Missouri Comprehensive Entry Point Subcommittee

1
Missouri Comprehensive Entry Point Subcommittee

• Consideration of Recommendations
• September 15, 2008
• Jefferson City, Missouri

2
Todays Focus

• Objective Set of recommendations to accompany
  report to Governor, General Assembly
• Review draft recommendations
• Discuss concepts
• Avoid temptation to wordsmith
• Park unresolved concerns for reconsideration

3
Overview

• Review SB577 report requirements
• Recap Subcommittees goals
• Consider each of six recommendations
• Consider approaches associated with each
  recommendation

4
SB 577 Report Requirements

• A complete statewide universal information and
  assistance system that
• is integrated into the web-based electronic
  patient health record that can be accessible by
  phone, in-person, via MO HealthNet providers and
  via the Internet
• connects consumers to services or providers and
  is used to establish consumers' needs for
  services
• allows consumers to be able to independently
  choose from a full range of home,
  community-based, and facility-based health and
  social services
• allows consumers to access appropriate services
  to meet individual needs and preferences from the
  provider of the consumer's choice

5
SB 577 Report Requirements

• A mechanism for developing a plan of service or
  care via the web-based electronic patient health
  record to authorize appropriate services

6
SB 577 Report Requirements

• A preadmission screening mechanism for MO
  HealthNet participants for nursing home care

7
SB 577 Report Requirements

• A case management or care coordination system to
  be available as needed and

8
SB 577 Report Requirements

• An electronic system or database to coordinate
  and monitor the services provided which are
  integrated into the web-based electronic patient
  health record.

9
Goals Adopted by CEP Subcommittee

• Full, accurate, quality, and consistent
  information about options through assessment of
  general needs
• Enhance current efforts to prevent premature/
  inappropriate placement in institutional settings
  by capitalizing on current systems
• Person-centered

10
Goals Adopted by CEP Subcommittee

• User-friendly, efficient, fair
• Minimize existing fragmentation
• Enhance access during the transition to more
  virtual system of information
• Incorporate a quality of care evaluation
  component to ensure maximization of state
  resources, quality of long-term care continuum

11
Recommendations

• Statutorily created system
• IR functions MCO ACCESS Resource Centers,
  Partners
• Capitalize on/link existing information systems
  resources
• Person centered approach
• Core functions/statewide/all Missourians, then
  add functions
• Strong evaluation component from outset

12
Recommendation 1

• Create, support and fund streamlined system of
  access to long-term care information and services
  through statute
• Require easy access to information in any
  health-care or social setting where certified and
  trained partners can provide information about
  the continuum of available long-term care options
• System must support the choices of all
  individuals regarding their preference of care
  setting most appropriate to meet their needs
• Long-term care systems must provide easy access
  to alternative care that allows individuals to
  remain in their homes and involved in their
  communities through effective use of personal
  resources to access needed care.

13
Recommendation 2

• IR system

14
Recommendation 2

• State agencies responsible for long-term care
  services collaborate to develop and implement MCO
  ACCESS Resource Centers and MCO ACCESS Partners

15
Recommendation 3

• Information technology systems managed by DSS,
  DHSS, and DMH, (both current and under
  development) be retained, shared, and enhanced as
  necessary to allow linkages that support the MCO
  ACCESS Resource Centers and MCO ACCESS Partner
  functions

16
Recommendation 4

• MCO-ACCESS system focus on the desires and
  abilities of the individual,
• Ensure that an acceptable quality of life for
  Missourians is afforded through safe, quality
  care through system requirements, oversight
• Incorporate safeguards to maximize the ability to
  honor personal choice while preventing waste and
  abuse of entrusted, limited state and federal
  resources.

17
Recommendation 5

• Core functions, e.g. IR, options counseling,
  standardization/input of demographic information
  to be rolled out for all populations, with
  further functionality added over time

18
Recommendation 6

• Designed from outset with strong evaluative
  component to determine impact system is having in
  desired outcomes, i.e. timely access to services
  in most appropriate setting, deferred costs to
  Medicaid

19
Recommendation 1

• Create, support and fund streamlined system of
  access to long-term care information and services
  through statute
• Require easy access to information in any
  health-care or social setting where certified and
  trained partners can provide information about
  the continuum of available long-term care options
• System must support the choices of all
  individuals regarding their preference of care
  setting most appropriate to meet their needs
• Long-term care systems must provide easy access
  to alternative care that allows individuals to
  remain in their homes and involved in their
  communities through effective use of personal
  resources to access needed care.

20
Recommendation 1 Approach

• Decentralized no wrong door design model for
  the MCO-ACCESS system
• All partners retaining their current functions
• Serve persons of all ages, disabilities and
  incomes statewide
• Reliable long-term care information can be
  accessed from numerous trained and certified
  network partners

21
Recommendation 1 Approach

• Initial contact can be in person, by phone or via
  Internet
• Sufficient information at intake provide
  appropriate information or to recognize whether
  there is an emergency situation
• Linkage to functional assessment, financial
  eligibility determination, pre-admission
  screening and case management form both public
  and private sources
• Providing decision support and long-term care
  planning tools.

22
Recommendation 2

• State agencies responsible for long-term care
  services collaborate to develop and implement MCO
  ACCESS Resource Centers and MCO ACCESS Partners

23
Recommendation 2

• IR system functions
• Related links, brief self-screening instruments
  and decision support tools, applications
• Accepted criteria for inclusion/exclusion of
  resources and for multiple modes of access for
  persons with various disabilities
• Resource Specialists to recognize, overcome and
  supplement limitations of existing resource
  databases, develop strategies for updating

24
Recommendation 2

• IR system functions (contd)
• Option for the consumer or caregiver to save
  information in a secure personal health record
• Capacity to retain consumer identification,
  demographic data, income/assets, other
  information that can be retrieved by authorized
  agencies and MO HealthNet providers
• Capacity to count contacts and referrals, track
  unmet needs and other data required for reporting
  
• Information systems to house data and conduct
  program evaluations
• Quality oversight program for certified partners
• Funding options such as partnership grants and
  ongoing monitoring of best practices in other
  states

25
Recommendation 2

• MCO ACCESS Resource Centers role
• Provide person-centered information, options
  counseling, and referrals to entities that
  provide public and private-pay home and community
  services and case management
• Recruit businesses, local agencies and
  faith-based organizations who wish to serve as
  MCO ACCESS Partners
• Streamline access by providing
• Information about long-term care planning and
  services through media partners
• Assistance to Missourians faced with difficult
  decisions regarding long-term care to determine
  the most appropriate services through options
  counseling
• Simplified eligibility processes through
  integrated information sharing with state and
  local partners.

26
Recommendation 2

• MCO ACCESS Resource Centers role (contd)
• Assist in outreach/marketing to promote public
  awareness of/access to the MCO ACCESS
• Enable access and provide intense short-term case
  management for individuals that are prescreened
  and eligible for publicly funded needs-based home
  and community based services
• Use Resource Specialists to keep electronic
  patient health record information regarding
  consumer participation current
• Increase health literacy and empower Missourians
  to take responsibility for their health through
  community-based public awareness initiatives

27
Recommendation 2

• MCO ACCESS Resource Centers role (contd)
• Provide education and training on Chronic Disease
  Self-Management Programs
• Link patients with chronic conditions or
  potential risk factors to Evidence-based Disease
  Management and Health Promotion Programs that
  provide effective, low-cost interventions
• Services targeted to patients with various
  conditions or potential risk factors in an effort
  to slow or reduce the risk of disease or
  disability, avoid hospitalization, or avoid
  increased limitations associated with disease
  progression

28
Recommendation 2

• State-certified MCO ACCESS Partners role
• Provide access to the Internet information and
  resource data base
• Assist consumers as necessary to access and use
  the Internet resource data base and facilitate
  appropriate referrals
• Refer consumers who need more specialized
  assistance to MCO ACCESS Resource Centers

29
Recommendation 2

• State-certified MCO ACCESS Partners role (contd)
• Advertise MCO ACCESS services as part of their
  usual marketing efforts
• Publicize and promote health literacy, Chronic
  Disease Self-management Programs, and
  Evidence-based Disease Management opportunities
  and
• Participate in on-going training as required to
  maintain certification and assure standardized
  service

30
Recommendation 2 Approach

• State agencies role
• Create standards for state certification of MCO
  ACCESS Resource Centers and Partners
• Provide orientation and on-going training
• Develop an on-line information and resource
  system

31
Recommendation 3

• Information technology systems managed by DSS,
  DHSS, and DMH, (both current and under
  development) be retained, shared, and enhanced as
  necessary to allow linkages that support the MCO
  ACCESS Resource Centers and MCO ACCESS Partner
  functions

32
Recommendation 3 Approach

• Incorporate information obtained through MCO
  ACCESS Resource Centers into the MO HealthNet
  electronic patient health record
• Make electronic Patient Health Records accessible
  to MCO ACCESS Resource Centers as necessary to
  identify current service recipients, provide
  comprehensive assistance

33
Recommendation 3 Approach

• Use data entered into the MO HealthNet electronic
  patient health record on consumers who meet
  nursing facility level of care can be utilized to
  complete reports of pre-admission screening
  efforts
• Flag those who choose to enter facilities for
  follow-up re-evaluation of their desire and
  capacity to return to home and community based
  care
• Generate reports on MCO ACCESS performance and
  unmet needs, track trends and consumer
  satisfaction, and formulate quality improvement
  plans using data entered by MCO ACCESS Resource
  Center staff

34
Recommendation 4

• MCO-ACCESS system focus on the desires and
  abilities of the individual,
• Ensure that an acceptable quality of life for
  Missourians is afforded through safe, quality
  care through system requirements, oversight
• Incorporate safeguards to maximize the ability to
  honor personal choice while preventing waste and
  abuse of entrusted, limited state and federal
  resources.

35
Recommendation 4 Approach

• Certification, on-going training to emphasize
  person-centered approach and statutory
  requirements for confidentiality/privacy and
  protection for those unable or unwilling to
  protect themselves
• On-line screening and assessment tool design
  guided by principles respectful of right to
  self-determination
• DHSS, DSS, DMH collaborate on streamlining
  access, assessment and eligibility determination
• DSDS develop processes to identify and follow up
  with consumers at risk of institutional
  placement, financially ineligible for publicly
  funded home and community based supports
• DHSS, DSS and DMH monitor regulatory compliance,
  quality of service by contracted
  providers/facilities receive/investigate reports
  of abuse, neglect, exploitation of consumers

36
Recommendation 5

• Core functions, e.g. IR, options counseling,
  standardization/input of demographic information
  to be rolled out for all populations, with
  further functionality added over time

37
Recommendation 5 Approach

• Initial rollout guided by equity, maximum impact
  in making information available to all current
  and potential users of long-term care services
  and supports
• Core function selection based on goal of making
  functions accessible statewide on shortest
  possible timeline with acceptable confidence of
  success
• Addition of further functionality over time based
  on a combination of potential impact, timelines
  with acceptable confidence of success

38
Recommendation 6

• Designed from outset with strong evaluative
  component to determine impact system is having in
  desired outcomes, i.e. timely access to services
  in most appropriate setting, deferred costs to
  Medicaid

39
Recommendation 6 Approach

• Designed on timeline that assures its completion
  prior to the onset of implementation activities.
• Design process to include meaningful opportunity
  for consumer, provider, and state agency
  stakeholder input
• Carried out by independent third party with
  expertise in design, delivery and administration
  of long term services and supports and in
  conducting rigorous quantitative, qualitative
  assessments of public programs

40
Recommendation 6 Approach

• Measures of success
• Increasing awareness
• Assuring visibility of MCO ACCESS, aging and
  disability networks role
• Fostering understanding of available resources
  and options
• Gaining trust of consumers, providers, others
• Integrating access to public programs by linking
  intake, eligibility, assessment processes

41
Parking Lot

• Outstanding issues