San Diego Long Term Care Integration Project (LTCIP)

1
San Diego Long Term Care Integration Project
(LTCIP)

• June 22, 2005
• LTCIP Planning Committee

2
CLINICS
3
Ideal System
Mrs. C Care Manager
Journal of the American Geriatrics Society, Feb.
1997
4
Long Term Care Integration Project Organizational
Chart Decision Tree
June 2005
www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
5
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

6
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

7
Medi-Cal Redesign ALTCI

• Option to mandatory primary acute
• 3 counties to enroll Medi-Medis
• Pooled Medi-Cal ( Medicare for duals) health and
  supportive service
• From defined benefit list to what individual
  needs/prefers

8
The Morning Presentations

• Actuary consultant to deliver
• Recommend web-based system design, w/info from
  stakeholder survey, for CM communication and
  coordination across Acute and Long Term Care
  (ALTCI) continuum, with appropriate levels of
  security and confidentiality
• Early estimates for costs
• Recommendations for local provider rates
• Recommendations for health plan and Operating
  Agency organizational structure/ staffing models
  based on program design
• Consultant Mercer Govt Human Resource
  Consulting

9
Afternoon Breakout Groups

• Provider Networks Member Services
• Care Management
• Community Cultural Responsiveness

10
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

11
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

12
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.

13
Timelines

• 6/30/05 Consultant recommendations
• 7/05 12/05 Stakeholders consider, revise, and
  reach consensus
• 1/06 - 3/06 County/BOS approval
• 3/06 County, State DHS, CMS begin working
  toward implementation
• 3/1/07 Begin enrollment in HSD

14
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