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2014 Truven Health Analytics Inc. Paul Saucier State Approaches to Integrating Care LTQA/NCHC Capitol Hill Forum April 24, 2014
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2012 Truven Health Analytics Inc. Traditionally, state Medicaid-funded medical systems, long term services and supports (LTSS) systems, and mental health systems have operated on parallel planes, and all 3 of these Medicaid systems have been very separate from Medicare Increasingly, states are turning to integrated care models to: Improve outcomes Enhance experience Reduce costs Streamline administration In particular, states have moved rapidly to integrate LTSS with medical services in Medicaid-only models and Medicaid-Medicare models OVERVIEW 2
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2012 Truven Health Analytics Inc. AZ NC WI NY CA 19 STATES HAD INTEGRATED LTSS AND MEDICAL CARE TO SOME EXTENT AS OF APRIL 2014, UP FROM 8 IN 2004 NM MN MI IL WA KS TN TX PA FL DE MA HI 3 RI MLTSS implemented 1989-2004 MLTSS implemented 2005-2014
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2012 Truven Health Analytics Inc. THE NUMBER OF LTSS USERS IN INTEGRATED PROGRAMS IS PROJECTED TO DOUBLE THIS YEAR 4 YearStatesLTSS Enrollees 20048105,000 201216389,000 201319554,000 2014 (projected) 241,170,000 Sources: 2004 and 2012: The Growth of MLTSS Programs: A 2012 Update (Truven Health for CMS) 2013 and 2014: Truven Health estimates.
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2012 Truven Health Analytics Inc. Care coordinator role is key: Assesses the consumer’s needs and preferences Works with PCP and multiple other parties to plan, authorize and coordinate services Monitors service plan Follows consumer across settings and through transitions of care Uses multiple methods to facilitate information transfer across multiple parties HOW IS CARE INTEGRATED? 5
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2012 Truven Health Analytics Inc. POPULAR IMAGE OF AN INTERDISCIPLINARY TEAM MEETING 6 PCP Specialist Physical TherapistDaughterSocial Worker Pharmacy Consultant Care CoordinatorConsumer
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2012 Truven Health Analytics Inc. REAL WORLD CARE COORDINATION 7 PCP Care CoordinatorConsumer Rx ConsultantSpecialist Home Care ProviderDaughterSocial Worker State/County Social Services, CBOs Phone F-to-F (home) F-to-F (co-located) Electronic Transfer Phone, Fax F-to-F (office visit) PhoneF-to-F (team mtg) Phone, Fax Internal Info System Phone Electronic Transfer EMR F-to-F (in-home services) Phone F-to-F (office visit) Phone F-to-F (home) Internal Info System F-to-F (team mtg) Phone, Fax Phone, Fax, Electronic Authorization Phone, F-to-F
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2012 Truven Health Analytics Inc. Qualifications Nurses, social workers, degrees, experience Contact with consumers Face-to-face almost always required, but intervals vary Person-centered planning Language is prevalent, details are rare Caseload ratios If specified, generally differ by risk category Partnerships with community based organizations that have traditionally provided coordination of LTSS A few states mandate relationships, but allow discretion in the nature of relationship STATES VARY CONSIDERABLY ON HOW DETAILED THEY MAKE CARE COORDINATION SPECIFICATIONS 8
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2012 Truven Health Analytics Inc. Role of traditional care coordination agencies (AAAs, CILs, and other CBOs) HIT in LTSS agencies Interoperability across systems Measures of integration and LTSS WORK IN PROGRESS 9
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paul.saucier@truvenhealth.com
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