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Paul Saucier. State Approaches to Integrating Care. LTQA/NCHC Capitol Hill Forum April 24, 2014. OVERVIEW. - PowerPoint PPT Presentation
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2014 Truven H
ealth Analytics Inc.
Paul Saucier
State Approaches to Integrating Care
LTQA/NCHC Capitol Hill ForumApril 24, 2014
2012 Truven H
ealth Analytics Inc.
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Traditionally, state Medicaid-funded medical systems, long term services and supports (LTSS) systems, and mental health systems have operated on parallel planes, and all 3 of these Medicaid systems have been very separate from Medicare
Increasingly, states are turning to integrated care models to: Improve outcomes
Enhance experience
Reduce costs
Streamline administration
In particular, states have moved rapidly to integrate LTSS with medical services in Medicaid-only models and Medicaid-Medicare models
OVERVIEW
2012 Truven H
ealth Analytics Inc.
AZNC
WI NY
CA
19 STATES HAD INTEGRATED LTSS AND MEDICAL CARE TO SOME EXTENT AS OF APRIL 2014, UP FROM 8 IN 2004
NM
MN
MI
IL
WA
KS
TN
TX
PA
FL
DE
MA
HI
3
RI
MLTSS implemented 1989-2004
MLTSS implemented 2005-2014
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ealth Analytics Inc.
THE NUMBER OF LTSS USERS IN INTEGRATED PROGRAMS IS PROJECTED TO DOUBLE THIS YEAR
4
Year States LTSS Enrollees
2004 8 105,0002012 16 389,0002013 19 554,0002014
(projected)24 1,170,000
Sources: 2004 and 2012: The Growth of MLTSS Programs: A 2012 Update (Truven Health for CMS)
2013 and 2014: Truven Health estimates.
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ealth Analytics Inc.
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Care coordinator role is key: Assesses the consumer’s needs and preferences
Works with PCP and multiple other parties to plan, authorize and coordinate services
Monitors service plan
Follows consumer across settings and through transitions of care
Uses multiple methods to facilitate information transfer across multiple parties
HOW IS CARE INTEGRATED?
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ealth Analytics Inc.
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POPULAR IMAGE OF AN INTERDISCIPLINARY TEAM MEETING
PCP
Specialist
Physical Therapist Daughter Social Worker
Pharmacy Consultant
Care CoordinatorConsumer
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ealth Analytics Inc.
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REAL WORLD CARE COORDINATION
PCP
Care CoordinatorConsumer
Rx ConsultantSpecialist
Home Care Provider Daughter Social Worker State/County Social Services, CBOs
Phone
F-to-F (home)
F-to-F (co-located)Electronic TransferPhone, Fax
F-to-F (office visit)Phone F-to-F (team mtg)
Phone, FaxInternal Info System
PhoneElectronic Transfer
EMR
F-to-F (in-home services)Phone
F-to-F (office visit)Phone
PhoneF-to-F (home)
Internal Info SystemF-to-F (team mtg)
Phone, Fax
Phone, FaxPhone, Fax, Electronic Authorization
Phone, F-to-F Phone, F-to-F
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ealth Analytics Inc.
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Qualifications Nurses, social workers, degrees, experience
Contact with consumers Face-to-face almost always required, but intervals vary
Person-centered planning Language is prevalent, details are rare
Caseload ratios If specified, generally differ by risk category
Partnerships with community based organizations that have traditionally provided coordination of LTSS A few states mandate relationships, but allow discretion in the nature of
relationship
STATES VARY CONSIDERABLY ON HOW DETAILED THEY MAKE CARE COORDINATION SPECIFICATIONS
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ealth Analytics Inc.
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Role of traditional care coordination agencies (AAAs, CILs, and other CBOs)
HIT in LTSS agencies
Interoperability across systems
Measures of integration and LTSS
WORK IN PROGRESS
