May 21, 2012 - Human Services Agency of San Francisco

Long Term Care Integration (LTCI) Design Group
Minutes from May 21, 2012 Meeting
Exploring the potential for LTCI in San Francisco and determining what is required to improve the
provision of long term services and supports for Medi‐Cal eligible older adults & adults with disabilities
Design Group Members Present:
Tangerine Brigham ‐ Deputy Director, Department of Public Health; CO‐CHAIR
Anne Hinton, ‐ Executive Director, Department of Aging and Adult Services
Nina Maruyama – Officer, Compliance & Regulatory Affairs, San Francisco Health Plan
Phil Arnold ‐ Deputy Director for Finance and Administration, San Francisco Human Services Agency
Betty Fung – Director of Programs, Self‐Help for the Elderly
Rebecca Malberg – Director, Home Care Division, SEIU – UHW
Donna Calame ‐ Executive Director, IHSS Public Authority, at large position
Margaret Baran – Executive Director, IHSS Consortium, at large position
Herb Levine – prior Executive Director of ILRC, and disability consumer advocate
Cindy Kaufman – Vice President, Institute on Aging, community services representative
Sean Atha ‐ Director, Regional Field Operations, Anthem Blue Cross
Design Group Members Absent:
Eileen Kunz – Director of Policy, Regulatory Affairs & Compliance, On Lok Senior Health, CO‐CHAIR
Melissa Howard – Fiscal and Policy Analyst, Mayor’s Office of Public Policy and Finance
Alternates Present:
Kelly Hiramoto – Director of Placement, Department of Public Health (alternate for Tangerine Brigham)
Sarah Crow – Senior Planning Analyst, Human Services Agency
Shireen McSpadden – Deputy Director, Department of Aging and Adult Services
Renee Willette – Deputy Director of Legislative & Government Affairs, City & County of San Francisco
Department of Aging and Adult Services Present:
Bill Haskell – Long Term Care Principal Investigator
Linda Edelstein – Long‐Term Care Operations Director
Megan Elliott – In‐Home Support Services
Carrie Wong – Adult Protective Services
Denise Cheung – Office on the Aging & County Veterans Services
Guests Present:
Cathy Spensley – Senior Division Director, Family Service Agency of San Francisco
Sandy Mori – Retired Development Director, Kimochi, Inc.
Libby Denebeim – Retired CPMC Board of Trustees
LTCI Consultants Present:
David Nolan ‐ Principal, Chi Partners
Lisa O’Connell ‐ Chi Partners
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MINUTES
MAY 21, 2012
Meeting began at 1:10 p.m.
1. Approval of April 16, 2012 Minutes
The Design Group approved the April 16, 2012 minutes.
2. Subcommittee Reports
a. Finance Subcommittee – Phil Arnold informed the Design Group that the Finance Committee
met on May 4, 2012 and presentations were made regarding the two health plans, On Lok and
the rate structure including a description of capitation rates. Concerns were expressed about
actions being taken by the State of California to pass on their budget cuts to the insurance
companies. Nina Maruyama also discussed the State’s carve outs for long‐term care.
Tangerine Brigham and Nina Maruyama then discussed the” risk corridor,” and the need to
ensure that the State of California will make the health plan whole at the end of the year if their
costs go up over a certain amount.
Phil Arnold said that at the next meeting of the Finance Subcommittee they will discuss data
measurement and what constitutes successful measurement. Herb Levine then talked about
measuring the percentage of the population which remains in the community and not in nursing
homes as a measure of success of managed care.
b. Scope of Services Subcommittee ‐ Megan Elliott mentioned that the Scope of Services
Subcommittee discussed how to create the ideal system for consumers. They will meet this
Wednesday, and have narrowed their focus regarding which services will be discussed.
Phil Arnolds suggested that the Scope of Services Subcommittee discuss what services should be
included in managed care. Megan Elliott stated that they will be discussing this issue.
c. Communications Subcommittee – Herb Levine stated that the Communications Subcommittee
discussed their scope of work at the first meeting. Their goal is to put together a
communications plan including deciding what messages would be drafted and at what time it
should be released. The subcommittee will make recommendations to the Design Group. The
Communications Subcommittee will assemble background information on the SF LTCI. A
communications plan has been drafted and will be revised as needed.
The Subcommittee has also started to assemble a list of key organizations that will receive
information from the Communications Subcommittee and then contact their members. When
managed care plans communicate with their members, their communications must be approved
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first by the State of California. The subcommittee will not be communicating through managed
care plans. Instead, they will be developing key talking points.
Tangerine Brigham suggested that the Communications Subcommittee use focus groups to test
materials and see if the public can understand the information being presented. Herb Levine
said that they would be testing the information for clarity.
3. Planning Memo for Design Group Meetings
David Nolan explained that topics for upcoming Design Group meetings need to be calendared to ensure
that all subjects are covered . He provided a memo detailing the subjects of the upcoming Design Group
meetings. He then asked if any topics were missing and whether the order of the topics should be
changed.
Tangerine Brigham suggested that a column be added to the memo indicating which subcommittee will
contribute to the discussion of that topic. This information will assist the subcommittee members in
knowing when their deliverables are due.
David Nolan introduced Lisa O’Connell, a member of Chi Partners, who will be mapping care
coordination in Alameda and SF counties.
David Nolan then stated that one of the goals of the Design Group is to define the target population, and
this population will be discussed at the July 16 th meeting. Rebecca Malberg added that we should
discuss the State of California’s healthcare budget at the July meeting as well. Tangerine Brigham noted
that the Design Group needed an update on where the Governor and the legislature were headed on
the budget.
Anne Hinton mentioned that the October 15 th meeting should discuss how to link the relevant data
being collected and used by various organizations and health plans. The October meeting of the Design
Group should also discuss how health plans communicate with their contractors and how quality
assurance data is collected. Tangerine Brigham added that the data should allow population based
planning. Bill Haskell noted that San Mateo County is using predicative modeling data, and looking at
the purpose of data to determine who uses the community services and who uses hospitals the most.
Herb Levine asked if some providers are not able to collect the data, what is the impact on the
consumers and the LTCI process. Nina Maruyama added that data should be collected on stateprovided
services in order to improve those services.
Phil Arnold suggested that the Design Group meeting on the topic of In‐Home Supportive Services (IHSS)
should occur earlier. Megan Elliott stated that it doesn’t matter when we discuss IHSS, but the universal
assessment tool needs to be discussed before we discuss IHSS.
Tangerine Brigham discussed the fact that the State of California is considering reducing the amount of
reimbursement to family caregivers in IHSS. Megan Elliott noted that we don’t know the Governor’s
final plans regarding IHSS.
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Rebecca Malberg commented that we need to use all of our resources as the incidence of chronic
disease is greatly increasing in SF. Tangerine Brigham remarked that there needs to be a transfer of
care, and a decrease in the use of emergency rooms and urgent care centers for non‐urgent care. We
need to place acute care recipients in the community and get them out of the hospitals. Savings will
come from managed care, managing the acute care population, and not reducing their hospitalization.
Tangerine Brigham also suggested that Ron Smith be contacted and invited to attend a Design Group
meeting on behalf of the Hospital Council.
4. Update on IHSS and LTSS Work Groups (DHCS)
Megan Elliott provided an update on In‐Home Supportive Services and Long Term Services and Supports
Work Groups. She explained that the California Duals project has a variety of subcommittees, and that
she has attended the long term services and supports meetings. At these LTSS meetings, they discussed:
approaches to network capacity and network quality, how to establish readiness, the standards for a
medical network, the required number of providers, operational readiness, financial stability, customer
service, the ability of providers to submit bills and obtain reimbursement, challenges for defining LTSS
network adequacy, and the fact that there is no federal standard for LTSS network adequacy. At the
LTSS meetings, they also covered geographic challenges.
Rebecca Malberg asked how we educate people about the services available. Megan Elliott explained
that under managed care, county social workers will work with managed care plans and participate on
care coordination teams. Managed care providers, county social workers and care‐coordination teams
will advise recipients of the services available. The teams will be used as needed for complex care cases
to assist in an overall plan that will improve health outcomes. In addition, it would be the recipient’s
choice to have a care team, if they want to participate on the team, and if they want their IHSS provider
on the team.
Megan Elliott also pointed out that IHSS recommended: the implementation of readiness criteria,
guidelines for creating the care coordination teams and creating a care assessment tool, and the
development of a home and community‐based care assessment tool which will be used by all programs
for dual eligibles. She also explained that the database that IHSS runs is called CMIPS. In addition, IHSS
is developing a universal assessment tool along with its development of CMIPS2 (the database under
development). In 2015, a coordinated care initiative will consider transitioning to a universal
assessment tool which will be used by all counties. While there is a functional ranking of recipients to
determine their eligibility for IHSS services, there is no state‐wide universal assessment tool to
determine their needs for home care and transportation for example. The goal of IHSS is to have statewide
uniformity in the assessment of recipients needs with a universal assessment tool.
Rebecca Malberg commented that county social workers need to use the same assessment tools. Then
if it is necessary for the number of care hours to be increased in order for the recipient to remain in the
community; the assessment tool will indicate the need for those increased hours of care.
Megan Elliott further commented that IHSS has said, that the number of hours of home care cannot be
decreased by the health plans, but only increased so as to avoid recipients’ hospitalizations.
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Furthermore, in San Mateo County, when a recipient enters the health plan and is a high risk recipient,
they should be given a risk assessment. The recipient can then decide if they want care coordination as
they have been deemed to be high risk.
May Budget Review
A review of the State of California’s budget was tabled by Tangerine Brigham.
5. Alameda Alliance for Health Meeting
DAAS staff met with key staff of the Alameda Alliance for Health, one of the two health plans in Alameda
County. While Alameda is currently a two‐plan model, it is exploring becoming a county organized
health system. Alameda Alliance and SF LTCI have agreed to meet regularly to share information and
lessons learned as both are part of DAAS’s SCAN proposal. These meeting will occur quarterly.
Chart of Long‐Term Services and Supports
Tangerine Brigham briefly discussed the chart of Long‐Term Services and Supports and Specific State
Plan Services for Medi‐Cal Dual Eligibles which was provided to the Design Group. The chart detailed
the type of services provided and the average number of monthly users per county in California for each
type of service. The data covers dates of service from January 2010 through December 2010. The chart
will be available for viewing at: www.sfdaas.org.
Next Meeting of the LTCI Design Group
The next meeting of the Design Group will be on June 18, 2012 at 1:00 p.m.
The meeting adjourned at 3:00 p.m.
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