L.A. COUNTY COORDINATED CARE INITIATIVE (CCI) Stakehlder Wrkgrup Meeting Minutes July 15, 2015; 1-3p.m. The Califrnia Endwment 1000 Alameda Street, Ls Angeles, CA 90012 CHC Ysemite B-LA (Multi-Purpse Rm) Web Cnference: G t: https://mlina.webex.cm/mlina/j.php?j=804614248 Telephne Dial-In: Call 855-665-4629 TIME TOPIC PRESENTER Attachments: 1:00 1:15 p.m. Welcme & Intrductins Apprval f April 15, 2015 Meeting Minutes N crrectins t minutes Minutes apprved by cmmittee James Nvell Chief Operatins Officer Mlina Healthcare f Califrnia 1:15 1:30 p.m. LTC Reprt: Califrnia Cmmunity Transitins (Mney Fllws the Persn) Purpse f CCT CCT develped because f the Olmstead Decisin. Peple shuld have the pprtunity t live in their cmmunities, nt facilities. Rebalance Medi-Cal spending (previusly 45% f spending was n facility care). Histry f CCT The Olmstead Decisin tk place in 1999 and then CMS released the Mney Fllws the Persn Demnstratin Grant (MFP). Califrnia used the MFP grant t develp and implement the CCT prgram. The CCT prgram will cntinue thrugh 2016 with the ACA extensin f the grant. There were apprximately 500 transitins last year. T date, 2,307 peple have been transitined ut f facilities and int the cmmunity setting f their chice. Guiding principles: Everyne has the right t Self-determinatin, independence, and chice. Ensure cnsumers have the full range f services necessary t live in their cmmunity when such services are apprpriate. Eligibility criteria fr CCT: CCT can be utilized by peple f any age T qualify individuals must have Medi-Cal fr at least ne day, be in a SNF fr at least 90 days, and still need the same level f care as they did while in the facility they re transitining ut f. Prcess - Lead Organizatins Transitin crdinatr ges t facilities fr pre- transitin preparatins. They secure mney fr first and last mnth s rent, Rebecca Malberg vn Lewenfeldt Directr f HCBS Integratin Harbage Cnsulting
furniture, transitinal persnal care befre IHSS is in place, vehicle mdificatins and mre. With the implantatin f CCI, nw CCT can crdinate with the cnsumer s health plan. This allws fr nging case management by crdinatr after the transitin The crdinatr als cnnects cnsumers with resurces, including help with emplyment resurces. CCT gals Fcus n the Whle Persn Apprach and identify early risk. CCT aims t crdinate with Health Plan and be invlved in member ICTs. Primary care and specialty care shuld be set up befre the transitin happens t allw fr a smther transitin. The Health Plan cnnecting with lcal lead rganizatin t help get their members t get CCT assistance. Future f CCT: Ensure that services and supprts are in place s that the cnsumer desn't end up back in a facility. Q & A Sessin Questin: Ashlee - Hw is this part f the Medicaid waiver? Answer: Rebecca - I can't answer this but will take the questin back t the State Answer: Pam @ Care first - Has successful CCT referrals and transitins and mentins differences with CMC and Medi-Cal prcess. Questin: Denny - Q: what kind f cmmunicatin and infrastructure is in place fr the Health Plan and the Transitins crdinatr? Answer: Rebecca this is a better questin fr the plans. Answer: Pam: Nte there have been many successful transitins. Mentins several f the prviders wh are invlved. It s a wrk in prgress and it s a lt f cmmunicatin. Rebecca It s imprtant t remember that frnt end cmmunicatin Questin: Lisa Hayes- Hw lng fr waiver, des it sunset in 2015? Answer: The grant was extended and will cntinue thrugh the end f 2016. Cmment: Lisa states cnsumers can be in CCT & a CMC health plan. Pam M. ntes cannt have CCT & the assisted living waiver while with a CMC plan. 1:30-1:50 p.m. IHSS and Health Plan Crdinatin Hw ICT s with DPSS & Health Plans wrk tgether t help members Terrance Hensn speaks abut IHSS and Health Plan Crdinatin. He will talk abut what he des and hw the prgram helps imprve lives f cnsumers. IHSS: There was preparatin befre CCI tk effect including ensuring that the scial mdel f IHSS stays intact. This means the cnsumer stays in charge as the emplyer f their prvider and Terrance Hensn, Manager LTSS Mlina Healthcare f Califrnia Marla Pearsn, HSAI, LA DPSS Phyllis Crawfrd, SW LA DPSS
the fcus remains n persn centered care. Terrance ntes the cunty is still in charge f eligibility and hurs determinatin Health Plan Cllabratin: LA Care leads a wrkgrup fr cllabratin. This allws fr pen cmmunicatin between Health Plans. Health plans have cntacts within IHSS t assist members quickly. Liaisn prcess Streamlined cmmunicatin with a central pint f cntact, making it easier t get an IHSS representative present at an ICT meeting. Expedited referrals Health plans wrk tgether with IHSS and this makes it pssible t get services t members faster wh are need f services. Health assessments are dne while the member is still in the facility s this wrks well with CCT. It allws fr IHSS t be set up befre the member transitins back int the cmmunity. Data Sharing We receive state data that includes the number f hurs, the types f services they receive, and when next reassessment is due are cmmunicated. Helps us t understand hw we can best serve ur members. Care Crdinatin This is what we d n a day t day basis. There is a streamlined prcess fr IHSS referrals and these can cme directly fr the health plan. T d this the health plan submits a request n behalf f the member t the intake unit at IHSS. Fllwing that, the Health Plan can help the member cmplete the Health Certificatin Frm. Open cmmunicatin between all parties invlved is key. Redeterminatin f hurs If the member s health status changes, their health plan can request reassessment fr mre IHSS hurs. Member updates - IHSS needs t have up t date cntact infrmatin, and be advised f hspitalizatins/snf care. Open cmmunicatin gets this infrmatin t all the relevant parties t allw fr better crdinatin. Caregiver assistance Health plan can refer them help them cnnect with an apprpriate caregiver. Health Plans can help wrk with caregiver t slve issues that may arise, such as lst timecards. Interdisciplinary Care Teams (ICT) It s a persn Centered Mdel f care. A care plan is develped with a case manager and they re member and is based n the mst imprtant health gals that the member wants t reach. Then the case manager brings that infrmatin t the ICT and everyne wrks tgether t help them achieve thse gals. ICTs have medical directrs, pharmacists, scial wrkers, nurses, and the IHSS Scial Wrkers. Other such as LTSS scial wrkers, caregivers can be at the ICT, but nly with the member s discretin. Mst imprtantly the member can be a part f their ICT. Frmal ICTs take place n a regular basis and Ad Hc ICTs ccur when a need arises.
Meeting interrupted t evacuate the space due t a strng natural gas dr. Meeting attendees are mved t a nearby cnference rm and then the meeting cntinues. Terrance cntinues: Terrance tells member stries - See slides Success stry 1: Member is a 70 year ld male Cal MediCnnect member wh had Diabetes. The member was authrized fr IHSS in Nvember f 2014 fr 85.5 hurs per mnth. Related t the diabetes, the member had his left ft amputated in February f this year. After the surgery, the member was presented in ICT in with IHSS present. During the ICT, IHSS was ntified f the amputatin as they were nt aware f this change in his cnditin. IHSS cnducted a reassessment based n the significant change. The member was awarded additinal hurs fr ambulatin, bathing and transprtatin t medical appintments. Success Stry 2: 42 year ld female wh develped gangrene in bth f her hands and was at risk fr amputatin. The member was unable t use her hands and required assistance with all ADL s and IADL s. The member culd n lnger care fr herself r her family. Mlina LTSS Liaisn wrked with IHSS t expedite an IHSS referral. CM gathered signatures fr the Health Certificatin Frm. IHSS assessed the member and apprved her case. Assessment was cmpleted within 14 days frm the start f applicatin. Success Stry 3: Husband and wife, 82 year ld female and 85 year ld male Cal MediCnnect members. Mlina CM nticed the wife s cgnitive ability was deterirating related t a Dementia diagnsis. The wife already had IHSS and needed additinal services. CM and Mlina LTSS Liaisn wrked with IHSS and member t establish Prtective Supervisin. The members number f apprved hurs changed frm 51 hurs t 283 (the IHSS max amunt). The husband was denied services the year befre, hwever, due t decreased functinal ability, the CM and Mlina Liaisn wrked with the member t re-apply and submit the SOC 873, Health Certificatin Frm. Member was apprved fr 29 hurs per mnth. Mlina CM als made MSSP referrals fr bth members and they are nw enrlled in the prgram. These aren t special cases; this is what we d n a day t day basis. Marla Pearsn Speaks Marla tell us she s ging t give an verview hw IHSS and health plan care crdinatrs wrk tgether at ICTs. ICT is a grup f prfessinals brught tgether alng with DPSS invlvement when it s determined that there is a need fr care crdinatin. DPSS wrks with all five CMC Health plans in LA Cunty. When it s determined the ICT is needed the plan cntacts the ICT liaisn. The apprpriate peple are cntacted at DPSS in rder t gather necessary infrmatin abut the member. The ICT takes place and then the DPSS representative takes that infrmatin back t the case scial wrk. The scial wrker then des a new assessment and mst f the time hurs are increased. Very rarely are hurs decreased, but that nly takes place DPSS learns that there are ther services in place fr that member, thus decreasing the need fr the same amunt f hurs. The utcme is reprted t the Liaisn
Requests fr ICTs are n the rise these started in January 2015. 247 ICTs have taken place, in 34 cases the hurs have been increased and in nly 3 cases have hurs been decreased. Marla ntes that Phyllis will nw speak and that she is ne f the scial wrkers present during the ICTs. Phyllis Crawfrd Speaks - At ICTs DPSS learns mre because f ICTs. Nrmally they nly see the client nce a year and the client culd need f mre hurs befre their next annual assessment. Health plans can ntify us abut the need fr reassessment prir t next annual assessment. Otherwise we wuldn t have knwn abut it. It s beneficial fr all when DPSS wrks with the health plans. Q&A Sessin: Questin: Stephanie Lee with CMC Ombudsman were additinal staff hired prir t CCI implementatin? Were there existing staff put in place as Liaisns r did yu hire new peple? What kind f nging evaluatins are happening t assess hw this ICT prcess with the health plans is ging? Answer: Marla We are hiring new staff t meet the needs. The health plans have a list f Reginal Liaisns t cntact when there s an issue. Cmment: Pam M. ICTs have been very psitive experiences. She has received quick turn-arund times with few issues. There s a lt f cmmunicatin between the health plan and IHSS scial wrkers Questin: Denny References the chart displayed and asks if the data represents each individual request r if it represents individual peple with multiple requests If the same persn has tw requests fr reassessment, are they cunted nce r twice in this data? Answer: Marla We cunt these manually and d nt have a way f identifying whether r nt it s the same individual. It s really the number f requests we receive. Questin: Denny - D yu have a sense f hw many IHSS cnsumers are enrlled in CMC. Answer: DHCS has nt shared that with DPSS. Questin: David frm CMC Ombudsman - Des yur ffice cntact HP when there's a cnsumer issue Answer: Marla - Des nt have data in rder t d this. The cnsumer has t cntact the health plan r DPSS. Questin: Dulce frm PASC peers - As a cnsumer, what can be dne fr traveling when my prvider can't jin me? Can yu find me a prvider in anther state? Answer: Marla- IHSS des nt hire prviders but can ffer resurces and referrals fr ut f state travel. IHSS will pay while yu're n vacatin fr a limited amunt f time.
Questin: Jennifer S. frm Alzheimer's assciatin: What abut peple with cgnitive disabilities? D yur systems identify family members r infrmal caregivers wh are prviding IHSS services, and if that infrmatin is cmmunicated t health plan? Answer: Marla - When the initial assessment is dne at hme, usually a family member will be present as the authrized representative fr a persn with cgnitive disabilities (r a guardian r cnservatr). Health plans are ntified f guardians and cnservatrs by data prvided by the state. Questin: Stakehlder - What is the typical timeframe frm the initial request fr ICT and what the determinatin utcme. Answer- Snia Perez Within tw weeks determinatins will be made frm the time f the ICT. Cmment: Terrance frm Mlina T clarify: State data prvided t the health plan is limited n the cnservatr infrmatin prvided t the health plan. We re nt tld whether it s a parent, sibling etc. - just that there is a cnservatr r guardian fr that member. 2:40p.m. Panel Discussin LA PASC Peers: Lisa Hayes speaks: The fcus f the meeting tday is n IHSS and all things arund IHSS. There is high % f pt ut rates fr CMC. We have an pprtunity t talk t PASC peers wh cmmunicate with ther IHSS cnsumers. We did this at ur internal meetings. Feedback was s insightful we thught that the entire grup shuld hear what they have t say. Intrduces Panel frm PASC Peers and invites them t the panel table: Randi Bardeaux Jrge Chuc Ducle Garcia Bertha Ple Emphasizes hw imprtant this discussin is fr health plans t hear. 1. Why pt ut? What are the issues IHSS cnsumers are saying? Randy Bardeaux - Apprximately 190,000 IHSS cnsumers in LA Cunty and 68 % are senirs. When we started having discussin grups with the IHSS cnsumers, the first respnse we gt frm the senirs was an earnest NO. We dn t trust the gvernment. As we tld them what the cncept was t crdinate all f their health care, and t get a crdinatin team they were interested in the cncept. Once the prgram gt underway, we fund that the cncept wasn t fllwed up n and that the care crdinatin was nt cmplete. Cnsumers cmplaining that prescriptins weren t fllwed thrugh during the transitin, prcedures started weren t carried n in a timely manner; they are experiencing lengthier wait times t get in t see a prvider. Frm the beginning many did nt want t changes their dctr and knew that with CMC they may lse Mderatr: Lisa Hayes, Directr Disability & Senir Access Mlina Healthcare f Califrnia PASC Panelists: 1) Randi Bardeaux 2) Jrge Chuc 3) Dulce Garcia 4) Bertha Ple
the dctr that they liked. We had sme ther cncerns that are cntinuing. When a CMC dctr feels that a IHSS recipient culd benefit frm mre hurs, they aren t getting thse hurs. It s really a thrill t see the success stries up n the slides, but I m hearing the peple wh are cmplaining abut the prgram. The biggest prblem is the smth integratin between Medicare and Medi-Cal prcesses fr CMC enrllees. Jrge Chuc- Yu re nt ding gd enugh utreach, things were nt clear in the beginning. Transprtatin is a big issue. A cnsumer changed plans because f the transprtatin and access issues with medicatin. This message is circulating and IHSS cnsumers wh are abut t turn 65 are hearing that and saying n I m nt ging t enrll in [the CMC] prgram. Bertha Ple My experience with thse wh pt-ut f CMC is fear f the unknwn. Many IHSS cnsumers are struggling with their caregiver. That ne f the biggest issues a cg in times in times f emergency r having caregivers in the hspital. When they g int a facility. Say the cnsumer is in the hspital, s many f them wind up with caregivers cming t help met their needs withut pay while the cnsumer is in the facility. This is an impsitin n bth cnsumer and prvider, there s stress and discmfrt fr the prvider and the prvider wrks withut pay. If there was a way fr the prvider fr t be paid, even fr fewer hurs, s thse needs culd still be met while the cnsumer. This wuld be an enrmus burden lifted. Anther area is in cases f emergency. PASC has a backup prgram fr urgent care, shuld yu find ut that yu ll be withut a prvider and yu have time t prepare. This is nt fr an emergency; there is n backup system unless yu have ne f yur wn. Many peple dn t live with their prviders, if smething were t happen in an emergency where their prvider was incapacitated r therwise, where wuld they be? Like me, yu can t get ut f bed, yu can t get dressed. If yu can help with that, maybe this wuld help. It is a cncern, nt always present struggle, but a cnstant cncern. Hw can yu help me with this? A lnger transitin perid wuld help. Many f us have fund dctrs we are cmfrtable with and 6 mnths is nt that lng. When yu have allergies and ther needs this wuld help with CMC enrllment rates. Dulce Garcia We dn t want t change these aspects f ur lives. It takes us years smetimes t find the right dctr wh understand ur needs and wrks with yu. Then yu have panel f dctrs an umbrella. I have 8-10 dctrs wh wrk n me every three mnths. I m cntinuusly getting certain tests because f my diagnsis. I pted ut because f that. Hw am I ging t g in there when I haven t had the help prir? I have reached ut and haven t gt any f the respnses that I requested r needed. I have t thrw a fit t be heard. Yu feel like yu re just a case number and nt a persn. A lt f it has t d with hw they ve been apprached in the past. Fr myself, I was nt ambulatry but I gt denied fr IHSS. I dn t knw why. (Panel member is very emtinal abut this). It s a big cncern fr a lt f cnsumers, if I dn t have smene t get me ut f bed, hw am I ging t get ut f bed? Hw am I ging t be turned in bed? Hw am I ging t take my medicatins if there s n ne t bring them t me? I called in fr an assessment because my cnditin became wrse than what it was befre. I gt my hurs cut and then I
had an additinal 6 hurs cut. The persn assessing said that the previus ffice that had assessed me befre was very lenient with hurs. Nw they are ging t review the hurs accrding t prtcl. They said I m srry but we have t g by the bk. S I cut my hurs cut. And that s the prblem that s many IHSS cnsumers face. It makes n sense. Then yu reach ut fr help and yu get the cld shulder r a scripted respnse. It s basically saying I ve answered yur questin It is what it is, suck it up. Lisa asks if the panelists all live n their wn. Dulce respnds, N I had t mve in with my family because f that. 2. What wuld need t change t get cnsumers t vluntarily enrll? Randi Bardeaux I think ne f the main issues is fr the dctrs t be n bard with this and t many [dctrs] are nt. And the dctrs wh are in the prgram are very frustrated with e current cmputer system and when they try t crdinate with the rest f their care team members, they believe in this cncept. The technlgy is s antiquated and very frustrating t be able t cmmunicate with their team. I ve been talking with a lt f dctrs wh are in Cal MediCnnect prgram. They say because f the paper wrk that s required f them and the cmputer system they have, nw 90% f their wrk is spent n paperwrk. They spend less time with patients. This has been very frustrating fr the dctrs. Were we get mre cnsumers, we need t get the dctrs fully supprted and help them encurage ur cnsumers t jin the prgram. Jrge Chuc- The prgram is there t help us. We re tld t sign papers, and until then, nthing happens. We need t educate the dctrs and the cmmunity. Bertha Ple- Anything that will facilitate a smther transitin and give exemptins when needed. This is ften an issue with medicatins. Anther thing that wuld help is the utreach. If peple knew that these services are available. During Terrance s presentatin, I nticed that ne f my neighbrs culd have been helped by an interdisciplinary care team. The Medical Certificatin Frm was a big prblem fr ne f my neighbrs. It ended up with her case being clsed. Her, prvider, ut f the gdness f her heart refused t leave her stranded and wrked unpaid fr several mnths. Just smene wh culd have ntified her that her dctr had nt submitted the Medical Certificatin frm culd have stpped all f that frm happening. S there are benefits t ICTs - it s just the cnsumers need t knw. Cmment: Terrance Wants t g back t first questin where bertha talks abut assist with hiring a caregiver r getting smene ut their in an emergency situatin. Is yur idea nly t be emergency situatins r a mre f a cmbined mdel where the either the IHSS cnsumer can hire their wn prvider r if the cnsumer wants, allw the health plan t hire smene n their behalf. Nt that it has t be ne way r ther, just t give the ptin. Respnse: Bertha I dn t like the idea f smene else hiring the caregiver because the self-directed mdel. Finding
their wn their wn caregivers is very imprtant t IHSS cnsumers and if yu talk abut shutting that dwn there s nthing else yu culd say that they wuld listen t. Cmment: Terrance S just in an emergency situatin? Respnse: Bertha- Yes just in an emergency situatin. We need a plan B. Just ne emergency can be s terrible, its always in the back f ur minds. It wuld be very reassuring t knw that that kind f assistance was available. Questin: Pam M with Care1st The health plans have the ability t cntract with hmecare prviders fr thse types f situatins, s yu really just need yur cntact at the health plan in thse types f situatins. S yu re nt getting the names and phne numbers f the peple wh are yur cntacts at the health plans? Respnse: Bertha Mst f the peple I knw pted ut. Thse are very real cncerns. If they were t knw that this kind f help was available that wuld help. The respnsibility t hire ur prviders is taken very seriusly. But anything can happen, and when anything des happen the cnsequence can be s severe. There was an emergency and my neighbr had t be hspitalized. They didn t give her the apprpriate type f care and when she came hme her prviders were hrrified t find that she had a stage 1 pressure sre. These are things that make us nt want t even cnsider enrlling in a managed care plan, because we might get lst in the cracks and fall right thrugh. Questin: Jyce furlugh with CareMre I just wanted t thank yu fr cming t share yur feedback with health plans. I understand the cmment abut fear and I understand it. I dn t think it s unique t any type f persn; life changes create fear and it sunds like having that prvider engaged and wrking with us will take care f sme f that fear. Set aside the prvider issue, what culd we cmmunicate better t help peple make a decisin abut managed care. What can we explain better r prvide mre infrmatin n? Lisa ntes this is a great segue t ur next questin, summarizes the cncerns nted already, and then transitin int asking the next questin. 3. What recmmendatins can yu give the state and/r the plans n messaging t IHSS cnsumers? Randi Bardeaux One f the mst beneficial things wuld be t have a panel like this ne, but include cnsumers and dctrs wh are part f CMC. Have them describe the successes. It was wnderful seeing the slides but we dn t hear abut them. Yu need panel discussins t in fr the public and cnsumers, share that there are success stries, that peple are happy with the prgram and what the benefits are. Jrge Chuc We want t hear what s really happening in the plans. Accmmdatins are imprtant t us. Mlina came ut with a pamphlet that describes what accmmdatins they have s I tk
that back and can really shw ther cnsumers what they can get. Then he discusses hw he waited fr an appintment fr 2 mnths but culdn t get the apprpriate accmmdatins fr transprtatin. The transprtatin culd nt actually transprt him s he had t miss his appintment and wait an additinal tw mnths fr anther appintment. States I didn t knw the health plans were respnsible fr this. I can take this [the pamphlet] and say this is what s happening. Bertha Ple I think it s s imprtant when dealing with IHSS cnsumers that yu reassure use that yu have ur back s, AND that ur autnmy will nt be cmprmised. In an emergency, that we wn t get hurt r lst in the system. If that can be cnveyed withut cmprmising ur autnmy, that is the key t IHSS cnsumers. Dulce Garcia Educatin is pwerful thing, dn t just educate the dctrs and nurses, educatin the patients. I m with L.A. Care and I get s much mail that I dn t read it. Find a way t that s nt just sending ut papers t cnvey the message t cnsumers. Invite them t cme ut t an event and shw them what s happening. As fr transprtatin, it s nt just saying we have transprtatin. I received transprtatin frm my health plans fr years and it was gd but recently they changed cntracted transprtatin prviders. I had a driver shw up and tell me t g up a ramp while he held it dwn. It was nt safe. I ve been left behind 5 times and missed appintments. This is nt just a matter f just ffering transprtatin, but fllwing thrugh with it. Real change, nt a csmetic change. 3:00p.m. Clsing Remarks Dr. Cruz ntes that this has been an illuminating discussin and thanks panel fr sharing their insight. Asks fr any additinal questins. James Cruz, MD Chief Medical Office Mlina Healthcare f Califrnia Stakehlder Questin: States that credentialing was very time cnsuming fr he and his staff. The prcess is a little cumbersme. Is there sme way yu can make that easier Answer: Dr. Cruz - There are sme things that are required by NCQA, but I can definitely check t see if there are ways t streamline. Stakehlder Cmment: Janet with PASC Thanks the peers and pening their ideas. Thanks the plans fr setting up this meeting. It wuld be wnderful t figure ut hw t imprve cmmunicatin with cnsumers s they can make chices based n facts and nt fear. Next Meeting: Octber 22, 2015 at the Califrnia Endwment L.A. Care will hst.