San Diego Long Term Care Integration Project (LTCIP)

1. San Diego Long Term Care Integration Project (LTCIP) Mental Health & Substance Abuse Working Committee October 21, 2003

2. Community Planning Process • Grass-roots effort to improve system of care for long term care consumers and providers • From 50 to 550+ key stakeholders over past 4 years: 10,000+ hours • Agreement to use existing providers, assure fair compensation • Planning within state LTCIP authorization, AB 1040 (form follows funding)

3. Long Term Care Integration Project Organizational Chart & Decision Tree San Diego County Board of Supervisors & State Office of Long Term Care Rodger G. Lum, Ph.D,Director County of San Diego, Health & Human Services Agency, (HHSA) • Internet • Facilitates communication • Provides broad public education Pamela B. Smith, Project Director Evalyn Greb, Project Manager Aging & Independence Services Lead County Agency Advisory Group: Goal: Make final decisions and recommendations for inclusion in the plan. Planning Committee: Goal: Guide the LTCIP planning process. Suspended Workgroups pending service delivery model decision Health Plan Workgroup Finance/Data Workgroup Options Workgroup Mental Health Workgroup Developmental Disabilities Workgroup Incremental LTCI Strategies: 1) Network of Care 2) Physician Strategy 3) Health Plan Pilots Make recommendation to PC re: inclusion of persons with developmental disabilities in LTCIP. Determine the financial feasibility of the proposed LTCIP for San Diego County. Make recommendation to Planning Committee re: inclusion of mental health and substance abuse services in LTCIP. Explore use of the Healthy San Diego model for potential Service delivery system for LTCIP. Governance -Case Management -Info/Technology -Quality Assurance -Scope of Services -Workforce Issues -Community Network Development 8/2003 www.sdcounty.ca.gov/cnty/cntydepts/health/ais/ltc/

4. Legislative Authority • AB 1040 in 1995 (revised in 1998) • State Office of LTC: • provides planning $$ • provides “Center” resources • provides liaison with other state programs • approves local activity toward LTCI • will assist in procuring federal waivers

5. San Diego LTCIP Stakeholder Vision for Elderly & Disabled • Develop service delivery “system” that: • provides continuum of all 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

6. 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 federal and state funding

7. Why change? • Impact of demographics on healthcare • Cost containment vs. care management • Health & support service fragmentation • Categorical admin $$ to service $$ • Consumer/outcomes not current focus

9. From Vision to Service Delivery Model…

10. From LTCIP Vision to Service Delivery Model… • Explore Healthy San Diego due to: • Access, education, prevention • Advocacy • Cost-effectiveness • Population-based • Existing infrastructure • Stakeholder-designed, BUT

11. HSD Currently Does NOT… • Tailor the program for chronic care or aged and disabled persons • Provide “wraparound” services • Provide chronic care management on a population basis • Receive adequate reimbursement for chronic care • Have much info on “duals”

12. Where are we now? • BOS: “come back with 3 options” • Dr. Mark Meiners strategies/looking for “consortium of funding”: • Network of Care • Physician Strategy • HSD Health Plan Pilots • Administrative Action Plan for FY 2003-04 State Development Grant • Establishment of Mental Health Workgroup

13. Network of Care • Testing with • consumers and caregivers • community based organizations • other providers, Call Center staff • To develop “continuous quality improvement” program • Measure behavior changes of providers and consumers

14. Physician Strategy • Partner w/physicians vested in chronic care • Develop interest/incentive for support of “after office” services (HCBC) • Identify care management resources to support physicians/office staff to link patients and communicate across systems • Train on healthy aging, geriatric/chronic disease protocol, pharmacy, HCBC supports

15. Health Plan Pilots • Pilots to do small, voluntary models of care integrated across the health, social, and supportive services continuum: • Evercare (or any other private healthcare entity) to contract with State if stakeholders agree (AB43) • Healthy San Diego Health Plans to develop pilot with consultant resources • Stakeholders currently providing feedback on consultant team’s final report

16. Mental Health & SA Today • Current Medi-Cal carve-out (UBH) • Limited Medicare reimbursement • LTCIP stakeholders want no carve-outs • Mental health and substance abuse problems under-diagnosed & under-treated • Quality of life and cost impact of untreated mental illness/substance abuse is huge • Most state integration projects do not enroll disabled w/primary MH diagnosis • Seniors do not self-identify as having MH &/or SA issues; don’t use MH Centers/SA services

17. Mental Health and LTCIP • Establishment of Mental Health Workgroup to: • hear from broad array of stakeholders • focus on consumer as “whole” in system • develop plan specific to San Diego and LTCIP • How do we “mainstream” mental health and substance abuse services for aged and disabled? • parity w/physical health for treatment • age-, disease-specific treatment • delivered as “part of the whole” • viewed within greater context of health

18. LTCIP Mental Health & Substance Abuse Workgroup • Goal: Make recommendation to Planning Committee on inclusion of mental health and substance abuse programs, populations, and services • Establishment of this Working Committee • Importance of consensus (consumers & providers) on a recommendation • Forward recommendation to larger Workgroup by January 2004