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Paul Saucier

Paul Saucier. State Approaches to Integrating Care. LTQA/NCHC Capitol Hill Forum April 24, 2014. OVERVIEW.

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Paul Saucier

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  1. Paul Saucier State Approaches to Integrating Care LTQA/NCHC Capitol Hill Forum April 24, 2014

  2. OVERVIEW • Traditionally, state Medicaid-funded medical systems, long term services and supports (LTSS) systems, and mental health systems have operated on parallel planes, and all 3 of these Medicaid systems have been very separate from Medicare • Increasingly, states are turning to integrated care models to: • Improve outcomes • Enhance experience • Reduce costs • Streamline administration • In particular, states have moved rapidly to integrate LTSS with medical services in Medicaid-only models and Medicaid-Medicare models

  3. WI NY CA NC AZ 19 STATES HAD INTEGRATED LTSS AND MEDICAL CARE TO SOME EXTENT AS OF APRIL 2014, UP FROM 8 IN 2004 WA MN MA MI RI PA IL DE KS TN NM TX FL HI MLTSS implemented 1989-2004 MLTSS implemented 2005-2014

  4. THE NUMBER OF LTSS USERS IN INTEGRATED PROGRAMS IS PROJECTED TO DOUBLE THIS YEAR Sources: 2004 and 2012: The Growth of MLTSS Programs: A 2012 Update (Truven Health for CMS) 2013 and 2014: Truven Health estimates.

  5. HOW IS CARE INTEGRATED? • Care coordinator role is key: • Assesses the consumer’s needs and preferences • Works with PCP and multiple other parties to plan, authorize and coordinate services • Monitors service plan • Follows consumer across settings and through transitions of care • Uses multiple methods to facilitate information transfer across multiple parties

  6. POPULAR IMAGE OF AN INTERDISCIPLINARY TEAM MEETING PCP Consumer Care Coordinator    Pharmacy Consultant Specialist Physical Therapist Daughter Social Worker

  7. REAL WORLD CARE COORDINATION Specialist PCP Rx Consultant • Phone    • Electronic Transfer • EMR • F-to-F (office visit) • F-to-F (co-located) • Electronic Transfer • Phone • F-to-F (team mtg) • F-to-F (office visit) • Phone, Fax • Internal Info System Phone • Phone, Fax • F-to-F (home) Consumer Care Coordinator Phone • F-to-F (in-home services) • F-to-F (team mtg) • F-to-F (home) Phone • Internal Info System Phone • Phone, Fax Phone, F-to-F Phone, F-to-F • Phone, Fax • Phone, Fax, Electronic Authorization State/County Social Services, CBOs Home Care Provider Daughter Social Worker

  8. STATES VARY CONSIDERABLY ON HOW DETAILED THEY MAKE CARE COORDINATION SPECIFICATIONS • Qualifications • Nurses, social workers, degrees, experience • Contact with consumers • Face-to-face almost always required, but intervals vary • Person-centered planning • Language is prevalent, details are rare • Caseload ratios • If specified, generally differ by risk category • Partnerships with community based organizations that have traditionally provided coordination of LTSS • A few states mandate relationships, but allow discretion in the nature of relationship

  9. WORK IN PROGRESS • Role of traditional care coordination agencies (AAAs, CILs, and other CBOs) • HIT in LTSS agencies • Interoperability across systems • Measures of integration and LTSS

  10. paul.saucier@truvenhealth.com

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