ValleyCare Demonstrates the Value of Home Delivered Meals


As
 part
 of
 SSC’s
 January
 31st
 Panel
 discussion
 on
 The
 Changing
 Landscape
 of
 Aging
 Services,
 Gabrielle
 Chow,
 Director
 of
 Community
 Nutrition,
 ValleyCare
 Hospital
 System,
 spoke
 about
 a
 project
 to
 prove
 the
 value
 of
 home‐delivered
 meals
 in
 reducing
 hospital
 readmissions
 among
 patients
 with
 congestive
 heart
 failure
 (CHF).
 ValleyCare
 produces
 therapeutic
 diet
 meals
 for
 Meals
 On
 Wheels
 in
 Dublin,
 Livermore
 and
 Pleasanton, 
which 
are 
then 
delivered 
by
 Spectrum 
Community Services.


The 
project
 began 
with
 a
 grant
 that
 allowed
 for 
a
 CHF 
Coordinator 
to 
work 
with 
patients
 after
 discharge,
 an
 effort
 that
 yielded
 positive
 results
 but
 did
 nothing
 to
 change
 the
 dismal
 hospital
 readmission 
rate 
of
 the 
patients.
 Recognizing
 that low 
sodium 
diet 
plays
 a
 critical
 role
 in
 managing
 CHF,
 and
 that
 patients
 were
 overloaded
 with
 information
 at
 discharge,
 Gabrielle’s 
team 
added 
home
 delivered 
meals 
as 
an 
additional
 component
 to
 the 
project.

Patients
 were
 offered
 the
 chance
 to
 enroll
 in
 the
 meal
 plan.
 ValleyCare
 and
 Spectrum
 collaborated
 to
 deliver
 two
 meals 
a
day
 for 
seven
 days 
for 
both 
the
 patient
 and
 spouse.
 ValleyCare 
pays
 for 
the 
first
 seven 
days 
and
 then 
Spectrum 
assesses patients’
 for 
Meals
 On 
Wheels
 program
 eligibility 
(so 
far,
 40%
 of 
the
 patients
 have
 stayed 
on 
beyond
 seven
 days).
 The
 initial
 results
 were
 startling:
 readmission
 rates
 for
 patients
 receiving
 meals
 decreased
 by
 40%.
 Now,
 ValleyCare
 is
 planning
 to
 add
 more
 comprehensive
 data
 collection 
and
 expand the 
project
 beyond
 patients
 with
 the 
primary
 diagnosis
 of
 CHF.

ValleyCare’s
 experience
 is
 an
 example
 of
 an
 organization
 taking
 concrete
 steps
 to
 document
 the
 measurable
 health
 outcomes
 of
 a
 LTSS
 intervention
 –
 uncovering
 a
 “bottom
line”
 outcome 
that 
hospitals 
and
 managed 
care
 plans 
will
 understand 
and
 can
 assign
 a
 value 
to.


 

For a report on the entire January 31st SSC Panel Discussion, click here.

To return to the Changing Landscape page, click here.

 

Bay Area Community Services Assesses Readiness

BACS
 Executive
 Director
 Jamie
 Almanza
 described
 how
 a
 SCAN
 Foundation
 “Linkage 
Lab” 
grant
 is 
helping
 her 
organization prepare
 for
 change.

The
 goal
 of
 the
 Linkage
 Lab
 grant
 is
 to
 provide
 BACS
 with
 the
 necessary
 training
 and
 technical
 assistance 
to 
develop
contracts
 with 
health
 care 
providers 
to 
deliver
 products
 or
 services
 that
 enable
 aging
 with
 dignity.
 BACS
 is
 one
 of
 six
 organizations
 selected
 to
 participate
 in
 Linkage 
Lab.
 This
 24
 month 
initiative
 will 
allow 
BACS
 to
 better
 coordinate
 its
 senior
 services
 with
 the
 health care
 sector,
 thus
 improving
 the
 quality
 of
 care
 for
 elders
 with
 chronic
 conditions
 and
 functional
 limitations
 while
 at
 the
 same
 time
 diversifying
 revenue 
streams 
for
 the 
organization.

BACS
 will
 begin
 by
 assessing
 their
 entire
 organization
 and
 infrastructure.
 They
 will
 identify
 both
 current
 and
 needed
 strengths
 and
 capabilities
 that
 would
 allow
 them
 to
 interface
 with
 health
 care
 partners;
 identify
 services
 and
 expertise
 that
 are
 valuable
 to
 managed
 care
 plans;
 and
 learn
 how
 to
 package
 those
 services
 and
 calculate
 their
 true
 cost.
 BACS
 will
 be
 building
 relationships
 with
 health
 care
 entities
 and
 following
 a
 practical
 path
 to
 partner
 and
 contract
 with
 local
 health
 plans
 to
 provide
 long‐term
 services
 and
 supports 
for 
dual
 eligibles.

Recognizing 
the 
role
 BACS
 will 
play
 as 
a 
change 
agent 
in 
Alameda
 County, 
Ms. 
Almanza
 will
 be
 sharing
 Linkage
 Lab
 training
 materials
 and
 tools
 with
 the
 supportive
 services
 community. 
Stay 
tuned
 as 
this
 project 
develops.

 

For a report on the entire January 31st SSC Panel Discussion, click here.

To return to the Changing Landscape page, click here.

In-Home Supportive Services Settlement

**Update – April 10, 2013** NSCLC has prepared a notice about the settlement for consumers and providers, download it here.

March 20, 2013 – A settlement has been reached in the law suit to stop the State of California from reducing In-Home Supportive Services hours and services. The cuts had been enacted in the state’s FY 2011-12 budget and FY 2009-10 budget, but were blocked by court injunction. The Governor’s proposed FY 2013-14 budget still assumed the state would win the suit and implement the cuts.

In the settlement, the State has agreed to repeal and eliminate two major cuts to IHSS: (1) the 20% across-the-board reduction in IHSS hours from 2011, and (2) the termination or reduction in IHSS for many recipients based on their functional index score from 2009.

Instead, the settlement:

  • Replaces the permanent 20% cut in IHSS hours with a temporary 8% cut in July 2013. (This is an additional 4.4% on top of the 3.6% current cut that was scheduled to expire in June.)
  • Reduces the total cut to 7% in July 2014.
  • Restores the hours lost from the 7% cut as early as the spring of 2015 if the State obtains federal approval of a provider fee which could bring significant new federal revenue to California.
  • Commits any savings from retroactive federal approval of the new provider fee to fund a program to benefit IHSS recipients, such as the SSI Special Circumstances program, which was used to pay for refrigerators and stoves, rent to avoid eviction and other emergency needs but has not been funded in the budget for many years.
  • Clarifies that IHSS consumers have a right to request a reassessment based on a change in circumstances, even if this change is not medical. Recipients will not be required to provide medical certification of a change in their medical condition to obtain a reassessment. This will help ensure that consumers who need additional hours will be able to obtain them.

We’ll have more details soon.

The settlement resolves a second lawsuit that challenged a cut to IHSS worker wages that was enacted in the state’s FY 2009 budget (a cut that was also blocked by the courts). The state agreed to rescind its reduction of the “state participation” share of IHSS worker wages.

The settlement is expected to win approval by the court.  The additional cuts in hours will cause hardship for many people who rely on IHSS, yet in light of the alternative, today’s settlement represents an important victory in protecting seniors, children and adults with disabilities from the terrible consequences of short-sighted public policy decisions. The plaintiffs in the suits were represented by lawyers from Disability Rights California, National Senior Citizens Law Center and others, and our hats off to them for this important accomplishment.

Return to the State Budget page here.

California’s Legislative Analyst’s Office Updated Analysis

February 28, 2013  –  California’s Legislative Analyst’s Office (LAO) just released their updated analysis of the Coordinated Care Initiative. See the LAO analysis here. The LAO warns that continued delay of a Duals Demonstration Memorandum of Understanding between the state and the federal government creates uncertainty regarding the timely and successful implementation of the CCI (currently scheduled for launch in Alameda County in April of 2014).

The LAO also states that “integration of IHSS under managed care is problematic” and recommends that the Legislature consider authorizing CCI to “test greater integration of In-Home Supportive Services… under managed care.”  The current CCI legislation allows plans to increase, but not decrease, IHSS hours. The LAO’s troubling recommendation is to give at least one plan the ability to “fully integrate” IHSS (that is, the flexibility to increase AND decrease hours) during the third year of the demonstration.

In its recent analysis of the Governor’s proposed Health and Human Services budget, the LAO recommends that the pending 20% across-the-board cut to IHSS (currently blocked by a preliminary injunction), be repealed, in favor of extending the soon-to-expire 3.6% cut.

 

Return to the Coordinated Care Initiative page here.

Introduction to the CCI

July 11, 2012 – The Governor’s Coordinated Care Initiative (CCI), included in the State’s FY 2012-13 Budget signed in June. It is a multi-year plan to coordinate health care and long term services and supports for dual eligibles (Medicare/Medi-Cal beneficiaries) and Medi-Cal Only seniors and people with disabilities. The CCI envisions all Medi-Cal long term services and supports coordinated within the framework of Managed Care.

The Duals Demonstration is the first phase of the CCI, and is now set to launch in eight counties – including Alameda County –  no earlier than January July 2014. The Demonstration will combine the two funding streams (Medi-Cal and Medicare) in Managed Care Plans that integrate medical and long term services and supports. It will require that dually eligible seniors and adults with disabilities enroll in a Medi-Cal Managed Care Plan. This enrollment will be mandatory, but individuals will have the option to “opt out” of the Demonstration and maintain their Medicare coverage on a fee-for-service basis. The Plans will be responsible not only for covering medical services, but for authorizing IHSS, MSSP, nursing facilities and CBAS/ADHC, and coordinating with other community-based services and supports.

The implementation of the Duals Demonstration plan is subject to approval by the Center for Medicare and Medicaid Services. Many of the important details of timing, enrollment and consumer protections are still being developed in conjunction with the state’s stakeholder workgroup process.

Here is a link to the state’s list of populations included and excluded from the Demonstration. **Note that this link does not include any changes from the new launch date of July 2014.**

The CCI legislation requires an IHSS maintenance of effort that would “hold county expenditures to the estimated level that would have occurred absent” the Demonstration. The legislation also includes the expectation that, at some point during the three year Demonstration, collective bargaining and employer-of-record responsibility will transfer from the county Public Authorities for IHSS to a state-wide Authority.

Return to the Coordinated Care Initiative page here.