Transcript Long-Term Care Integration What is it and Why do it?

Long-Term Care Integration
in San Mateo County
Jean Fraser
Maya Altman
March 10, 2011
Long-Term Care Integration
Core Concepts
► Emphasize
home and community-based
services to allow individuals to remain in
community settings
► Consolidate preventive, primary, acute,
Long-Term Care, and Home- and
Community-Based services and funding
► Allow more local control and flexibility
► Eliminate administrative duplication and
complexity
Core Concepts (continued)
► Enhance
assessment, care planning, and
medical management
► Establish smooth and appropriate transitions
between levels of care
► Reinvest savings back into San Mateo
County community
► Improve service delivery and access to care
Goals: Long-Term Care Integration
►Person-centered
care
►Improved health &
quality of life
►Greater access to home and
community-based services
►Lower number of premature
nursing home placements
Current Situation
Barriers
80 year old
Living alone
Result
Multiple
chronic
problems
Chronic lack of support health
leads to
hospitalization
at home
LackDeclining
of long-term
planning
Socially
isolatedhome
Discharge
to nursing
Lives in an institution
No coordinated
Very
expensive care
Person unable to reside at home alone
Future of Long-Term Care
80 year old
Living
alone
Result
Primary
providers
with
Multiplecare
chronic
healthconnect
problems
case manager
for
long-term
care assessment
Improved
Declining
at health
home
Socially
isolated setting
Lives in
most integrated
Services selected based on need and
long-term
plan
More costcare
efficient
Support provided in the home
Why now?
San Mateo County is facing a
huge increase in
older adults.
Minus a fully coordinated
system, more people will
fall through the cracks.
Work Toward Long-Term Care
Integration in San Mateo County
Year
Milestones
1980s
and
1990s
•
•
•
•
2003
•
•
2006
•
•
2008
•
2010
•
•
San Mateo County consolidation of HCBS in Health System
Creation of Commissions on Aging and Disabilities
SMC, HPSM, and SMC Hospital Consortium propose LTCI
IHSS Public Authority Advisory Committee
SMC selected as pilot for Uniform Assessment Tool
County hospital Senior Care Center Opens (Ron Robinson SCC)
HPSM Medicare CareAdvantage operations begin
CareAdvantage subcontract with SMC Behavioral Health and
Recovery Services
Partnership with CalOptima in Orange County to advocate for LTCI in
both counties
LTC institutional benefit added to HPSM
HPSM initiates clinical care management in nursing facilities
HPSM serves 95,000 people through
six programs.
HPSM Medicaid
59,000 members
42% of whom are
California
seniors and disabled
8,000 of whom are
Special Needs Plan
members
San Mateo
County
CareAdvantage (Special Needs Plan)
• 8,000 enrollees (60% of those eligible)
• Member benefits
– Dental and vision care
– Transportation for medically related services
– Subcontract with County Behavioral Health
• Customer service
– Staff dedicated to and expert in serving older and disabled
members
– Staff fluent in Spanish, Chinese, Tagalog, and Russian
– Help for members in navigating the Medicaid / Medicare maze
– Assistance in maintaining Medi-Cal status
• <1,000 people “saved” from losing Medi-Cal in past year
• Work with Legal Aid to help people with share of cost
CareAdvantage (con.)
• Care management
–
–
–
–
–
–
–
Identification of members at high risk
In home physician visits
Help with managing medications
Care transitions between hospital and home
Connecting members to medical homes
Interdisciplinary care coordination teams
Case conferences with County Behavioral Health
and Aging and Adult Services / IHSS
– Clinical management in long term care facilities
Medicaid Funded Services
Acute Medical /
Ancillary Care
Institutional Long
Term Care
Home & Community
Based Services
(HPSM/County)
(HPSM as of Feb 2010)
(Many operated by County/FFS)
Outpatient/Clinic Based
Primary Care
Distinct Part Skilled Nursing
Facilities
In-Home Supportive
Services (IHSS)
Specialty Medical Care/
County Mental Health
Services
Freestanding Nursing
Homes
Multipurpose Senior
Services Program (MSSP)
Ancillary Services (Lab,
pharmacy, radiology,
durable medical
equipment)
Caveat: Reimbursement
only with LTC aid code
Hospice, Adult Day Health
Care, Adult Day Care,
Alzheimer’s Day Care
Resource Centers
Inpatient Services
Services combined into LTCI
Adult Day Care
Nutrition
MSSP
Skilled Nursing
PACE
In-Home Care
Mental Health
Alcohol & Other Drug
Model for LTCI
Component
Options
Population
• All adult Seniors and Persons with Disabilities (SPDs)
Medical Criteria
• Eligible for nursing home level of care
• At risk for nursing home level of care in the near term
Coverage
• Dual eligible enrolled in CareAdvantage
• Medicaid only
• Dual eligible not enrolled in CareAdvantage
Assessment
• Uniform assessment tool for all integrated services
Model for LTCI—Continued
Component
Options
Acute Services
• All Medicaid primary and acute care
• All Medicare primary and acute care for duals in CareAdvantage
Long Term Care
• Medicaid nursing facility services
• Medicare nursing facility services for CareAdvantage duals
HCBS
• All Medicaid HCBS:
 Adult day health care
 Personal care (IHSS)
 MSSP
• “In Lieu” Services, e.g.:
Services in assisted living
Services in Board and Care
Expanded Transportation
Home modifications
Model for LTCI—Continued
Component
Options
Medical Home
• Primary Care Medical Home (enhanced primary care)
Interdisciplinary Team
• Member specific teams
• Member is part of the team
• Personal care worker may be part of the team
Individual Care Plan
• Address physical as well as psychosocial needs
• Accessible by all
• Member involved in development of plan
Case Management
• Case management based on individual care plan
Model for LTCI—Continued
Component
Options
Community Services
• Leverage existing San Mateo County Health System and
community resources
• Integrate services already available
Enhanced Data
• Single initiative to track and trend interventions / outcomes
Public Authority
• Contract with Public Authority for personal care services
Stakeholders
• Program oversight by local stakeholders
What Will Be Different?
Now
One place to go for help
One uniform assessment for all services
Variety of options available with focus
on keeping people in the most homelike environment
System for MD and community agencies
to refer patients who need help before
they decline & need hospital care
Patient is the decision-maker
LTCI
Questions?