a promising collaboration access to independence and care1st health plan san diego, california...
TRANSCRIPT
A Promising CollaborationAccess to Independence and
Care1st Health PlanSan Diego, California
October 14, 201511:30 – 12:45 PM Pacific Time
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Welcome – Housekeeping
• We will take questions at the end of the presentation
• Type your questions in the chat box• The webinar transcript and slides will be
available following the webinar on the DREDF website – dredf.org
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Aging and Disability Partnership for Managed Long Term Services and Supports
• Established by the National Association of Area Agencies on Aging (N4A) as part of a project funded by the Administration for Community Living (ACL)
• Project partners:– National Disability Rights Network– Justice in Aging– Disability Rights Education and Defense Fund (DREDF)– Health Management Associates (HMA)
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Aging and Disability Partnership for Managed Long Term Services and Supports
• Project goals:– Leverage the aging and disability networks’
extensive infrastructure, service capacity, and expertise to ensure delivery of high quality managed long-term services and support to seniors and people with disabilities
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Webinar Series Purpose
• Purpose: To share three promising practices that feature collaborations between Independent Living Centers, ADRCs, AAAs, Medicaid managed care plans, and healthcare providers
– # 1: FREED and ADRCGrass Valley, California
– # 2: Center for Independent Living, Alameda Alliance Health Plan, LifeLong Medical Care
Berkeley, California– # 3: Access to Independence and Care1st Health Plan
San Diego, California
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Webinar Series Goals
• Goals: To illustrate how collaborations between ILCs, ADRCs, AAAs, Medicaid managed care plans, healthcare providers, and other partners– Infuse IL philosophy and services into M/LTSS– Improve health outcomes for seniors and PWD– Increase community integration and participation
for seniors and PWD– Have the potential to generate cost savings
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Presenters
Louis Frick
Executive Director
Access to Independence
San Diego, California
Pamela M. Mokler
VP of Long Term Services
& Supports
Care1st Health Plan
Monterey Park, California
Silvia Yee
Senior Attorney
DREDF
Berkeley, California
Mary Lou Breslin
Senior Policy Advisor
DREDF
Berkeley, California
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An Independent Living and Managed Care Collaboration
• Background – San Diego preparing for managed care for Medicaid beneficiaries with disabilities
• Goals: pilot project with homeless people with disabilities in San Diego, CA
• Methods to identify participants• Assessment and services provided • Outcomes• Lessons learned
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Background: Preparing for Move to Managed Care--2012
• 8057 people with disabilities and seniors who were Medicaid beneficiaries in SD* – 992 – seniors– 243 – seniors with both Medicare and Medicaid
(duals)– 5783 – people with disabilities – 1039 –people with disabilities with both Medicare
and Medicaid (duals)
*Medicare and Medicaid utilization data
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High Priority Challenges and Needs of PWD/Seniors
• Homeless or transient• Mental health and substance use disorder issues,
including serious mental illness• High emergency room utilization• Priority needs:– Emergency shelter, transitional or temporary
housing, permanent housing, food and transportation
– Long term services and supports/supportive services
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PWD and Seniors Pilot Goals
• Test and develop and working model to prepare for dually eligible demonstration
• Test impact of housing placement for homeless PWD and seniors on Health Care Utilization
• Build institutional knowledge and capacity of Care1st by fostering institutional knowledge about PWD and seniors who are homeless
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PWD and Senior Pilot Project Time Frame
• December, 2012: Initial meeting with Access to Independence (A2i)
• February, 2013: Care1st staff hired• Contract with A2i for external case management
(ECM)• March—April, 2013: Clinical systems developed,
work flow, kickoff meetings, test cases, web portal• May—November, 2013: 7-month pilot• Post—pilot: Evaluation
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Pilot Participant Selection CriteriaPhase I:• Current members as of April 2013– Cannot be reached by phone, or– Have “Homeless” in address field AND– 293 people identified by 6-month utilization
thresholds• Greater than $10,000 and up total• Greater than $5,000 Emergency Room
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How 66 Participants Were FoundPhase II • 58% identified during hospital stays• 19% identified during emergency room visits• 16% Identified via total utilization of all
services • 7% didn’t meet above criteria - identified via
case management activities & providers as at potential risk for placement
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PWD and Seniors Pilot WorkflowAccess to Independence
• STEP ONE: Referral request for services from Care1st
• STEP TWO: Find/contact member to conduct assessments, obtain consent
• STEP THREE: First 30 days, complete and upload– Independent Living Plan (ILP)– Pilot Heath Risk Assessment (Pilot HRA)– Care Transition Plan for members in SNFs, rehab.
and cute care hospitals
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PWD and Seniors Pilot WorkflowAccess to Independence
• STEP THREE: Months 2 – 6– Update ILP or– Update Care Transition Plan– Participate in Care1st Care Coordination meetings– Monthly reports
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PWD and Seniors Pilot WorkflowCase Manager/Social Worker
• Case Management– Member Assessment• Health Risk Assessment (HRA)• Individualized Care Plan
– Member Case Management• Problems, Goals, Interventions • Coordination of medical care with St. Vincent, FQHCs• Authorizations for services and transportation, etc.
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PWD and Seniors Pilot WorkflowCase Manager/Social Worker
• Social Services– ILP/ICP review, coordination with Access to
Independence– Weekly case conference with Medical Director and
VP Medical Management
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Identifying PWD and Senior Pilot Participants
• 66 PWD and seniors identified/recruited/enrolled– 48 found in hospitals– 18 found by Access to Independence
• 51 completed the pilot– 10 received care through homeless clinic (St.
Vincent de Paul’s)– 41 received care through primary care providers or Federally
Qualified Health Centers (FQHCs)• 23 of 51 who completed Pilot, continued to be case
managed by A2i following Pilot and were still eligible as Care1st member
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Housing Placements for Pilot Participants
• 45% of 66 (29 people) were placed in housing– A2i has close ties to housing providers
• Out of 23 still eligible after Pilot, 15 were placed in housing
• 14% received services other than housing– A2i provided groceries, furniture, rent,
environmental adaptations
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Hospitalizations and Length-of-StayPre-, During, and Post-Pilot – All Participants• Pre-pilot (4 months)
– Number of hospitalizations: 1– Ave. length of stay: 4.88 days
• Pilot (7 months)– Number of hospitalizations: 2.88– Ave. length of Stay: 8.96 days*
• Post-pilot (4 months)– Number of hospitalizations: 1.13– Ave. length of stay: 4.43 days
* Increased hospitalizations and lengths of stay during pilot due to increased services following HRA and A2i’s Independent Living Plan (Care Plan)
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Hospitalizations and Lengths of Stay for 15 Placed in Housing
(out of 23 still eligible at end of Pilot)
• Pre-pilot (4 months)– Number of hospitalizations: 1.53– Ave. length of stay: 6.67 days
• Pilot (7 months)– Number of hospitalizations: 3.2– Ave. length of Stay: 15.87 days*
• Post-pilot (4 months)– Number of hospitalizations: 0.25– Ave. length of stay: 0.5 days
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Readmissions to Hospital for 15 Members Placed in Housing
(out of 23 still eligible at end of Pilot)
• Pre-pilot (4 months)– Number of members: 2– Readmissions: 5
• Pilot (7 months)– Number of members: 4– Readmissions: 12
• Post-pilot (4 months)– Number of members: 1– Readmissions: 1
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Emergency Room (ER) Visits for 51 Members who Completed Pilot
• Pre-pilot (4 months)– Number of ER visits: 2.63
• Pilot (7 months)– Number of ER visits: 4.11
• Post-pilot (4 months)– Number of ER visits: 1.70
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Emergency Room Visits for 23 who were Care1st Members at End of Pilot
• Pre-pilot (4 months)– Number of ER visits: 2.41
• Pilot (7 months)– Number of ER visits: 4.09
• Post-pilot (4 months)– Number of ER visits: 1.70
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Emergency Room Visits Among 15 of 23 Remaining Members who were Placed in Housing
• Pre-pilot (4 months)– Number of ER visits: 4.36
• Pilot (7 months)– Number of ER visits: 6.85
• Post-pilot (4 months)– Number of ER visits: 0.38
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Reflections and Observations
• Pilot results need further study to look at why utilization increased during pilot; also to study long-term outcomes of individuals participating in Pilot who are still Care1st members
• Benefits derived from housing placement and case management
• Lessons learned about member population and placement– Helped build foundation for dually eligible demonstration– Created a commitment by both Care1st and Access to
Independence to continuing the collaboration
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Reflections and Observations• Most important outcomes:– (1) Intervention worked for those placed in
housing who remained a Care1st member at end of Pilot; and– (2) strong partnership between Care1st and
A2i, the Independent Living Center in San Diego County.
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Questions?
• Please take this opportunity to type your questions in to the CHAT box while we bring up a few of the questions that have been asked so far.
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San Diego County
• Mandatory Medicaid managed care for SPDs since 2011-2012, dual eligibles included in 2014
• Is one of only two counties that offer a choice of several Medi-Cal managed care organizations (MCOs)
• In the Coordinated Care Initiative (CCI), so has mandatory long-term services and supports (MLTSS) integrated within mandatory Medi-Cal
Proposed Medicaid Managed Care Rule
• On July 1, CMS proposed its first major revision of Medicaid managed care since 2002
• Medicaid has grown, MCO delivery of Medicaid has substantially grown, and there is now significant MLTSS across the country
• The proposed rule attempts to regulate this new landscape
• Not final – 60 day comment period closed
Rule - MLTSS Principles
• The proposed rule incorporates existing 2013 Guidance from CMS that set out 10 MLTSS “Principles,” including the enhanced provision of home and community-based services in accordance with the Supreme Court’s Olmstead decision, and person-centered needs assessment and service planning
• 1st time definition of MLTSS – quite broad
Rule - Care Coordination
§ 438.208(b)(2) expands MCO coordination obligations by requiring:• Coordination between care settings and with
services provided outside of the MCO, including fee-for-service Medicaid benefits such as LTSS
• Potentially may set an additional standard to require community or social support services
Rule - Network Adequacy
• For the first time, the rule requires states to develop standards on the adequacy of Medicaid MCO provider networks, including LTSS providers when part of the MCO network (§ 438.68 (2))
• Currently time and distance standards when consumers travel to the LTSS provider, and other kinds of standards when LTSS providers travel to the consumer
• It is unclear how ADRC services would be categorized, or when they would be “sufficient”
• LTSS subcontractors – accountability and data
Rule - LTSS Provider Credentialing
• The proposed rule newly establishes a “credentialing” and “recredentialing requirement for the providers that enter MCO contracts or participation agreements, including LTSS, behavioral, and substance use disorder providers
• Big potential impact on community-based LTSS providers who work with Medicaid beneficiaries now and want to do so under managed care
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Thank you!• More questions?• Contact:– Louis Frick – [email protected]– Pam Mokler– [email protected]– Mary Lou Breslin – [email protected]– Silvia Yee – [email protected]
• For more information, visit:DREDF
www.dredf.orgAging and Disability Partnership http://mltssnetwork.org/