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San Diego Long Term Care Integration Project (LTCIP)
June 22, 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
June 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
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
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 Gov’t Human Resource Consulting
Afternoon Breakout Groups
Provider Networks & Member Services
Care Management
Community & Cultural Responsiveness
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
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
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.
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+
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]
