1. Inland Comprehensive Health Care Community Care Management, Serving Unincorporated Regions of San Diego County

2. Bruce L. Baumann Executive Director Inland Comprehensive Health Care

3. Cindy Hasz Community Liaison Inland Comprehensive Health Care Cindy Hasz Community Liaison Inland Comprehensive Health Care

4. Charles Fraley Health Care Consultant Inland Comprehensive Health Care

5. Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

6. Senior Population Growth in the Unincorporated Regions of San Diego County Estimated Growth: 2000 – 2030 185 % 2002 Seniors 14% 2030 Seniors 33% Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

7. Looming Doctor Shortage in San Diego County Estimated 1500 Vacant Nursing Positions in San Diego County Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

8. Vision  A Comprehensive, Integrated continuum of long-term care services.  A Matrix of “Community Care Management” (“Wrap Around Services” “Safety Net”)  Enables the elder patient to avoid nursing home placement and/or navigate the system in accordance with their changing needs.  Affordable Nurse Case Management offered on a sliding scale.  Nurse Case Management delivered in coordinated and therapeutic manner.  Increased access to existing services.  Increased availability of health care.  Increased information and education of health issues.  Improved quality of life! Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

9. Directive  Contracted Providers using the socio-medical “Community Care Management” model.  Use of existing community providers to optimal levels.  Invitations to other providers to service underserved communities.  Facilitation of community health information and education. Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

10. Scope  Serving the senior, frail and homebound population in the communities of Ramona and Julian at first, then expanding to the other rural underserved communities.  Long term plans to serve the larger population. Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

11. Benefits · Home and Community Based Care · Individual consumer directed · Increases access to/and options for care · Improves outcomes and satisfaction · Using resources more creatively and cost effectively · Decreases ER visits/burden on overtaxed health care system. Improved quality of life! Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

12. Client Referral Patterns

16. A Tale of Two Systems Managed Care and Care Management Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County

17. LONG TERM CARE IN: ACUTE SYSTEM CHRONIC SYSTEM Starting Point Vertical Horizontal Institution centered Patient centered Facility-Stationary Residence-Mobile Crisis based Maintains Normalcy Method of Delivery Single-system based Partnership based Managed Care Care Management Insurance Fee for service Character of System RIGID DYNAMIC Fixed-Slow-Inefficient Flexible-Fast-Efficient Functional Outcome Emergency Resolved Homeostasis Maintained Inland Comprehensive Health Care

18. ACUTE Vertical Managed Care Institution Centered Rigid Crisis Emergency VARIABLE Current Managed Care System

19. CHRONIC Horizontal Care Management Patient Centered Dynamic Homeostasis STABLE Community Care Management

20. ACUTE CHRONIC The Acute/Vertical and Chronic/Horizontal Cross; This Allows For The Best Utilization Of Both Systems

21. Community Care Management: Choice Dignity Quality of Life. Inland Comprehensive Health Care Community Care Management, Serving the Unincorporated, Rural Regions of San Diego County