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San Diego Long Term Care Integration Project
LTCIP Planning Committee
December 13, 2006
Strategies Developed to Support “Vision”
Network of Care/Aging & Disability Resource Center
Physician Strategy
Healthy San Diego Plus
Network of Care/ADRC
Activity to-date
Supplemental Grant: Access Center
Focus of next 6 months
California Endowment & Healthcare Alliance Proposal:
TEAM SAN DIEGO Resources to build a local social network of
chronic care innovators across sectors, setting, and funding by:– Community development of “team
dynamic” through joint provider education– Enhancement of available IT
communication supports for docs, office staff, ancillary and community providers, consumers, caregivers
Healthy San Diego Plus (HSD+)
Governor’s 2006 Budget proposal: Medicare HMO Wraparound– Medicare Advantage Part D (MAPD) – or – Medicare Special Need Plan (SNP) for “duals” – + Medi-Cal contract for “wraparound” services
(ADHC+SNF) +– Looks like MassSCO, except for 21 yo-64 yo– Runs parallel to, exclusive of, IHSS
Medicare Special Needs Plans (SNPs) for Dual Eligibles
1. Requires health plans to provide all regular Medicare acute and primary care and coordinates services with Medi-Cal
2. Several plans to start enrolling in San Diego in January 2007, many more at State level
3. Health policy experts predict increased Medi-Cal costs. Why? Medi-Cal not included in cap rate to SNPs
“HMO Wraparound Demo”
MAPD or “dual” SNP pre-qualified locally– contracts w/DHS (& CMS?)– takes risk, gets actuarially sound cap rates
Plan provides all primary, acute, and HCBS Pooled caps eliminate incentive to cost shift to Medi-Cal Demo provides basis for study w/counties that have only
Medicare SNPs for duals:– Comparing Medi-Cal costs and consumer outcomes– Analyzing impact to IHSS program
State learns impact of new Medicare program on Medicaid costs of enrolled duals in CA
For more information: See website for background & info:
www.sdltcip.org
– Call or e-mail: [email protected],
858-495-5428 or [email protected],
858-694-3252
