San Diego Long Term Care Integration Project Planning Committee Presentation September 10, 2003
Jan 06, 2018
San DiegoLong Term Care Integration Project
Planning Committee PresentationSeptember 10, 2003
Community Planning Process
From 50 to 400+ key stakeholders over past 4 years: 10,000+ hours
Seeking to improve system of care for consumers and providers
Planning within state LTCIP authorization (form follows funding)
San Diego County Board of Supervisors&
State Office of Long Term Care
Rodger G. Lum, Ph.D, 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.
GovernanceWorkgroup
Case Management Workgroup
Finance/DataWorkgroup
Information TechnologyWorkgroup
Internet• -Facilitates
communication• -Provides broad public
education
Pamela B. Smith, Project DirectorAging & Independence Services
Lead County Agency
Quality AssuranceWorkgroup
Develop a model thatsupports integration acrossthe continuum of care to ensureeasy access to care & services.
Determine the financialfeasibility of the proposedLTCIP for San Diego County.
Determine consumerprotection & qualityassurance standards &requirement for the LTCIP.
Identify the information &technology requirementsneeded to support a LTCIdelivery system.
Develop a recommendationfor the governance structurefor the implementation phaseof the LTCIP.
Workforce IssuesWorkgroup
Increase the number of trained providers across the long term care continuum workforce, with an emphasis on quality care.
Long Term Care Integration Project Organizational Chart & Decision Tree
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
Legislative Authority
AB 1040 in 1995 (revised in 1998) State Office of LTC:
– provides planning $$– provides “Center” resources– provides liaison with other state programs– approves local activity toward LTCI– will assist in procuring federal waivers
Why change?
To align incentives for optimum care across the continuum
To impact quality of life for aged and disabled, especially high cost users
To respond to demographics that require Medicare to respond to chronic care needs
To shift focus to consumer and outcomes To respond to Olmstead Decision
Mrs. C
84 year old woman lives alone CHF, HTN, diabetes, hearing and vision
loss, IADL dependencies 16 medications by 6 MDs Medicare and Medi-Cal beneficiary Only child lives in Chicago
Client Referral Patterns
CUSTOMER ACCESS with LTCIP
Customer At Home/Community
Care Manager w/ Network of Care
IncomeAsst.
SeniorCntr.
In-homecare
HICAP
MedicalClinic
BloodPressure
Cks
ShoppingAsst. rehab
Transp.Escort
housingHealth Care
Intake Worker InformationProvided
From Vision to Service Delivery Model… Explore Healthy San Diego due to:
– Access, education, prevention– Advocacy– Cost-effectiveness– Population-based– Existing infrastructure– Stakeholder-designed, BUT
HSD Currently Does NOT…
Tailor the program for chronic care or aged and disabled persons
Provide “wraparound” services Provide chronic care management on a
population basis Receive adequate reimbursement for
chronic care Have much info on “duals”
Where are we now?
Last year, BOS: “come back with 3 options” next Spring
Since then: Dr. Mark Meiners assists w/strategies development:– Network of Care– Physician Strategy – HSD Health Plan/Pilot Projects
Network of Care
Beta testing with– consumers and caregivers– community based organizations– other providers, Call Center staff
To develop “continuous quality improvement” program
Measure behavior changes of providers and consumers
Physician Strategy
Partner w/physicians vested in chronic care Develop interest/incentive for support of “after
office” services (HCBC) Identify care management resources to
support physicians/office staff to link patients and communicate across systems
Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports
Health Plan Pilots
Pilots to do small, voluntary models of care integrated across the health, social, and supportive services continuum:– State to contract with private entity if
stakeholders agree– Healthy San Diego Health Plans to develop
pilot with consultant resources
New Parallel Initiatives
Medicare reform: Drugs and Duals CMS “chronic care” M+C demos SHMOs and “special needs” plans AB 43 in California and LTCIP pilot Medi-Cal and disease management PACE in San Diego Mass. Senior Care Organization
Consultant Team for HP Strategy
Dr. Mark Meiners, National Program Director, RWJ Medicare/Medicaid Integration Program
Dave Ogden, Milliman USA Charles Birmingham and Karin Kalk,
Health Plan Consultants LTCIP Staff and Stakeholders
Consultant Proposal Long Range
95,000 have 2 choices– Physician Strategy
• MD incentives• Support for chronic care• Across
Medicare/Medicaid– HSD+
• NF & “certifiable” duals• Aged, then younger• Then all HSD ABDs• Then all ABDs
Consultant Proposal Funding
Who?– HSD plans that meet
requirements– With or without
current Medicare participation
– May subcontract for LTC
– Care management must be overarching
Medi-Cal– Acute, LTC, IHSS,
1915(c) waiver Medicare
– Waiver to allow HSD to serve duals w/cap
– “demo” status to add “frailty adjuster”
Actuarial Consultant “Scenarios”
Scenario A– Initial, moderately managed utilization– 16% of Medicare payment available for
admin, profit, HCBC Scenario B
– More developed, managed utilization– 22% of Medicare payment available for
admin, profit, HCBC
Key Program Components
Common entry point: intake, risk screens, and needs assessment
Care plan development: electronic assessment and C-E triggers
Care coordination standards: contracted to gain CQI via team care approach
Common data: risk assessment, point of service PDA, data warehouse
Network development support: HCBS focus
Proposal issues already identified
Physician Strategy diminishes HSD plans’ potential provider network capacity
Younger disabled do not appear to be financially “attractive”
What to do re: mental health?
Next Steps
Health Plan and Stakeholder input on Consultant Proposal
Develop Administrative Action Plan (Jan. ’04)– NOC (AoA/CMS funding?!)– Physician Strategy (CA Endowment $$)– Health Plan Pilots: HSD & AB 43
Stakeholder consensus (Feb. ’04) Board of Supervisors approval (Mar. ’04) Examine new federal initiatives
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 [email protected]