

Outcomes


Outcomes1

Outcomes


Results of provider satisfaction survey

Results of Provider Satisfaction Survey


Medi cal redesign revisited

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

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

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

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

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

Community Feedback on Stakeholder Recommendations

  • Provider Network

  • Care Management

  • Community & Cultural Responsiveness


Provider network development member service recommendations

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

    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

    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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