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San Diego Long Term Care Integration Project (LTCIP). July 13, 2005 LTCIP Planning Committee. CLINICS. Ideal System. In-Home Services. Primary Care. Acute Hospital. Meals Service. MRS. C. Day Health Care. Transit. Medical Specialty. Skilled Nursing Facility. Mrs. C & Care

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san diego long term care integration project ltcip

San Diego Long Term Care Integration Project (LTCIP)

July 13, 2005

LTCIP Planning Committee


Ideal System












Mrs. C &



Journal of the American Geriatrics Society, Feb. 1997


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




Options Workgroup



Community Education


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



-Case Management


-Quality Assurance

-Scope of Services

-Workforce Issues

-Developmental Disabilities

-Community Network Development

July 2005

san diego stakeholder ltcip vision for elderly disabled
San Diego Stakeholder LTCIP Vision for Elderly & Disabled
  • Develop “system” that:
    • Is consumer driven and responsive
    • Provides continuum of health, social and support services that “wrap around consumer” w/prevention & early intervention focus
    • Pools associated (categorical) funding
    • 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 value of federal and state funding
where are we now
Where are we now?
  • BOS: “come back with 3 options”
  • Dr. Mark Meiners and 3 strategies:
    • Healthy San Diego Plus (HSD+)
    • Physician Strategy
    • Network of Care
  • Proposed Medi-Cal Redesign
medi cal redesign altci
Medi-Cal Redesign & ALTCI
  • In SD, known as Healthy San Diego Plus (HSD+)
  • Builds on geographic managed care model for Medi-Cal
  • Option to mandatory primary & acute enrollment for ABDs
  • Pooled Medi-Cal (& Medicare for duals) health and supportive service $$
  • From defined benefit list to what individual needs/prefers
  • Care manager and member in “hub”
physician strategy
Physician Strategy
  • Fee-for-service initiative to improve chronic care management
  • Funding: $142,000 (planning) CA Endowment
  • Partner w/physicians vested in chronic care
  • Develop interest/incentive for support of HCBC
  • ID care management resources
  • Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports
  • Falls Prevention initiative
network of care noc
Network of Care (NOC)
  • Test/improve existing web-based system & expand to support 2 service delivery models
  • Funding: AoA, $610,000 over 3 years for Aging & Disability Resource Center
  • Expand as communication link btw MD, consumer, caregiver, community providers
  • Develop CQI program/Community Education Workgroup
morning presentations
Morning Presentations
  • Community-Based Organizations (CBO)
    • Challenge Center – Bill Bodry
    • Meals on Wheels – Roger Bailey
    • Southern Caregiver resource Center – Kurt Buske
cbo questions key issues
CBO Questions & Key Issues
  • Where and how are CBO/safety net provider (HCBC) representatives included in planning discussions between the County and HSD health plans?
  • Where is it stated that  preference will be given to local traditional safety net providers?
cbo questions key issues1
CBO Questions & Key Issues
  • Who will be given evaluation oversight authority for HSD+? 
  • Will there be a consumer/provider /health plan/County body charged with defining and monitoring success metrics?  How will we know that the HSD+ model is ultimately successful?
cbo questions key issues2
CBO Questions & Key Issues
  • Health plans should be required to "buy" rather than "build" HCBC services IF a qualified local HCBC safety net provider already exists to provide the service
  • Include CBO/safety net providers in defining the criteria and process for evaluating what is or is not a "qualified Home & Community Based Care (HCBC) safety net provider"
cbo questions key issues3
CBO Questions & Key Issues
  • Require health plans to pay a "fair market price" (need an agreed upon definition and  include thresholds for workforce compensation) for HCBC services
  • Assure that populations are  "carved-in" not “carved-out"
cbo questions key issues4
CBO Questions & Key Issues
  • Secure a waiver from the state to allow health plans to subcontract to non Medi-Cal certified providers
  • Assure a level playing field that allows for diversity of HCBC providers - both public and private.
how to influence planning
How to influence planning?
  • Get on LTCIP mailing list for updates
  • Log onto website for background & info:
  • Call or e-mail input/ideas: 858-495-5428 or or 858-694-3252 or