San Diego Long Term Care Integration Project (LTCIP)

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San Diego Long Term Care Integration Project
(LTCIP)

• July 13, 2005
• LTCIP Planning Committee

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CLINICS
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Ideal System
Mrs. C Care Manager
Journal of the American Geriatrics Society, Feb.
1997
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Long Term Care Integration Project Organizational
Chart Decision Tree
July 2005
www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
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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

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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 value of federal and state funding

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Where are we now?

• BOS come back with 3 options
• Dr. Mark Meiners and 3 strategies
• Healthy San Diego Plus (HSD)
• Physician Strategy
• Network of Care
• Proposed Medi-Cal Redesign

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Medi-Cal Redesign ALTCI

• In SD, known as Healthy San Diego Plus (HSD)
• Builds on geographic managed care model for
  Medi-Cal
• Option to mandatory primary acute enrollment
  for ABDs
• Pooled Medi-Cal ( Medicare for duals) health and
  supportive service
• From defined benefit list to what individual
  needs/prefers
• Care manager and member in hub

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Physician Strategy

• Fee-for-service initiative to improve chronic
  care management
• Funding 142,000 (planning) CA Endowment
• Partner w/physicians vested in chronic care
• Develop interest/incentive for support of HCBC
• ID care management resources
• Train on healthy aging, geriatric/chronic disease
  protocol, pharmacy, HCBC supports
• Falls Prevention initiative

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Network of Care (NOC)

• Test/improve existing web-based system expand
  to support 2 service delivery models
• Funding AoA, 610,000 over 3 years for Aging
  Disability Resource Center
• Expand as communication link btw MD, consumer,
  caregiver, community providers
• Develop CQI program/Community Education Workgroup
• www.sandiego.networkofcare.org

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Morning Presentations

• Community-Based Organizations (CBO)
• Challenge Center Bill Bodry
• Meals on Wheels Roger Bailey
• Southern Caregiver resource Center Kurt Buske

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CBO Questions Key Issues

• Where and how are CBO/safety net provider (HCBC)
  representatives included in planning discussions
  between the County and HSD health plans?
• Where is it stated that  preference will be given
  to local traditional safety net providers?

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CBO Questions Key Issues

• Who will be given evaluation oversight authority
  for HSD? 
• Will there be a consumer/provider /health
  plan/County body charged with defining and
  monitoring success metrics?  How will we know
  that the HSD model is ultimately successful?

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CBO Questions Key Issues

• Health plans should be required to "buy" rather
  than "build" HCBC services IF a qualified local
  HCBC safety net provider already exists to
  provide the service
• Include CBO/safety net providers in defining the
  criteria and process for evaluating what is or is
  not a "qualified Home Community Based Care
  (HCBC) safety net provider"

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CBO Questions Key Issues

• Require health plans to pay a "fair market price"
  (need an agreed upon definition and  include
  thresholds for workforce compensation) for HCBC
  services
• Assure that populations are  "carved-in" not
  carved-out"

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CBO Questions Key Issues

• Secure a waiver from the state to allow health
  plans to subcontract to non Medi-Cal certified
  providers
• Assure a level playing field that allows for
  diversity of HCBC providers - both public and
  private.

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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_at_sdcounty.ca.gov or 858-694-3252 or
  sara.barnett_at_sdcounty.ca.gov