Long-Term Care Integration in San Mateo County

1. Long-Term Care Integrationin San Mateo County Jean Fraser Maya Altman March 10, 2011

2. 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

3. 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

4. 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

5. Current Situation Barriers 80 year old Living alone Multiple chronic health problems Declining at home Socially isolated Result Lack of long-term planning Lives in an institution Very expensive care • Chronic lack of support leads to hospitalization • Discharge to nursing home • No coordinated care • Person unable to reside at home alone

6. Future of Long-Term Care 80 year old Living alone Multiple chronic health problems Declining at home Socially isolated Result Improved health Lives in most integrated setting More cost efficient Primary care providers connect with case manager for long-term care assessment Services selected based on need and long-term care plan Support provided in the home

7. 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.

8. Work Toward Long-Term Care Integration in San Mateo County

9. HPSM serves 95,000 people through six programs. 1987: Founded 2001: HealthWorx 2008: San Mateo County ACE 2006: CareAdvantage SNP 1998: Healthy Families 2010: Long-term Care 2003: Healthy Kids

10. HPSMMedicaid 59,000 members42% of whom areseniors and disabled 8,000of whom areSpecial Needs Plan members California San MateoCounty

11. 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

12. 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

13. Medicaid Funded Services

14. Services combined into LTCI Nutrition Adult Day Care Skilled Nursing Skilled Nursing MSSP PACE In-Home Care Mental Health Alcohol & Other Drug

15. Model for LTCI

16. Model for LTCI—Continued

17. Model for LTCI—Continued

18. Model for LTCI—Continued

19. What Will Be Different?

20. Questions?