San Diego Long Term Care Integration Project (LTCIP)

April 13, 2005

LTCIP Planning Committee

San Diego Stakeholder LTCIP Vision for Elderly & Disabled 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 value of federal & state funding

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

April 2005

Client Referral Patterns

Journal of the American Geriatrics Society, Feb. 1997

In-HomeServices

DayHealthCare

AcuteHospital

TransitSkilledNursingFacility

MedicalSpecialty

MealsService

PrimaryCare

MRS.C.

Ideal System

Mrs. C & Care

Manager

HSD/Healthy San Diego Plus Relationships

Joint Committee

Diverse stakeholder representation

Health Plans

MOU’s

County (Operating Agency)

* *

State

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

Key ALTCI Features

Eligible Population Scope of Benefits Plan Selection/Administration/Rates Medicaid waivers Medicare participation Member Outreach & Education

Key ALTCI Features

Enrollment Care Management Provider Networks Member Services Quality Assurance/Improvement Information Technology

Reimbursement Model

1)Recommendations for capitation reimbursement model for ALTCI (i.e., payment structure from the State)- Build off other analyses – Use joint Medi-Cal and

Medicare data set- Identify the major cost drivers (i.e.,

demographics, dual eligibility, service setting,disease states, and etc.)

- Consider reimbursement mechanisms utilizedelsewhere – Often used in combination

- End goal is to design a model that matches reimbursement to risk (with the right incentives)

Reimbursement ModelContinued

2)Analyze Medicare Reimbursement- State want to require all contractors/health plans

to also participate in Medicare Advantage - Apply current Medicare payment adjusters based

on historical claims data- Compare results to actual claims cost and

trend both (reimbursement and costs) forward to 2006

- Goal is to assess the overall sufficiency of Medicare reimbursement for the dual eligiblemembers

Information Technology

1)Survey consumers, providers, and other stakeholders- Assess current community Information

Technology capacity and utilization- Identify desired potential uses and functionality- Surveys are available electronically or hard-copy

2)Recommend design of Web-based IT system to support ALTCI- Prioritize development of the system, as it will

likely be developed over several phases

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+

Afternoon Breakout Groups

Provider Network

Care Management

Community & Cultural Responsiveness

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 evalyn.greb@sdcounty.ca.gov or 858-694-3252 or sara.barnett@sdcounty.ca.gov