San Diego Long Term Care Integration Project

1
San Diego Long Term Care Integration Project

• Presentation to
• LTCIP Planning Committee
• April 12, 2006

2
Agenda items

• Three-Strategy Overview and Update
• Discussion of Recommendations to Board of
  Supervisors
• Physician Strategy Implementation Plan

3
Mrs. C

• 84 year old woman lives alone
• CHF, HTN, diabetes, hearing and vision loss, IADL
  dependencies
• 16 medications by 6 physicians
• Medicare and Medi-Cal beneficiary
• Only child lives in Chicago

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(No Transcript)
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Ideal System
Mrs. C Care Manager
Journal of the American Geriatrics Society, Feb.
1997
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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

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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 federal and state funding

8
NOC Update

• AoA CMS funds of 610,000 (3 yrs)
• For Aging Disability Resource Center
• Goals provide improved access to LTC,
  communication across continuum, build on existing
  resources
• Activity surveys, Call Centers, CBOs input leads
  to improvements
• Next test fixes then media/PR/outreach to
  underserved communities

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BOS Recommendation for NOC/ADRC

• Accept the Annual Report on the Network of
  Care/ADRC Strategy

10
Healthy San Diego Plus Update

• Personal Care Services Workgroup
• Governors proposal
• Stakeholder support
• Decision re Governors proposal

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Governors Proposal Highlights

• GMC counties HSD for Medi-Medis
• Voluntary enrollment, 5 year pilot
• IHSS not included
• Dual capitation from Medicare and Medi-Cal to
  support preference, home and community-based care
  (including PCS) to avoid high-cost utilization
  (hospital, ER, SNF)

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BOS Recommendations for HSD

• Approve the development of a voluntary pilot
  called Healthy San Diego Plus (HSD) for acute
  and long term care integration, based on the
  Governors Access Plus proposal, with authority
  for the HHSA Director to implement any necessary
  program changes.
• Direct staff to seek the appropriate venue for
  necessary legislative changes for HSD.
• Approve grant applications and receipt of grant
  funds from the State Department of Health
  Services and the California Health Care
  Foundation to complete readiness activities for
  HSD.

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Physician StrategyPlanning Phase

• Fee-for-service initiative to improve chronic
  care management
• Partner w/physicians vested in chronic care
• Develop interest/incentive for support of HCBC
• Implementation Plan for continued funding
• Train on healthy aging, geriatric/chronic disease
  protocol, pharmacy, HCBC supports
• Funding 142,000 (planning) CA Endowment

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Physician Strategy Update

• 50 physicians engaged in initiative at varying
  levels
• Compiled list of barriers to improved chronic
  care
• LTCIP CBOs engaged in problem-solving discussions
  with docs
• Draft Implementation Plan developed for
  additional 3 years of funding

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BOS Recommendation for Physician Strategy

• Accept the Physician Strategy Final Planning
  Phase Report and proposed Implementation Plan

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Implementation Plan Proposal (FY 06-09)

• Community Care Training/Team-Building
• Chronic Care Management
• Understanding aged and disabled populations and
  needs
• Collaboration techniques across health and social
  service providers
• Finding resources for community-based services,
  patient education material, communication with
  other providers, etc.

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Next Steps

• 50 physicians have been invited to review and
  provide input
• Invite out to expand physician participation to
  more caring for underserved/minorities
• Revise Plan with input of docs
• Grant application to CA Endowment
• May PC meeting Medicare FFS pilots

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For more information

• Log onto website for background info
  www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
  
• Call or e-mail evalyn.greb_at_sdcounty.ca.gov,
  858-495-5428 or sara.barnett_at_sdcounty.ca.gov,
  858-694-3252