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San Diego Long Term Care Integration Project

San Diego Long Term Care Integration Project . LTCIP Planning Committee December 13, 2006. Strategies Developed to Support “Vision”. Network of Care/Aging & Disability Resource Center Physician Strategy Healthy San Diego Plus. Network of Care/ADRC. Activity to-date

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San Diego Long Term Care Integration Project

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  1. San Diego Long Term Care Integration Project LTCIP Planning Committee December 13, 2006

  2. Strategies Developed to Support “Vision” • Network of Care/Aging & Disability Resource Center • Physician Strategy • Healthy San Diego Plus

  3. Network of Care/ADRC • Activity to-date • Supplemental Grant: Access Center • Focus of next 6 months

  4. 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

  5. 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

  6. Medicare Special Needs Plans (SNPs) for Dual Eligibles • Requires health plans to provide all regular Medicare acute and primary care and coordinates services with Medi-Cal • Several plans to start enrolling in San Diego in January 2007, many more at State level • Health policy experts predict increased Medi-Cal costs. Why? Medi-Cal not included in cap rate to SNPs

  7. “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

  8. For more information: • See website for background & info: www.sdltcip.org • Call or e-mail: evalyn.greb@sdcounty.ca.gov, 858-495-5428 or sara.barnett@sdcounty.ca.gov, 858-694-3252

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