San Diego Long Term Care Integration Project (LTCIP) September 14, 2005 LTCIP Planning Committee

Medi-Cal Redesign On Hold n Mandatory Medi-Cal Managed Care for Aged, Blind, and Disabled (ABDs) clients in all current managed care counties n Implement Acute and Long Term Care Integration (ALTCI) Projects in Contra Costa, Orange, and San Diego to test innovative approaches for enabling more individuals to receive care in setting that maximizes community integration

Health San Diego Plus (HSD+) n Medi-Cal Aged, Blind, and Disabled offered voluntary enrollment in LTC Integrated Plan in San Diego (HSD+) n Models of care integrated across the health, social, and supportive services continuum: –Private entity to contract with State through RFP with stakeholder support –Healthy San Diego Plus Health Plans to develop program details with consultant resources

Health Plan Readiness n Analysis of relevant use and cost data n Network adequacy assessment n Care Coordination and Care Management n Carve outs n Quality monitoring and improvement n Linkage with non- Medi-Cal Services n Linkage with Medicare Special Needs Plans n Stakeholder input in implementation

Community Feedback on Stakeholder Recommendations n Provider Networks & Member Services n Care Management n 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 n 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? n 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 n Workgroup Facilitator: Jong Won Min, PH.D.

San Diego Stakeholder LTCIP Vision for Elderly & Disabled n Develop “system” that: –provides continuum of health, social and support services that “wrap around consumer” w/prevention & early intervention focus –pools associated (categorical) funding –is consumer driven and responsive –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 federal and state funding

SD LTCIP Components n Board of Supervisors: “come back with 3 options” for LTCIP n Since then: Strategy development: –Network of Care –Physician Strategy –Healthy San Diego Plus

Network of Care n Beta testing with –consumers and caregivers –community based organizations –other providers, Call Center staff n To develop “continuous quality improvement” program n Measure behavior changes of providers and consumers

Physician Strategy n Partner w/physicians vested in chronic care n Develop interest/incentive for support of “after office” services (Home and Community Based care-HCBC) n Identify care management resources to support physicians/office staff to link patients and communicate across systems n Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports

ALTCI Building Blocks n Stakeholder Process n Community Education and Outreach n Care Coordination Improvement n Community Network Development n Community & Cultural Responsiveness n Personal Care Workforce Support n Integrated IT Development n Primary Care Teams/Physician support n Quality Monitoring and Measurement

How to influence planning? n Get on LTCIP mailing list for updates n Log onto website for background & info: n Participate in meetings n Call or input/ideas: or or or