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San Diego Long Term Care Integration Project (LTCIP)
July 13, 2005
LTCIP Planning Committee
Client Referral Patterns
CLINICS
Journal of the American Geriatrics Society, Feb. 1997
In-HomeServices
DayHealthCare
AcuteHospital
TransitSkilledNursingFacility
MedicalSpecialty
MealsService
PrimaryCare
MRS.C.
Ideal System
Mrs. C & Care
Manager
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
July 2005
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
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
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
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”
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
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
Morning Presentations
Community-Based Organizations (CBO)– Challenge Center – Bill Bodry
– Meals on Wheels – Roger Bailey
– Southern Caregiver resource Center – Kurt Buske
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?
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?
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"
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"
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.
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 [email protected] or 858-694-3252 or [email protected]
