BUILDING A COMMUNITY SYSTEM FOR

EVERYONE: MINNESOTA’S INITIATIVE TO CREATE A

CROSS-DISABILITY AND AGING SERVICE

SYSTEM

Reinventing Quality 2014 Conference

August 4, 2014

Alex Bartolic, Director, Disability Services Division

Jean Wood, Director, Aging and Adult Services Division

Minnesota Department of Human Services

OVERVIEW OF PRESENTATION

Minnesota’s Approach to LTSS

History and Context

Cross-Population Initiatives

Transformation Initiatives

Reform 2020

Additional Cross-Population Initiatives

MINNESOTA’S APPROACH TO LONG-

TERM SUPPORTS AND SERVICES

MN DEPARTMENT OF HUMAN SERVICES

ORGANIZATIONAL CHART

4

MN DEPARTMENT OF HUMAN SERVICES

ORGANIZATIONAL CHART

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MINNESOTA’S LTSS SYSTEM

Local and Regional Administration

Lead agencies

Counties: assess eligibility and provide case management

for Medicaid Waiver FFS programs serving primarily

people with disabilities under age 65

Health Plans: administer the public managed care

programs that provide LTSS to the majority of Medicaid

Waiver-eligible older adults

Tribes: two tribes assess eligibility and provide case

management for Medicaid Waiver FFS programs

Area Agencies on Aging: administer Pre-Admission

Screening, contract for Older Americans Act-funded

services, partner with providers to develop services

to fill gaps

CCA MISSION

Improve the dignity, health and independence of the people we serve

CCA VISION

Minnesotans have choices in how they receive services and how they live their lives

C ─ Community membership / integration

H ─ Health, wellness and safety

O ─ Own place to live

I ─ Important long-term relationships

C ─ Control over supports

E ─ Employment earnings and stable income

CONTINUING CARE ADMINISTRATION

MISSION AND VISION

CONTINUING CARE ADMINISTRATION

VALUES

Choice & Independence for the people CCA serves

Stewardship of human service resources

Self-determination and personal responsibility by the people CCA serves

Integrity by CCA and others

Diversity because our differences make us strong

Partnerships and collaboration, with clear roles, responsibilities and accountability for ourselves and others

Accountability

CONTINUING CARE ADMINISTRATION

STRATEGIC PLAN

Current plan was developed in 2010 for State Fiscal

Years 2011-2015.

1. To support and enhance the quality of life for older

people and people with disabilities.

2. To manage an equitable and sustainable long-term

care system that maximizes value.

3. To continuously improve how we administer services.

4. To promote professional excellence and engagement

in our work.

9

HOME AND COMMUNITY BASED SERVICES

Waivers

Developmental Disabilities

Community Alternatives for Disabled Individuals

Community Alternative Care

Brain Injury

Elderly

Home Care

State-funded service examples:

Alternative Care program

Family Support Grants

Semi-Independent Living Services

Older Americans Act services

HISTORY AND CONTEXT

HISTORY AND CONTEXT

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De-Institutionalization

Olmstead

Decision

Older Americans Act

Home and Community-Based Services Waivers

Americans with Disabilities Act

Welch Decree

Long-Term

Care Task

Force Report

Consumer

Direction

Managed

Care

models

Affordab

le Care

Act

New technology

Re-balancing Long-Term Care

MOUNTING PRESSURES ON THE LONG-TERM

CARE SYSTEM

Growing demand

Constrained resources

Increased complexity

LEVERAGING COMPLEX PRESSURES TO

ACHIEVE BETTER OUTCOMES FOR PEOPLE

Opportunity:

Build a framework for a more effective system

Efficiencies for sustainability

Data to drive best practices & innovation

Better outcomes for the person

TRANSFORMING TO ACHIEVE OUR MISSION

Promoting equity across individuals, lead agencies, providers

Providing quality services that can be measured and maximized

Operating with more transparency, efficiency, consistency

Leveraging all viable resources to reduce dependence on public funds

Continuously improve how we administer services

INDIVIDUALS BEFORE PROGRAMS

From “What do you qualify for?”… to “What is important to you, and for you to live the life you choose?”

Respect individual’s desire for more autonomy and control

Transition to a strengths-based assessment and support planning process with equitable solutions

LONG-TERM SOLUTIONS

SUPPORT INDEPENDENCE

Value abilities, respect needs, empower choice

Engage individuals in planning toward their goals

Connect individuals to resources to bring their plans to life

BUILD A SUSTAINABLE SYSTEM

Leverage partnerships, collaboration, community resources to achieve best results

Support system-wide coordination, continuous quality improvement

Use technology-based tools that work across systems to support consistency, efficiency

CONCEPTUAL FRAMEWORK:

HCBS SYSTEM NOW

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CONCEPTUAL FRAMEWORK:

NEW HCBS SYSTEM

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EARLY CROSS-POPULATION INITIATIVES

MINNESOTA’S AGING AND DISABILITY

RESOURCE CENTER (ADRC)

Early and ongoing example of Quality

Architecture in action

15 years of experience developing a shared

platform to support informed choice

Provides a platform for other initiatives;

sometimes “same”, sometimes “different”

Minnesotahelp.info

Disability Linkage Line®

Senior LinkAge Line®

Veterans Linkage LineTM

Disability Benefits 101

BUILDING SHARED INTERNAL SYSTEMS

Quality Essentials Team

Performance Measures Initiatives Team

Fiscal Analysis Collaboration Team (FACT)

Business Information Technology Solutions

CURRENT MAJOR CROSS-POPULATION

INITIATIVES

TRANSFORMATION INITIATIVES

MnCHOICES

One assessment process takes the place of three (DD screening, LTC consultation, PCA assessment—and in the future, PDN assessment)

People will have an assessment and support planning that identifies their individual preferences, strengths and needs

People will be assessed equitably across populations and geography

People will have access to more support options in one process

HCBS Waiver Provider Standards

Basic standards will be consistent and have a consistent enforcement mechanism

People will have health, safety and rights protections

People have choice of the provider they wish to use

Providers will have specializations, and services are customized to the person’s plan

Disability Waivers Rates System

There will be statewide, uniform methodologies used to determine the rate for each service

Rates will reflect the person’s support plan

Customized Living Rate Methodology for the Elderly Waiver

Rates reflect the support plan and type/frequency of services to be provided

REFORM 2020

Bi-partisan initiative to reform MA

Effort to meet the challenges of rising MA costs and

growing demand

Opportunity to develop/test new ways of operating;

successful models will be expanded and in place by

2020

Several foundational transformation projects,

already underway, set the platform for other

reform efforts

Some initiatives require approval and/or

participation of the federal government

Several initiatives require state legislative action

REFORM 2020 – EXAMPLES OF INITIATIVES

Community First Services and Supports

Converting current PCA program to Community First option to gain flexibility in services and delivery models

First Contact Initiative

Pre-Admission Screening federal requirements

Increased upstream engagement

Vulnerable Adult Common Entry Point

One statewide CEP

Better data tracking, allowing improved response to emerging trends and issues

ADDITIONAL EXAMPLES

National Core Indicators

HCBS Report Card and Quality Add on

CMS HCBS Rule Criteria and Transition Plan

LTSS Gaps Analysis

Personal Health Record for LTSS Demonstration

MINNESOTA’S OLMSTEAD PLAN

2013: Release of Putting Olmstead’s Promise into

Practice: Minnesota’s 2013 Olmstead Plan

Working across state agencies to address goals

related to:

Employment

Housing

Transportation

Supports and Services

Lifelong Learning and Education

Healthcare and Healthy Living

Community Engagement

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WORKING WITH STAKEHOLDERS

Challenge: systems have different approaches

Continually working to discern “what’s the same/what’s different”

Working to do a better job hearing the voices of those who use services

Determine if we need to be Autonomous, Coordinated or Integrated

STAKEHOLDER VENUES

HCBS Partners Panel

46 organizations crossing aging and disability represented

DSD and AAS leadership are members

Charge: support continuous improvement in the HCBS system by providing communication link among the system’s stakeholders and by supporting specific initiatives They talk to each other, not just to talk to the State

Project work groups

Almost all initiatives have work groups that include external stakeholders

State Quality Council

Not just there to provide feedback/input—they help do the work

Support building a quality system that is person-directed, outcome-based, quality-driven and effective in its use of public funds

LESSONS LEARNED

LESSONS LEARNED: HAVE A THEORETICAL

BASE

From Glenda Eoyang, Human Systems

Dynamics

LESSONS LEARNED: COMMUNICATIONS

ARE CRITICAL

From Glenda Eoyang, Human Systems

Dynamics

FOR MORE INFORMATION

HOW IT ALL FITS TOGETHER

FOR MORE INFORMATION

Continuing Care Administration’s Strategic Plan

http://www.dhs.state.mn.us/main/groups/disabilities/document

s/pub/dhs16_172066.pdf

MN’s State Profile of LTSS System

http://www.dhs.state.mn.us/main/groups/aging/documents/pub

/dhs16_144888.pdf

Biennial Report on LTSS for People with

Disabilities

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6656-ENG

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Minnesota’s Olmstead Plan

http://www.dhs.state.mn.us/main/groups/olmstead/docu

ments/pub/dhs16_180147.pdf

DHS dashboards

http://dashboard.dhs.state.mn.us/

Public reporting/performance

management http://www.dhs.state.mn.us/main/dhs16_144803

FOR MORE INFORMATION, CONT.

MnCHOICES http://mn.gov/dhs/partners-and-providers/continuing-care/reform-

initiatives/mnchoices/

Provider Standards and Provider

Enrollment initiative http://mn.gov/dhs/partners-and-providers/continuing-care/reform-

initiatives/provider-standards/waiver-provider-standards.jsp

Disability Waiver Rates initiative http://mn.gov/dhs/partners-and-providers/continuing-

care/reform-initiatives/rate-setting/disability-waiver-rates.jsp

FOR MORE INFORMATION, CONT.

2012 LTSS Gaps Analysis http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA

MIC_CONVERSION&RevisionSelectionMethod=LatestReleased

&dDocName=dhs16_141764

FOR MORE INFORMATION, CONT.