San Diego Long Term Care Integration Project

San Diego Long Term Care Integration Project

LTCIP Planning Committee

August 9, 2006

Client Referral Patterns

Journal of the American Geriatrics Society, Feb. 1997

In-HomeServices

DayHealthCare

AcuteHospital

TransitSkilledNursingFacility

MedicalSpecialty

MealsService

PrimaryCare

MRS.C.

Ideal System

Mrs. C & Care

Manager

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)

– 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

Strategies Developed to Support “Vision”

Aging & Disability Resource Center

Physician Strategy

Healthy San Diego Plus

San Diego County Board of Supervisors&

State Office of Long Term Care

Jean Shepard, DirectorCounty of San Diego, Health & Human Services

Agency, (HHSA)

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

Suspended Workgroups pending need for further action/decision-making

Health Plan Partners Workgroup

Health Plan Partners Workgroup Finance/Data

Workgroup

Finance/DataWorkgroup Options Workgroup

Options Workgroup

Internet• Facilitates

communication• Provides broad public

education

Pamela B. Smith, Project DirectorEvalyn Greb, Project ManagerAging & Independence Services

Lead County Agency

Personal Care ServicesWorkgroup

Personal Care ServicesWorkgroup

Explore use of the Healthy SanDiego model for potentialService delivery system for LTCIP.

Determine the financialfeasibility of the proposedLTCIP for San Diego County.

Make recommendation to Planning Committee on how to best integrate PCS into the fully integrated model.

LTCI Strategies:1) Network of Care2) Physician Strategy3) Healthy San Diego Plus Workgroups:Care Management, Provider Networks, Cultural Responsiveness

Governance-Mental Health & Substance Abuse-Info/Technology-Quality Assurance-Scope of Services-Workforce Issues-Developmental Disabilities-Community Network Development

Community EducationWorkgroup

Community EducationWorkgroup

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

Long Term Care Integration Project

Organizational Chart & Decision Tree

Aging & Disability Resource Center (ADRC)/Network of Care Beta testing with

– consumers and caregivers– community based organizations– MDs, other providers, Call Center staff

To develop “continuous quality improvement” program

Measure behavior changes of providers and consumers

Funding: Federal Aging & Disability Resource Center grant application

ADRC Update

Revised Year 3 Work Plan Supplemental funding request to

strengthen partnership with disability community

Physician Strategy

Partner w/physician “champions” Develop interest/incentive for support of

“after office” services (HCBC) Identify care management resources to

link physicians/office staff to patients Train on healthy aging, geriatric/chronic

care management, pharmacy, HCBC supports

Physician Strategy Update

CA Endowment request to fund Implementation Plan:– Finalize/deliver community care

management/team training for health and social service providers

– Develop, evaluate outcome measures – Enhance IT infrastructure, decision support

tools, resources, etc

Healthy San Diego Plus (HSD+) Builds on San Diego’s geographic

managed care model for Medi-Cal Medi-Cal Aged, Blind, and Disabled

(ABD) offered voluntary enrollment Service delivery model that provides full

continuum of health and social services Pooled Medi-Cal & Medicare $$ Care manager and member in “hub”

HSD+ Update

Governor’s proposal/AB 2979– “Medicare HMO Wraparound pilot”– For dual eligible ABDs only– Rates to include skilled nursing facility

(SNF) & adult day health care (ADHC)– Supported by Medicare Modernization Act

(SNPs) and Budget Deficit Reduction Act

www.sdltcip.org Get on LTCIP mailing list for updates Attend Planning Committee meetings Log onto website for background & info Call or e-mail input/ideas: 858-495-5428

or [email protected] or 858-694-3252 or [email protected]