building a community system for everyone: …...building a community system for everyone:...
TRANSCRIPT
BUILDING A COMMUNITY SYSTEM FOR
EVERYONE: MINNESOTA’S INITIATIVE TO CREATE A
CROSS-DISABILITY AND AGING SERVICE
SYSTEM
Reinventing Quality 2014 Conference
August 4, 2014
Alex Bartolic, Director, Disability Services Division
Jean Wood, Director, Aging and Adult Services Division
Minnesota Department of Human Services
OVERVIEW OF PRESENTATION
Minnesota’s Approach to LTSS
History and Context
Cross-Population Initiatives
Transformation Initiatives
Reform 2020
Additional Cross-Population Initiatives
MINNESOTA’S APPROACH TO LONG-
TERM SUPPORTS AND SERVICES
MN DEPARTMENT OF HUMAN SERVICES
ORGANIZATIONAL CHART
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MN DEPARTMENT OF HUMAN SERVICES
ORGANIZATIONAL CHART
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MINNESOTA’S LTSS SYSTEM
Local and Regional Administration
Lead agencies
Counties: assess eligibility and provide case management
for Medicaid Waiver FFS programs serving primarily
people with disabilities under age 65
Health Plans: administer the public managed care
programs that provide LTSS to the majority of Medicaid
Waiver-eligible older adults
Tribes: two tribes assess eligibility and provide case
management for Medicaid Waiver FFS programs
Area Agencies on Aging: administer Pre-Admission
Screening, contract for Older Americans Act-funded
services, partner with providers to develop services
to fill gaps
CCA MISSION
Improve the dignity, health and independence of the people we serve
CCA VISION
Minnesotans have choices in how they receive services and how they live their lives
C ─ Community membership / integration
H ─ Health, wellness and safety
O ─ Own place to live
I ─ Important long-term relationships
C ─ Control over supports
E ─ Employment earnings and stable income
CONTINUING CARE ADMINISTRATION
MISSION AND VISION
CONTINUING CARE ADMINISTRATION
VALUES
Choice & Independence for the people CCA serves
Stewardship of human service resources
Self-determination and personal responsibility by the people CCA serves
Integrity by CCA and others
Diversity because our differences make us strong
Partnerships and collaboration, with clear roles, responsibilities and accountability for ourselves and others
Accountability
CONTINUING CARE ADMINISTRATION
STRATEGIC PLAN
Current plan was developed in 2010 for State Fiscal
Years 2011-2015.
1. To support and enhance the quality of life for older
people and people with disabilities.
2. To manage an equitable and sustainable long-term
care system that maximizes value.
3. To continuously improve how we administer services.
4. To promote professional excellence and engagement
in our work.
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HOME AND COMMUNITY BASED SERVICES
Waivers
Developmental Disabilities
Community Alternatives for Disabled Individuals
Community Alternative Care
Brain Injury
Elderly
Home Care
State-funded service examples:
Alternative Care program
Family Support Grants
Semi-Independent Living Services
Older Americans Act services
HISTORY AND CONTEXT
HISTORY AND CONTEXT
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De-Institutionalization
Olmstead
Decision
Older Americans Act
Home and Community-Based Services Waivers
Americans with Disabilities Act
Welch Decree
Long-Term
Care Task
Force Report
Consumer
Direction
Managed
Care
models
Affordab
le Care
Act
New technology
Re-balancing Long-Term Care
MOUNTING PRESSURES ON THE LONG-TERM
CARE SYSTEM
Growing demand
Constrained resources
Increased complexity
LEVERAGING COMPLEX PRESSURES TO
ACHIEVE BETTER OUTCOMES FOR PEOPLE
Opportunity:
Build a framework for a more effective system
Efficiencies for sustainability
Data to drive best practices & innovation
Better outcomes for the person
TRANSFORMING TO ACHIEVE OUR MISSION
Promoting equity across individuals, lead agencies, providers
Providing quality services that can be measured and maximized
Operating with more transparency, efficiency, consistency
Leveraging all viable resources to reduce dependence on public funds
Continuously improve how we administer services
INDIVIDUALS BEFORE PROGRAMS
From “What do you qualify for?”… to “What is important to you, and for you to live the life you choose?”
Respect individual’s desire for more autonomy and control
Transition to a strengths-based assessment and support planning process with equitable solutions
LONG-TERM SOLUTIONS
SUPPORT INDEPENDENCE
Value abilities, respect needs, empower choice
Engage individuals in planning toward their goals
Connect individuals to resources to bring their plans to life
BUILD A SUSTAINABLE SYSTEM
Leverage partnerships, collaboration, community resources to achieve best results
Support system-wide coordination, continuous quality improvement
Use technology-based tools that work across systems to support consistency, efficiency
CONCEPTUAL FRAMEWORK:
HCBS SYSTEM NOW
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CONCEPTUAL FRAMEWORK:
NEW HCBS SYSTEM
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EARLY CROSS-POPULATION INITIATIVES
MINNESOTA’S AGING AND DISABILITY
RESOURCE CENTER (ADRC)
Early and ongoing example of Quality
Architecture in action
15 years of experience developing a shared
platform to support informed choice
Provides a platform for other initiatives;
sometimes “same”, sometimes “different”
Minnesotahelp.info
Disability Linkage Line®
Senior LinkAge Line®
Veterans Linkage LineTM
Disability Benefits 101
BUILDING SHARED INTERNAL SYSTEMS
Quality Essentials Team
Performance Measures Initiatives Team
Fiscal Analysis Collaboration Team (FACT)
Business Information Technology Solutions
CURRENT MAJOR CROSS-POPULATION
INITIATIVES
TRANSFORMATION INITIATIVES
MnCHOICES
One assessment process takes the place of three (DD screening, LTC consultation, PCA assessment—and in the future, PDN assessment)
People will have an assessment and support planning that identifies their individual preferences, strengths and needs
People will be assessed equitably across populations and geography
People will have access to more support options in one process
HCBS Waiver Provider Standards
Basic standards will be consistent and have a consistent enforcement mechanism
People will have health, safety and rights protections
People have choice of the provider they wish to use
Providers will have specializations, and services are customized to the person’s plan
Disability Waivers Rates System
There will be statewide, uniform methodologies used to determine the rate for each service
Rates will reflect the person’s support plan
Customized Living Rate Methodology for the Elderly Waiver
Rates reflect the support plan and type/frequency of services to be provided
REFORM 2020
Bi-partisan initiative to reform MA
Effort to meet the challenges of rising MA costs and
growing demand
Opportunity to develop/test new ways of operating;
successful models will be expanded and in place by
2020
Several foundational transformation projects,
already underway, set the platform for other
reform efforts
Some initiatives require approval and/or
participation of the federal government
Several initiatives require state legislative action
REFORM 2020 – EXAMPLES OF INITIATIVES
Community First Services and Supports
Converting current PCA program to Community First option to gain flexibility in services and delivery models
First Contact Initiative
Pre-Admission Screening federal requirements
Increased upstream engagement
Vulnerable Adult Common Entry Point
One statewide CEP
Better data tracking, allowing improved response to emerging trends and issues
ADDITIONAL EXAMPLES
National Core Indicators
HCBS Report Card and Quality Add on
CMS HCBS Rule Criteria and Transition Plan
LTSS Gaps Analysis
Personal Health Record for LTSS Demonstration
MINNESOTA’S OLMSTEAD PLAN
2013: Release of Putting Olmstead’s Promise into
Practice: Minnesota’s 2013 Olmstead Plan
Working across state agencies to address goals
related to:
Employment
Housing
Transportation
Supports and Services
Lifelong Learning and Education
Healthcare and Healthy Living
Community Engagement
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WORKING WITH STAKEHOLDERS
Challenge: systems have different approaches
Continually working to discern “what’s the same/what’s different”
Working to do a better job hearing the voices of those who use services
Determine if we need to be Autonomous, Coordinated or Integrated
STAKEHOLDER VENUES
HCBS Partners Panel
46 organizations crossing aging and disability represented
DSD and AAS leadership are members
Charge: support continuous improvement in the HCBS system by providing communication link among the system’s stakeholders and by supporting specific initiatives They talk to each other, not just to talk to the State
Project work groups
Almost all initiatives have work groups that include external stakeholders
State Quality Council
Not just there to provide feedback/input—they help do the work
Support building a quality system that is person-directed, outcome-based, quality-driven and effective in its use of public funds
LESSONS LEARNED
LESSONS LEARNED: HAVE A THEORETICAL
BASE
From Glenda Eoyang, Human Systems
Dynamics
LESSONS LEARNED: COMMUNICATIONS
ARE CRITICAL
From Glenda Eoyang, Human Systems
Dynamics
FOR MORE INFORMATION
HOW IT ALL FITS TOGETHER
FOR MORE INFORMATION
Continuing Care Administration’s Strategic Plan
http://www.dhs.state.mn.us/main/groups/disabilities/document
s/pub/dhs16_172066.pdf
MN’s State Profile of LTSS System
http://www.dhs.state.mn.us/main/groups/aging/documents/pub
/dhs16_144888.pdf
Biennial Report on LTSS for People with
Disabilities
https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6656-ENG
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Minnesota’s Olmstead Plan
http://www.dhs.state.mn.us/main/groups/olmstead/docu
ments/pub/dhs16_180147.pdf
DHS dashboards
http://dashboard.dhs.state.mn.us/
Public reporting/performance
management http://www.dhs.state.mn.us/main/dhs16_144803
FOR MORE INFORMATION, CONT.
MnCHOICES http://mn.gov/dhs/partners-and-providers/continuing-care/reform-
initiatives/mnchoices/
Provider Standards and Provider
Enrollment initiative http://mn.gov/dhs/partners-and-providers/continuing-care/reform-
initiatives/provider-standards/waiver-provider-standards.jsp
Disability Waiver Rates initiative http://mn.gov/dhs/partners-and-providers/continuing-
care/reform-initiatives/rate-setting/disability-waiver-rates.jsp
FOR MORE INFORMATION, CONT.
2012 LTSS Gaps Analysis http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA
MIC_CONVERSION&RevisionSelectionMethod=LatestReleased
&dDocName=dhs16_141764
FOR MORE INFORMATION, CONT.