San Diego Long Term Care Integration Project LTCIP Planning Committee October 11, 2006
Strategies Developed to Support “Vision” n Aging & Disability Resource Center n Physician Strategy n Healthy San Diego Plus
California Endowment Proposal San Diego Team Resources to build a local social network of chronic care innovators across sectors, setting, and funding by: –Community development of “team dynamic” through joint provider education –Enhancement of available IT communication supports for docs, office staff, ancillary and community providers, consumers, caregivers
Key Elements of San Diego Team –Work with the UCSD Geriatric Education Center to: Influence geriatric training Improve coordination between disciplines Promote national policy improvements –Listen to doctors and other providers to develop additional policy improvements within LTCIP
Healthy San Diego Plus (HSD+) n Medi-Cal Aged, Blind, and Disabled offered voluntary enrollment in LTC Integrated Plan n Models of care integrated across funding & the health and social services continuum: –Health Plans to contract with State and CMS through RFP with local pre-qualification –HSD+ Health Plans to develop program details with consultant resources
Medicare Special Needs Plans (SNPs) Allows a SNP to restrict enrollment for certain categories of special needs individuals n Institutional Beneficiaries (in or expected to reside >90 days; Community NHC) n Dually Eligible (subsets of duals OK now with State partner) n Beneficiaries with Severe and Disabling Chronic Conditions (untested to be evaluated on case by case; e.g. disease specific) SNP Lumpers vs. Splitters!
CMS Guidance to Integrating Medicare/Medicaid n How to coordinate marketing of Medicare and Medicaid to duals. n How to do streamlined MC enrollment of duals. n How to do MC quality integration for duals. n How to support State targeted SNP enrollments. n Clarity in bidding process to enable State savings. n Model SNP/State/CMS integrated relationship n Improved quality measures for SNP populations