San Diego Long Term Care Integration Project (LTCIP)

1. San Diego Long Term Care Integration Project (LTCIP) June 22, 2005 LTCIP Planning Committee

2. CLINICS

3. 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

4. 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 June 2005 www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/

5. 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

6. 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

7. Medi-Cal Redesign & ALTCI • Option to mandatory primary & acute • 3 counties to enroll Medi-Medis • Pooled Medi-Cal (& Medicare for duals) health and supportive service $$ • From defined benefit list to what individual needs/prefers

8. The Morning Presentations Actuary consultant to deliver: • Recommend web-based system design, w/info from stakeholder survey, for CM communication and coordination across Acute and Long Term Care (ALTCI) continuum, with appropriate levels of security and confidentiality • Early estimates for costs • Recommendations for local provider rates • Recommendations for health plan and Operating Agency organizational structure/ staffing models based on program design • Consultant: Mercer Gov’t Human Resource Consulting

9. Afternoon Breakout Groups • Provider Networks & Member Services • Care Management • Community & Cultural Responsiveness

10. 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

11. 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

12. 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.

13. Timelines • 6/30/05: Consultant recommendations • 7/05 – 12/05: Stakeholders consider, revise, and reach consensus • 1/06 - 3/06: County/BOS approval • 3/06 – County, State DHS, CMS begin working toward implementation • 3/1/07 – Begin enrollment in HSD+

14. How to influence planning? • Get on LTCIP mailing list for updates • Log onto website for background & info: www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/ • Call or e-mail input/ideas: 858-495-5428 or evalyn.greb@sdcounty.ca.gov or 858-694-3252 or sara.barnett@sdcounty.ca.gov