SACRAMENTO, Calif., June 13, 2013 /PRNewswire/ -- With the implementation of the Affordable Care Act in California and a spotlight on managed care, Independent Living Centers (ILCs) have an opportunity to further the Olmstead Decision by providing cost-effective, coordinated care for dual eligible beneficiaries or individuals who qualify for health care services through both Medicare and Medi-Cal programs. According to the California Department of Health Care Services (DHCS), there are approximately 1.1 million dual eligible beneficiaries in California. Through the Coordinated Care Initiative (CCI) and Cal MediConnect, California's efforts to transform the Medi-Cal delivery system for home and community-based (HCBS) long-term services and supports, ILCs have the chance to work with managed care plans to expand access to HCBS services. This would be accomplished by including them in the benefit package for dual eligibles and contracting with managed care organizations to deliver these services in a community setting.
"We believe ILCs can play a crucial role in the implementation of managed care," said State Independent Living Council Executive Director Liz Pazdral. "ILCs have established and effective relationships with community-based organizations and can help managed care plans contain costs by assisting individuals living with disabilities to live independently in their homes rather than in institutions."
The CCI and Cal MediConnect will be implemented in eight counties, including Santa Clara County, which Silicon Valley Independent Living Center's (SVILC) Director of Programs Todd Teixeira has been actively tracking. With the state and health plans still negotiating the rates to provide services to dual eligible beneficiaries, SVILC is determining the best way to package its services. For Teixeira, it will be important to help health plans see the value of ILCs as a "link or bridge" between medically necessary and socially necessary services as part of the plans' overall strategy to provide comprehensive, integrated care for dual eligible beneficiaries, including individuals with disabilities.
"In the past, ILCs have never had to demonstrate to health plans the benefit of the services we provide and how those services can effect positive outcomes such as reducing re-hospitalization or providing in-home support services that keep individuals out of emergency rooms," said Teixeira. "Given the role we can play in keeping costs down while providing quality services, it will be critical for ILCs to collect data and track outcomes that demonstrate our value to the managed care plans."
Since January 2013, SVILC has been learning about what it means to partner effectively with health plans in providing services. SVILC is one of six organizations, and the only ILC, to participate in the SCAN Foundation's Linkage Lab project designed to assist these organizations in building connections and looking at how best to offer coordinated care services to managed care organizations. Through a series of educational programs and strategy sessions, SVILC has been examining its costs and services to determine the optimal way to package them for the capitated model of managed care and demonstrate readiness.
"The health plans in the eight counties, which for Santa Clara County are Anthem and Santa Clara Family Health Plan, have to show their readiness to provide HCBS," said Teixeira. "In our county, SVILC is the only organization providing transition work from skilled nursing facilities into the community. With our core independent living services and relationships with community-based organizations like the Council on Aging, we can be part of the health plans' readiness, which is one of the reasons the plans are talking to us."
Another element of SVILC's readiness is its participation, since 2010, as a lead organization in California's Community Transitions Project (CCT) or Money Follows the Person Rebalancing Demonstration project. The project is funded by the Centers for Medicare & Medicaid Services (CMS) through September 2016 and is designed to assist with transitioning individuals from health facilities to community living. SVILC provides comprehensive pre-transition coordination and post-transition community living services, including peer support, independent living skills training, housing assistance, assistive technology and more.
"These are exactly the types of services we plan to bundle in working with the health plans," explained Teixeira. "For example, if they identify someone who is a frequent user of high-cost benefits, such as emergency room visits that could result in one- to two-day hospitalizations, we can help by providing peer support, independent living skills when assisting with activities of daily living or self-advocacy skills when working with physicians. And we can do this very cost effectively and cheaper than hospitalizations."
As the health plans prepare for enrollment through Cal MediConnect, which is expected to begin no earlier than the first quarter of 2014, links between plans and communities will be essential. Teixeira remains hopeful SVILC will be well positioned to carry out what he believes was intended by the Olmstead Decision—ensuring access to affordable and beneficial services AND independent living in the community.
"ILCS are part of the crucial fabric for individuals living with disabilities to stay at home and avoid institutionalization," said Teixeira. "I believe the health plans understand this, and the good news is, they are talking to us."
The California State Independent Living Council is an independent state agency which, in cooperation with the California State Department of Rehabilitation, prepares and monitors the State Plan for Independent Living.
SOURCE California State Independent Living Council (SILC)