San Diego Long Term Care Integration Project (LTCIP)

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San Diego Long Term Care Integration Project
(LTCIP)

• April 13, 2005
• LTCIP Planning Committee

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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
• Utilizes existing providers

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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 value of federal state funding

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Long Term Care Integration Project Organizational
Chart Decision Tree
April 2005
www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
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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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HSD/Healthy San Diego Plus Relationships
State

• Joint Committee
• Diverse stakeholder representation

County (Operating Agency)
Health Plans
MOUs
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Medi-Cal Redesign ALTCI

• Option to mandatory primary acute
• 3 counties to enroll Medi-Medis
• Pooled Medi-Cal ( Medicare for duals) health and
  supportive service
• From defined benefit list to what individual
  needs/prefers

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Key ALTCI Features

• Eligible Population
• Scope of Benefits
• Plan Selection/Administration/Rates
• Medicaid waivers
• Medicare participation
• Member Outreach Education

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Key ALTCI Features

• Enrollment
• Care Management
• Provider Networks
• Member Services
• Quality Assurance/Improvement
• Information Technology

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Reimbursement Model

• 1)Recommendations for capitation reimbursement
  model for ALTCI (i.e., payment structure from the
  State)- Build off other analyses Use joint
  Medi-Cal and Medicare data set- Identify the
  major cost drivers (i.e., demographics, dual
  eligibility, service setting, disease states,
  and etc.)- Consider reimbursement mechanisms
  utilized elsewhere Often used in
  combination- End goal is to design a model that
  matches reimbursement to risk (with the right
  incentives)

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Reimbursement ModelContinued

• 2)Analyze Medicare Reimbursement- State want to
  require all contractors/health plans to also
  participate in Medicare Advantage - Apply
  current Medicare payment adjusters based on
  historical claims data- Compare results to
  actual claims cost and trend both (reimbursement
  and costs) forward to 2006- Goal is to assess
  the overall sufficiency of Medicare
  reimbursement for the dual eligible members

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Information Technology

• 1)Survey consumers, providers, and other
  stakeholders- Assess current community
  Information Technology capacity and
  utilization- Identify desired potential uses and
  functionality- Surveys are available
  electronically or hard-copy
• 2)Recommend design of Web-based IT system to
  support ALTCI- Prioritize development of the
  system, as it will likely be developed over
  several phases

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Timelines

• 6/30/05 Consultant recommendations
• 7/05 12/05 Stakeholders consider, revise, and
  reach consensus
• 1/06 - 3/06 County/BOS approval
• 3/06 County, State DHS, CMS begin working
  toward implementation
• 3/1/07 Begin enrollment in HSD

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Afternoon Breakout Groups

• Provider Network
• Care Management
• Community Cultural Responsiveness

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How to influence planning?

• Get on LTCIP mailing list for updates
• Log onto website for background info
  www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/
  
• Call or e-mail input/ideas 858-495-5428 or
  evalyn.greb_at_sdcounty.ca.gov or 858-694-3252 or
  sara.barnett_at_sdcounty.ca.gov