San DiegoLong Term Care Integration Project

Planning Committee Update

January 9, 2002

What is San Diego’s view ofLong Term Care Integration? Acute, primary, social, personal care Delivered in the home, institutions, and

assisted living settings Designed to maintain health, function,

independence, choice Supported by current federal and state

Medi-Cal, new “waivered” resources

San Diego County’s LTCIP Vision Develop “system” for elderly and

disabled that:– provides continuum of health, social and

supportive services– pools associated (categorical) funding– is consumer driven and responsive– expands access to care– decreases fragmentation/duplication– improves quality/cost effectiveness

What Are We Trying To Achieve? To control runaway costs To focus on prevention and early intervention To change paradigm to “consumer centered” To increase community based choices To access all care via single point of entry To pool funding streams, avoid fragmentation To fairly compensate all providers To strengthen the County role To improve quality of care

2001 Milestones

3 LTCIP advisory group members added to HSD Joint (governance) Committee

Consensus to explore HSD model expansion for LTCIP service delivery

• health plans participate in planning/confer with experts of 2 successful & like models: TX & AZ

• health plan options for participation drafted

• HSD health plans support continued progress toward planning for implementation of LTCIP through HSD expansion

2001 Milestones (continued)

State Department of Health Services (OLTC & Div. of Managed Care) join SD planning

Data/Finance Workgroup makes recommendations re: populations

Merged Medicare and Medi-Cal data available for 1996 and 1997

Planning begins for state & federal waivers

Next Steps: within 6 months

Presentation to CAO,Board of Supervisors re: LTCIP and HSD

Development Grant application (3/02) to plan implementation based on HSD expansion for LTCIP

Finalize HP Options for Participation Add “permissive” language to HSD

waiver for possible phase-in 10-03

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

GovernanceWorkgroup Case Management

Workgroup

Case Management Workgroup Finance/Data

Workgroup

Finance/DataWorkgroup Information Technology

Workgroup

Information TechnologyWorkgroup

• Internet - Facilitates communication

• Community at Large Pamela B. Smith, Project DirectorAging & Independence Services

Lead County Agency

Quality AssuranceWorkgroup

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

Workforce IssuesWorkgroup

Increase the number of trained providers across the long term care continuum workforce, with an emphasis on quality care.

San Diego CountyLong Term Care Integration Project - Phase II & III

Today

Discussion & consensus re:– “phased-in” populations– development grant application

Discussion re: continuing work on HP Options for Participation

Recommendation #1:

Postpone decision regarding phase-in of 18 to 20 year olds pending receipt of pertinent data from the state and convening of stakeholders for input.

Recommendation #2:

Postpone phase-in of services and funding for persons with developmental disabilities until stakeholders can be convened and develop recommendations for inclusion in LTCIP.

Recommendation #3

Support application for the OLTC Development Grant to continue planning for the successful implementation of LTCIP through the expansion of the Healthy San Diego model.

Health Plan Options for Participation Test different models Allow current/new plans to participate Partner with plans in developing options To partner with CBO Provider

Workgroup in developing “designation process” specifics

To work with state/feds for approval

San Diego’s LTCIP

…another step closer!