Overview
Mission Statement and Guiding Principles
LTCIP Fact Sheet Legislative Authority - AB1040 Three-Strategy Overview
MISSION STATEMENT: GUIDING PRINCIPLES:
HISTORY: LTCIP VISION & BACKGROUND:
After thorough examination of various service delivery models, in January 2001 by consensus decision, LTCIP stakeholders recommended exploring the feasibility of using San Diego County’s existing geographic Medi-Cal managed care program, Healthy San Diego (HSD), as the preferred delivery system model to explore. HSD is a geographic Medi-Cal managed care model that incorporates multiple health plans into its design. Unlike other Medi-Cal managed care models, HSD is unique in that County staff within the integrated Health and Human Services Agency support and monitor system-wide issues regarding quality improvement, consumer protection, information management and enrollment activities, in addition to performing eligibility determination. HSD is also unique because it is based on negotiated consensus from community stakeholders and allows for local influence over the program by the advisory body, the Joint Consumer/Professional Advisory Committee. Three representatives of the LTCIP Advisory Group, including the Public Authority Executive Director, have been added to the Joint Committee with full voting privileges. The Board of Supervisors reviewed the recommendation to explore expansion of HSD in March 2002 and approved that, also requesting development of two additional options, one of those being fee-for-service. Since then, Dr. Mark Meiners, who leads the Medicare/Medicaid Integration Program, a multi-state Robert Wood Johnson Foundation initiative with similar goals and a wealth of relevant experience, has helped San Diego develop three smaller, incremental strategies that will help San Diego continue to progress toward the vision of full acute and long-term care integration. These are: (1) HSD+/Health Plan Pilots (2) Physician Strategy (3) Network of Care Strategy. On July 13, 2004, the Board of Supervisors officially approved and supported continued development of all three LTCIP strategies (Minute Order No. 17). For more information please contact Evalyn Greb, Chief of Long Term Care Integration, Aging and Independence Services at (858) 495-5428 evalyn.greb@sdcounty.ca.gov Click here for the highest-level overview of the three strategies Health Plan Pilots: Healthy San Diego Plus (HSD+) is one of the three strategies requested by the local Board of Supervisors and supported by key stakeholders in acute and long-term care improvement for elderly and disabled persons in San Diego. HSD+ will be a voluntary, fully integrated service delivery model, with a capitated payment from Medi-Cal, and from Medicare for the “dually eligible.” To date, development of the HSD+ model has been supported by the California Department of Health Services Office of Long Term Care (OLTC). The Healthy San Diego Plus model would build on the “medical home” approach provided by the County’s Healthy San Diego managed care program for Medi-Cal recipients, extended to include the broader array of services that become possible when Medi-Cal and Medicare are integrated. The Healthy San Diego Plus model would take full advantage of the ability
to improve consumer benefits by pooling Medicare and Medicaid funding,
minimizing administrative barriers, eliminating cost shifting incentives,
and offering care coordination support to consumers to help them better
use community-based social and health care. Healthy San Diego Plus is
the most comprehensive of the three LTCIP strategies and, if implemented,
would likely be the most effective in creatively meeting the needs of
aged and disabled beneficiaries. Physician Strategy: The underlying goal of this managed fee-for-service delivery model is similar to that of HSD+: quality, consumer-centered health and social services through improved chronic care management, but without the capitation risk. The Planning Phase will target specific stakeholders--physicians, consumers and caregivers, and community-based providers--to help identify strategies and incentives for improving health promotion, care coordination, and chronic care management within the fee-for-service system. A planning grant from the California Endowment is being used to support this strategy. The deliverable is an Implementation Plan that will be brought to the Board in Fall 2005. Network of Care (NoC): The Network of Care, which though not a service delivery option, has the potential to serve as the central data and communication system for the two service delivery models described above. This strategy builds upon an investment made by the County to provide web-based access to a site loaded with local health and social service resources (www.sandiego.networkofcare.org). A three-year Aging and Disability Resource Center (ADRC) Grant from the Administration on Aging and the Centers for Medicare and Medicaid Services that is held in partnership between San Diego’s LTCIP, Del Norte Area Agency on Aging, and the California Department of Aging, is being used to support this strategy. The grant will help LTCIP: (1) develop a warehouse of information on
self-care management, healthy lifestyle choices, and other information
to improve quality of life for our aging and disabled populations; (2)
improve the user-friendly nature of information that links health and
social services for these user groups; (3) enhance the use of the system
as a communication tool, including for the two LTCIP service delivery
strategies (HSD+ & Physician Strategy); and (4) perform formalized
testing to assess the adequacy of the database and function of this information
for physicians, community-based providers, consumers, caregivers and Call
Center staff.
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