San Diego Long Term Care Integration Project Presentation to: LTCIP Planning Committee April 12, 2006

Agenda items 1. Three-Strategy Overview and Update 2. Discussion of Recommendations to Board of Supervisors 3. Physician Strategy Implementation Plan

Mrs. C n 84 year old woman lives alone n CHF, HTN, diabetes, hearing and vision loss, IADL dependencies n 16 medications by 6 physicians n Medicare and Medi-Cal beneficiary n Only child lives in Chicago

Journal of the American Geriatrics Society, Feb In-Home Services Day Health Care Acute Hospital Transit Skilled Nursing Facility Medical Specialty Meals Service Primary Care MRS. C. Ideal System Mrs. C & Care Manager

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

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

NOC Update n AoA & CMS funds of $610,000 (3 yrs) n For “Aging & Disability Resource Center n Goals: provide improved access to LTC, communication across continuum, build on existing resources n Activity: surveys, Call Centers, CBOs input leads to improvements n Next: test fixes then media/PR/outreach to underserved communities

BOS Recommendation for NOC/ADRC Accept the Annual Report on the Network of Care/ADRC Strategy

Healthy San Diego Plus Update n Personal Care Services Workgroup n Governor’s proposal n Stakeholder support n Decision re: Governor’s proposal

Governor’s Proposal Highlights n GMC counties: HSD+ for Medi-Medi’s n Voluntary enrollment, 5 year pilot n IHSS not included n Dual capitation from Medicare and Medi-Cal to support preference, home and community-based care (including PCS) to avoid high-cost utilization (hospital, ER, SNF)

BOS Recommendations for HSD+ Approve the development of a voluntary pilot called Healthy San Diego Plus (HSD+) for acute and long term care integration, based on the Governor’s “Access Plus” proposal, with authority for the HHSA Director to implement any necessary program changes. Direct staff to seek the appropriate venue for necessary legislative changes for HSD+. Approve grant applications and receipt of grant funds from the State Department of Health Services and the California Health Care Foundation; to complete readiness activities for HSD+.

Physician Strategy—Planning Phase n Fee-for-service initiative to improve chronic care management n Partner w/physicians vested in chronic care n Develop interest/incentive for support of HCBC n Implementation Plan for continued funding n Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports n Funding: $142,000 (planning) CA Endowment

Physician Strategy Update n 50 physicians engaged in initiative at varying levels n Compiled list of barriers to improved chronic care n LTCIP CBOs engaged in problem- solving discussions with docs n Draft Implementation Plan developed for additional 3 years of funding

BOS Recommendation for Physician Strategy Accept the Physician Strategy Final Planning Phase Report and proposed Implementation Plan

Implementation Plan Proposal (FY 06-09) n Community Care Training/Team-Building –Chronic Care Management –Understanding aged and disabled populations and needs –Collaboration techniques across health and social service providers –Finding resources for community-based services, patient education material, communication with other providers, etc.

Next Steps n 50 physicians have been invited to review and provide input n Invite out to expand physician participation to more caring for underserved/minorities n Revise Plan with input of docs n Grant application to CA Endowment n May PC meeting: Medicare FFS pilots

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