san diego long term care integration project (ltcip) november 9, 2005 ltcip planning committee
TRANSCRIPT
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San Diego Long Term Care Integration Project (LTCIP)
November 9, 2005
LTCIP Planning Committee
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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
MH & SAWorkgroup
MH & SAWorkgroup
Explore use of the Healthy SanDiego model for potentialService delivery system for LTCIP.
Determine the financialfeasibility of the proposedLTCIP for San Diego County.
Make recommendations to Planning Committee re: inclusion of mentalhealth and substance abuse services in LTCIP.
LTCI Strategies:1) Network of Care2) Physician Strategy3) Healthy San Diego Plus Ad Hoc workgroups:Care Management, Provider NetworkDevelopment, Cultural Responsiveness
Governance-Case Management-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 April 2005
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Client Referral Patterns
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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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Journal of the American Geriatrics Society, Feb. 1997
In-HomeServices
DayHealthCare
AcuteHospital
TransitSkilledNursingFacility
MedicalSpecialty
MealsService
PrimaryCare
MRS.C.
Ideal System
Mrs. C & Care
Manager
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Special Needs Plans
• Institutional Beneficiaries (In or expected reside ther >90 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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Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Improved Outcomes
DeliverySystemDesign
DecisionSupport
ClinicalInformation
Systems
Self-Management
Support
Health System
Resources and Policies
Community
Health Care Organization
Chronic Care Model
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A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
A PS D
A P
S D
D S
P A
A P
S D
AP
S D
A P
S D
D S
P A
A P
S D
AP
SD
A P
S D
D S
P A
Community Resources and Policy
Self-Manage-ment Support
Delivery System Design
Clinical Information
Systems
Develop Strategies for Each Component of the CCM
Overall Aim: Implement the CCM for a specific Dual Eligible/Chronic Care Population
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
AP
S D
A P
S D
D S
P A
Organiz-ation of health care
Decision Support
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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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Bringing Medicare
and MassHealth Together
Senior Care Options
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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 ProgramWisconsin Partnership Program
Charting the Future for Special Charting the Future for Special Needs Plans: Needs Plans:
2005 Leadership Forum2005 Leadership Forum
Fairfax, VirginiaFairfax, VirginiaNancy CrawfordNancy Crawford
November 2005November 2005
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OutcomesOutcomes
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OutcomesOutcomes
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Results of Provider Results of Provider Satisfaction SurveySatisfaction Survey
64.1%
91.3%
81.5%
55.7%
7.0%10.9%
3.4% 2.7%
41.6%
5.4%7.6%
28.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Satisfied AppropriateReimbursement
Satisfied AmountPaperwork
Satisfied Amount PhoneWork
Access to Out-of-NetworkProviders
Almost Always & Usually Sometimes & Rarely No Opinion
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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.