San Diego Long Term Care Integration Project (LTCIP)

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San Diego Long Term Care Integration Project
(LTCIP)

• November 9, 2005
• LTCIP Planning Committee

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Long Term Care Integration Project Organizational
Chart Decision Tree
April 2005
www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
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(No Transcript)
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• Why the Interest in ALTCI?
• Unintended consumer consequences
• Cost shifting in both directions
• Important public financing considerations
• An opportunity to do better with limited
  resources
• Managed/Integrated Care implications
• Aging of the population/Chronic Care
  Imperative

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Ideal System
Mrs. C Care Manager
Journal of the American Geriatrics Society, Feb.
1997
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• Special Needs Plans
• Institutional Beneficiaries (In or expected
  reside ther gt90 days Community NHC)
• Dually Eligible (subsets of duals OK)
• Beneficaries with Chronic Conditions (untested
  to be evaluated on case by case e.g. disease
  specific, plan focuses)
• Lumpers vs. Splitters!

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CMS Guidance to Integrating Medicare/Medicaid

• Models
• Buy-In Wraparound
• Capitated Wraparound
• Three-Party Integrated
• Plan-Level Integrated

• Key Considerations
• Enrollment
• Operations
• Benefits
• Payments
• Appeals
• Part D Implementation

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Chronic Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Improved Outcomes
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Overall Aim Implement the CCM for a specific
Dual
Eligible/Chronic Care Population
Community Resources and Policy
Clinical Information Systems
Organiz-ation of health care
Self- Manage- ment Support
Delivery System Design
Decision Support
Develop Strategies for Each Component of the CCM
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• Core Building Blocks
• Targeting Beneficiaries Risk vs. Reward
• Case Management / Care Coordination
• - Integrating Information
• Quality Methods and Measures
• Primary Care / Chronic Care Management

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sco
Senior Care Options
Bringing Medicare and MassHealth Together
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What Works?

• Centralized Enrollee Record
• 24/7 Access to Nurse Case Manager
• Joint CMS-state Medicare-style monitoring
• Extra benefits, i.e. vision, dental, hearing,
  podiatry services to encourage enrollments
• Rates sufficient for start-up phase
• Real people to support automated enrollment,
  screening, and reporting requirements

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Exciting Outcomes

• High enrollment in underserved, diverse
  neighborhoods (SCOs hire residents to do
  marketing/customer service)
• Initial resistance by Aging industry slowly
  shifting to new AAA-SCO business
• MMA transition to SNP MA-PD option as fast track
  to formal Medicare status
• Enthusiastic, high-profile bi-partisan support
  within state government

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Wisconsin Partnership Program

• Charting the Future for Special Needs Plans
• 2005 Leadership Forum
• Fairfax, Virginia
• Nancy Crawford
• November 2005

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Outcomes
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Outcomes
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Results of Provider Satisfaction Survey
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Medi-Cal Redesign Revisited

• Mandatory Medi-Cal Managed Care for Aged, Blind,
  and Disabled (ABDs) clients in all current
  managed care counties
• Implement Acute and LTC Integration Projects in
  Contra Costa, Orange, and San Diego to test
  innovative approached for enabling more
  individuals to receive care in setting that
  maximize community integration.

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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

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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

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ALTCI Building Blocks

• Stakeholder Process
• Community Education and Outreach
• Care Coordination Improvement
• Community Network Development
• Community Cultural Responsiveness
• Personal Care Workforce Support
• Integrated IT Development
• Primary Care Teams/Physician support
• Quality Monitoring and Measurement

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Health San Diego Plus

• MediCal Aged, Blind, and Disabled offered
  voluntary enrollment in LTC Integrated Plan
• Models of care integrated across the health,
  social, and supportive services continuum
• Private entity to contract with State through RFP
  with stakeholder support
• Healthy San Diego Health Plus Plans to develop
  program details with consultant resources

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Community Feedback on Stakeholder Recommendations

• Provider Network
• Care Management
• Community Cultural Responsiveness

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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

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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

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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.