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Quality of Life Strategy: LTCIP

Quality of Life Strategy: LTCIP. Presentation to CA Legislative Staff March 27, 2003 Evalyn Greb San Diego Long Term Care Integration Project. Goals. Improve consumer satisfaction and outcomes Use resources more creatively and cost effectively

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Quality of Life Strategy: LTCIP

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  1. Quality of Life Strategy: LTCIP Presentation to CA Legislative Staff March 27, 2003 Evalyn Greb San Diego Long Term Care Integration Project

  2. Goals • Improve consumer satisfaction and outcomes • Use resources more creatively and cost effectively • Fulfill the spirit of the Olmstead decision: what we want for ourselves and parents

  3. Vision Statement • Develop “system” with consumer and care manager as partners at “hub” that: • Provides continuum of health, social, support services that “wrap around” the consumer • Focuses on prevention & early intervention • Pools associated (categorical) funding • Is consumer driven, responsive, engaging • Expands access to/options for care

  4. Vision Statement (continued) • Fairly compensates all providers w/rate structure developed locally • Engages MD as pivotal team member • Decreases fragmentation/duplication with ”no wrong door” access • Revolves on single, web-based plan of care (HIPAA) • Improves quality & is budget neutral • Implements Olmstead decision locally • Maximizes federal and state funding

  5. Today’s Situation • Mrs. C. a la Dr. Kate Wilber • Institutional bias of Medi-Cal • Cost shifting between Medi-Cal and Medicare • Managed Care vs. managed care • Current silos, barriers, fragments

  6. Silos of Care in California Medicare Medi-Cal Federal County

  7. Mrs. C with a new “home” • System contact; screened at high risk • Care manager assigned and contacts Mrs. C • Multi-dimensional in-home assessment • All physicians/providers involved contacted • Care plan developed with providers & Mrs. C • Care plan algorithm assures cost-effectiveness • Health & social service brokerage • Monitoring and reassessment as planned

  8. Ideal System In-HomeServices PrimaryCare AcuteHospital MealsService MRS. C. DayHealthCare Transit Medical Specialty SkilledNursingFacility Mrs. C & Care Manager Journal of the American Geriatrics Society, Feb. 1997

  9. Recommendations • Support the vision and get to the product! • Pool Medi-Cal and Medicare $$ for aged and disabled persons and be budget neutral • Maximize consumer influence and choice • Establish medical and social service “home” • Work w/feds for $$, NF waiver services/demos

  10. Bottom Line: the Consumer • “The main thing is to keep the main thing the main thing.”

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