san diego long term care integration project (ltcip)
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San Diego Long Term Care Integration Project (LTCIP). Mental Health & Substance Abuse Working Committee October 21, 2003. Community Planning Process. Grass-roots effort to improve system of care for long term care consumers and providers - PowerPoint PPT PresentationTRANSCRIPT
San Diego Long Term Care Integration Project (LTCIP)
Mental Health & Substance Abuse Working Committee
October 21, 2003
Community Planning Process
Grass-roots effort to improve system of care for long term care consumers and providers
From 50 to 550+ key stakeholders over past 4 years: 10,000+ hours
Agreement to use existing providers, assure fair compensation
Planning within state LTCIP authorization, AB 1040 (form follows funding)
San Diego County Board of Supervisors&
State Office of Long Term Care
Rodger G. Lum, Ph.D, DirectorCounty 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 service delivery
model decision
Suspended Workgroups pending service delivery
model decisionHealth Plan Workgroup
Health Plan Workgroup Finance/Data
Workgroup
Finance/DataWorkgroup Options Workgroup
Options Workgroup
Internet• Facilitates
communication• Provides broad public
education
Pamela B. Smith, Project DirectorEvalyn Greb, Project ManagerAging & Independence Services
Lead County Agency
Mental HealthWorkgroup
Mental HealthWorkgroup
Explore use of the Healthy SanDiego model for potentialService delivery system for LTCIP.
Determine the financialfeasibility of the proposedLTCIP for San Diego County.
Make recommendation to Planning Committee re: inclusion of mentalhealth and substance abuse services in LTCIP.
Incremental LTCI Strategies:1) Network of Care2) Physician Strategy3) Health Plan Pilots
Governance-Case Management-Info/Technology-Quality Assurance-Scope of Services-Workforce Issues-Community Network Development
Developmental DisabilitiesWorkgroup
Developmental DisabilitiesWorkgroup
Make recommendation to PC re: inclusion of persons with developmental disabilities in LTCIP.
Long Term Care Integration Project
Organizational Chart & Decision Tree
8/2003
Legislative Authority
AB 1040 in 1995 (revised in 1998) State Office of LTC:
– provides planning $$– provides “Center” resources– provides liaison with other state programs– approves local activity toward LTCI– will assist in procuring federal waivers
San Diego LTCIP Stakeholder Vision for Elderly & Disabled Develop service delivery “system” that:
– provides continuum of all health, social and support services that “wrap around consumer” w/prevention & early intervention focus
– pools associated (categorical) funding– is consumer driven and responsive– expands access to/options for care
Stakeholder Vision (continued)
– Fairly compensates all providers w/rate structure developed locally
– Engages MD as pivotal team member– Decreases fragmentation/duplication
w/single point of entry, single plan of care– Improves quality & is budget neutral– Implements Olmstead Decision locally– Maximizes federal and state funding
Why change?
Impact of demographics on healthcare Cost containment vs. care management Health & support service fragmentation Categorical admin $$ to service $$ Consumer/outcomes not current focus
Client Referral Patterns
From Vision to Service Delivery Model…
CUSTOMER ACCESS w ith LTCIP
Customer At Home/Community
Care Manager w/ Network of Care
IncomeAsst.
SeniorCntr.
In-homecare
HICAP
MedicalClinic/Health
Care
BloodPressure
Cks
ShoppingAsst. Mental
Health
Transp.
Escort
housingRehab
Intake Worker InformationProvided
From LTCIP Vision to Service Delivery Model… Explore Healthy San Diego due to:
– Access, education, prevention– Advocacy– Cost-effectiveness– Population-based– Existing infrastructure– Stakeholder-designed, BUT
HSD Currently Does NOT…
Tailor the program for chronic care or aged and disabled persons
Provide “wraparound” services Provide chronic care management on a
population basis Receive adequate reimbursement for
chronic care Have much info on “duals”
Where are we now? BOS: “come back with 3 options” Dr. Mark Meiners strategies/looking for
“consortium of funding”:– Network of Care– Physician Strategy – HSD Health Plan Pilots
Administrative Action Plan for FY 2003-04 State Development Grant
Establishment of Mental Health Workgroup
Network of Care Testing with
– consumers and caregivers– community based organizations– other providers, Call Center staff
To develop “continuous quality improvement” program
Measure behavior changes of providers and consumers
Physician Strategy Partner w/physicians vested in chronic care Develop interest/incentive for support of “after
office” services (HCBC) Identify care management resources to
support physicians/office staff to link patients and communicate across systems
Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports
Health Plan Pilots Pilots to do small, voluntary models of care
integrated across the health, social, and supportive services continuum:– Evercare (or any other private healthcare entity) to
contract with State if stakeholders agree (AB43)– Healthy San Diego Health Plans to develop pilot
with consultant resources Stakeholders currently providing feedback on
consultant team’s final report
Mental Health & SA Today Current Medi-Cal carve-out (UBH) Limited Medicare reimbursement LTCIP stakeholders want no carve-outs Mental health and substance abuse problems
under-diagnosed & under-treated Quality of life and cost impact of untreated
mental illness/substance abuse is huge Most state integration projects do not enroll
disabled w/primary MH diagnosis Seniors do not self-identify as having MH &/or
SA issues; don’t use MH Centers/SA services
Mental Health and LTCIP Establishment of Mental Health Workgroup to:
– hear from broad array of stakeholders – focus on consumer as “whole” in system– develop plan specific to San Diego and LTCIP
How do we “mainstream” mental health and substance abuse services for aged and disabled?– parity w/physical health for treatment– age-, disease-specific treatment– delivered as “part of the whole”– viewed within greater context of health
LTCIP Mental Health & Substance Abuse Workgroup Goal: Make recommendation to Planning
Committee on inclusion of mental health and substance abuse programs, populations, and services
Establishment of this Working Committee Importance of consensus (consumers &
providers) on a recommendation Forward recommendation to larger
Workgroup by January 2004