San Diego Long Term Care Integration Project (LTCIP) April 13, 2005 LTCIP Planning Committee

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 value of federal & state funding

San Diego County Board of Supervisors & State Office of Long Term Care Jean Shepard, Director County 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 Health Plan Partners Workgroup Finance/Data Workgroup Options Workgroup Internet Facilitates communication Provides broad public education Pamela B. Smith, Project Director Evalyn Greb, Project Manager Aging & Independence Services Lead County Agency MH & SA Workgroup Explore use of the Healthy San Diego model for potential Service delivery system for LTCIP. Determine the financial feasibility of the proposed LTCIP for San Diego County. Make recommendations to Planning Committee re: inclusion of mental health and substance abuse services in LTCIP. LTCI Strategies: 1) Network of Care 2) Physician Strategy 3) Healthy San Diego Plus Ad Hoc workgroups: Care Management, Provider Network Development, Cultural Responsiveness Governance -Case Management -Info/Technology -Quality Assurance -Scope of Services -Workforce Issues -Developmental Disabilities -Community Network Development Community Education Workgroup 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

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

HSD/Healthy San Diego Plus Relationships Joint Committee  Diverse stakeholder representation Health Plans MOU’s County (Operating Agency) ** State

Medi-Cal Redesign & ALTCI n Option to mandatory primary & acute n 3 counties to enroll Medi-Medis n Pooled Medi-Cal (& Medicare for duals) health and supportive service $$ n From defined benefit list to what individual needs/prefers

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

Key ALTCI Features n Enrollment n Care Management n Provider Networks n Member Services n Quality Assurance/Improvement n 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 utilized elsewhere – Often used in combination -End goal is to design a model that matches reimbursement to risk (with the right incentives)

Reimbursement Model Continued 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 Goal is to assess the overall sufficiency of Medicare reimbursement for the dual eligible members

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 n 6/30/05: Consultant recommendations n 7/05 – 12/05: Stakeholders consider, revise, and reach consensus n 1/06 - 3/06: County/BOS approval n 3/06 – County, State DHS, CMS begin working toward implementation n 3/1/07 – Begin enrollment in HSD+

Afternoon Breakout Groups n Provider Network n Care Management n Community & Cultural Responsiveness

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