Long Term Care Integration Project

1. Long Term Care Integration Project November 13, 2002 Planning Committee Briefing

2. Activity Since June • Dr. Mark Meiners presents to Planning Committee and Options Workgroup • Dr. Meiners meets with Dr. Lum to discuss RWJ interest in CA LTCIP • 3 groups form/meet to produce “micro strategies” as recommended by Dr. Meiners

3. Activity Since June (continued) • Jim McConnell provides update on Oregon LTC Program • Dr. Meiners returns and meets with strategy groups and key stakeholders • Dr. Meiners meets with Dr. Lum, Pam Smith to plan “consortium of funding” for demonstration model support

4. Options Strategy Groups

5. Network of Care • Beta testing with • consumers • caregivers • community based organizations • other providers, Call Center staff • To develop “continuous quality improvement” program

6. Socio-Medical Care Management • Partner w/physicians vested in chronic care • Develop interest/incentive for support of “after office” services (HCBC) • Provide care management resources to support physicians/office staff • Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports • Maintain Fee-for-Service reimbursement

7. Health Plans/Pilots • Pilots to do small, voluntary models of care integrated across the health, social, and supportive services continuum: • Lifemark Evercare (national LTCI provider) to contract with State w/stakeholder agreement • State to procure 1915(c) waiver resources • Will test “integrated” care on voluntary, pilot basis with evaluation for future expansion

8. Health Plan Pilots (continued) • Healthy San Diego Health Plans to develop pilot with consultant resources • full continuum services and care management provided to ABDs enrolled in HSD • state to procure 1915(c) resources • will test voluntary “integrated” model in existing Medi-Cal managed care environs

9. Recommendations from Options Workgroup • Forward options to Planning Committee to forward to Board of Supervisors for support, as they requested • Seek funding for activities leading to and implementing options

10. Next Steps • Develop funding proposal by 11/15/02 • Apply for a “consortium of funding” by 1/15/02 • Prepare option implementation plan 2/15/02 • BOS support for full actuarial study • Let actuarial RFP by 3/01/02

11. LTC Issues: National & State Legislative Initiatives

12. Medicare • Pharmacy benefit: what happened? • Prevention (S 982): hypertension, osteoporosis, high cholesterol, etc • Chronic care (S 2057): geriatric assessment & care management for serious conditions • LTC tax credits (S 627): up to $3000 • Home Health (S 1619): OK in ADHC

13. Medicaid • National Governors Association request • 1915(c) waiver application streamlined • Olmstead Decision: New Freedom Initiative

14. Medi-Cal • Legislative Analyst: “mandate aged and disabled into Medi-Cal managed care” (25% of eligibles using 67% of resources) • AB 1040 “clean-up”: allows voluntary LTCI enrollment & smaller population • “admin” $$ cut this year, but next year???

15. Medi-Cal (continued) • Lowest per capita Medicaid expenditures in nation except Puerto Rico • Olmstead Plan: older adult consumers/caregivers needed at State Workgroup, November 22

16. What can you do? • Research candidate “stand” on issue • Vote (get your friends to vote) • Hold politicians to campaign promises • Call/FAX your elected officials and let them know how to represent you • (If you use Internet, get on legislative “listserv”)