San Diego Long Term Care Integration Project

1
San Diego Long Term Care Integration Project

• LTCIP Planning Committee
• December 13, 2006

2
Strategies Developed to Support Vision

• Network of Care/Aging Disability Resource
  Center
• Physician Strategy
• Healthy San Diego Plus

3
Network of Care/ADRC

• Activity to-date
• Supplemental Grant Access Center
• Focus of next 6 months

4
California Endowment Healthcare Alliance
ProposalTEAM SAN DIEGO

• 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

5
Healthy San Diego Plus (HSD)

• Governors 2006 Budget proposal Medicare HMO
  Wraparound
• Medicare Advantage Part D (MAPD)
• or
• Medicare Special Need Plan (SNP) for duals
• Medi-Cal contract for wraparound services
  (ADHCSNF)
• Looks like MassSCO, except for 21 yo-64 yo
• Runs parallel to, exclusive of, IHSS

6
Medicare Special Needs Plans (SNPs) for Dual
Eligibles

• Requires health plans to provide all regular
  Medicare acute and primary care and coordinates
  services with Medi-Cal
• Several plans to start enrolling in San Diego in
  January 2007, many more at State level
• Health policy experts predict increased Medi-Cal
  costs. Why? Medi-Cal not included in cap rate
  to SNPs

7
HMO Wraparound Demo

• MAPD or dual SNP pre-qualified locally
• contracts w/DHS ( CMS?)
• takes risk, gets actuarially sound cap rates
• Plan provides all primary, acute, and HCBS
• Pooled caps eliminate incentive to cost shift to
  Medi-Cal
• Demo provides basis for study w/counties that
  have only Medicare SNPs for duals
• Comparing Medi-Cal costs and consumer outcomes
• Analyzing impact to IHSS program
• State learns impact of new Medicare program on
  Medicaid costs of enrolled duals in CA

8
For more information

• See website for background info
  www.sdltcip.org
• Call or e-mail evalyn.greb_at_sdcounty.ca.gov,
• 858-495-5428 or sara.barnett_at_sdcounty.ca.gov,
• 858-694-3252