BUILDING A COMMUNITY SYSTEM FOR EVERYONE: MINNESOTA S INITIATIVE TO CREATE A CROSS-DISABILITY AND AGING SERVICE SYSTEM

Transcription

1 BUILDING A COMMUNITY SYSTEM FOR EVERYONE: MINNESOTA S INITIATIVE TO CREATE A CROSS-DISABILITY AND AGING SERVICE SYSTEM Reinventing Quality 2014 Conference August 4, 2014 Alex Bartolic, Director, Disability Services Division Jean Wood, Director, Aging and Adult Services Division Minnesota Department of Human Services

2 OVERVIEW OF PRESENTATION Minnesota s Approach to LTSS History and Context Cross-Population Initiatives Transformation Initiatives Reform 2020 Additional Cross-Population Initiatives

3 MINNESOTA S APPROACH TO LONG- TERM SUPPORTS AND SERVICES

4 MN DEPARTMENT OF HUMAN SERVICES ORGANIZATIONAL CHART 4

5 MN DEPARTMENT OF HUMAN SERVICES ORGANIZATIONAL CHART 5

6 MINNESOTA S LTSS SYSTEM Local and Regional Administration Lead agencies Counties: assess eligibility and provide case management for Medicaid Waiver FFS programs serving primarily people with disabilities under age 65 Health Plans: administer the public managed care programs that provide LTSS to the majority of Medicaid Waiver-eligible older adults Tribes: two tribes assess eligibility and provide case management for Medicaid Waiver FFS programs Area Agencies on Aging: administer Pre-Admission Screening, contract for Older Americans Act-funded services, partner with providers to develop services to fill gaps

7 CONTINUING CARE ADMINISTRATION MISSION AND VISION CCA MISSION Improve the dignity, health and independence of the people we serve CCA VISION Minnesotans have choices in how they receive services and how they live their lives C Community membership / integration H Health, wellness and safety O Own place to live I Important long-term relationships C Control over supports E Employment earnings and stable income

8 CONTINUING CARE ADMINISTRATION VALUES Choice & Independence for the people CCA serves Stewardship of human service resources Self-determination and personal responsibility by the people CCA serves Integrity by CCA and others Diversity because our differences make us strong Partnerships and collaboration, with clear roles, responsibilities and accountability for ourselves and others Accountability

9 CONTINUING CARE ADMINISTRATION STRATEGIC PLAN Current plan was developed in 2010 for State Fiscal Years To support and enhance the quality of life for older people and people with disabilities. 2. To manage an equitable and sustainable long-term care system that maximizes value. 3. To continuously improve how we administer services. 4. To promote professional excellence and engagement in our work. 9

10 HOME AND COMMUNITY BASED SERVICES Waivers Developmental Disabilities Community Alternatives for Disabled Individuals Community Alternative Care Brain Injury Elderly Home Care State-funded service examples: Alternative Care program Family Support Grants Semi-Independent Living Services Older Americans Act services

11 HISTORY AND CONTEXT

12 HISTORY AND CONTEXT Re-balancing Long-Term Care New technology Olmstead Decision Consumer Direction Americans with Disabilities Act Affordab le Care Act De-Institutionalization Welch Decree Home and Community- Based Services Waivers Older Americans Act Long-Term Care Task Force Report Managed Care models 12

13 MOUNTING PRESSURES ON THE LONG-TERM CARE SYSTEM Growing demand Constrained resources Increased complexity

14 LEVERAGING COMPLEX PRESSURES TO ACHIEVE BETTER OUTCOMES FOR PEOPLE Opportunity: Build a framework for a more effective system Efficiencies for sustainability Data to drive best practices & innovation Better outcomes for the person

15 TRANSFORMING TO ACHIEVE OUR MISSION Promoting equity across individuals, lead agencies, providers Providing quality services that can be measured and maximized Operating with more transparency, efficiency, consistency Leveraging all viable resources to reduce dependence on public funds Continuously improve how we administer services

16 INDIVIDUALS BEFORE PROGRAMS From What do you qualify for? to What is important to you, and for you to live the life you choose? Respect individual s desire for more autonomy and control Transition to a strengths-based assessment and support planning process with equitable solutions

17 LONG-TERM SOLUTIONS SUPPORT INDEPENDENCE Value abilities, respect needs, empower choice Engage individuals in planning toward their goals Connect individuals to resources to bring their plans to life BUILD A SUSTAINABLE SYSTEM Leverage partnerships, collaboration, community resources to achieve best results Support system-wide coordination, continuous quality improvement Use technology-based tools that work across systems to support consistency, efficiency

18 CONCEPTUAL FRAMEWORK: HCBS SYSTEM NOW 18

19 CONCEPTUAL FRAMEWORK: NEW HCBS SYSTEM 19

20 EARLY CROSS-POPULATION INITIATIVES

21 MINNESOTA S AGING AND DISABILITY RESOURCE CENTER (ADRC) Early and ongoing example of Quality Architecture in action 15 years of experience developing a shared platform to support informed choice Provides a platform for other initiatives; sometimes same, sometimes different Minnesotahelp.info Disability Linkage Line Senior LinkAge Line Veterans Linkage Line TM Disability Benefits 101

22 BUILDING SHARED INTERNAL SYSTEMS Quality Essentials Team Performance Measures Initiatives Team Fiscal Analysis Collaboration Team (FACT) Business Information Technology Solutions

23 CURRENT MAJOR CROSS-POPULATION INITIATIVES

24 TRANSFORMATION INITIATIVES MnCHOICES One assessment process takes the place of three (DD screening, LTC consultation, PCA assessment and in the future, PDN assessment) People will have an assessment and support planning that identifies their individual preferences, strengths and needs People will be assessed equitably across populations and geography People will have access to more support options in one process HCBS Waiver Provider Standards Basic standards will be consistent and have a consistent enforcement mechanism People will have health, safety and rights protections People have choice of the provider they wish to use Providers will have specializations, and services are customized to the person s plan Disability Waivers Rates System There will be statewide, uniform methodologies used to determine the rate for each service Rates will reflect the person s support plan Customized Living Rate Methodology for the Elderly Waiver Rates reflect the support plan and type/frequency of services to be provided

25 REFORM 2020 Bi-partisan initiative to reform MA Effort to meet the challenges of rising MA costs and growing demand Opportunity to develop/test new ways of operating; successful models will be expanded and in place by 2020 Several foundational transformation projects, already underway, set the platform for other reform efforts Some initiatives require approval and/or participation of the federal government Several initiatives require state legislative action

26 REFORM 2020 EXAMPLES OF INITIATIVES Community First Services and Supports Converting current PCA program to Community First option to gain flexibility in services and delivery models First Contact Initiative Pre-Admission Screening federal requirements Increased upstream engagement Vulnerable Adult Common Entry Point One statewide CEP Better data tracking, allowing improved response to emerging trends and issues

27 ADDITIONAL EXAMPLES National Core Indicators HCBS Report Card and Quality Add on CMS HCBS Rule Criteria and Transition Plan LTSS Gaps Analysis Personal Health Record for LTSS Demonstration

28 MINNESOTA S OLMSTEAD PLAN 2013: Release of Putting Olmstead s Promise into Practice: Minnesota s 2013 Olmstead Plan Working across state agencies to address goals related to: Employment Housing Transportation Supports and Services Lifelong Learning and Education Healthcare and Healthy Living Community Engagement 28

29 WORKING WITH STAKEHOLDERS Challenge: systems have different approaches Continually working to discern what s the same/what s different Working to do a better job hearing the voices of those who use services Determine if we need to be Autonomous, Coordinated or Integrated

30 STAKEHOLDER VENUES HCBS Partners Panel 46 organizations crossing aging and disability represented DSD and AAS leadership are members Charge: support continuous improvement in the HCBS system by providing communication link among the system s stakeholders and by supporting specific initiatives They talk to each other, not just to talk to the State Project work groups Almost all initiatives have work groups that include external stakeholders State Quality Council Not just there to provide feedback/input they help do the work Support building a quality system that is person-directed, outcomebased, quality-driven and effective in its use of public funds

31 LESSONS LEARNED

32 LESSONS LEARNED: HAVE A THEORETICAL BASE From Glenda Eoyang, Human Systems Dynamics

33 LESSONS LEARNED: COMMUNICATIONS ARE CRITICAL From Glenda Eoyang, Human Systems Dynamics

34 FOR MORE INFORMATION

35 HOW IT ALL FITS TOGETHER

36 FOR MORE INFORMATION Continuing Care Administration s Strategic Plan s/pub/dhs16_ pdf MN s State Profile of LTSS System /dhs16_ pdf Biennial Report on LTSS for People with Disabilities 36

37 FOR MORE INFORMATION, CONT. Minnesota s Olmstead Plan ments/pub/dhs16_ pdf DHS dashboards Public reporting/performance management

38 FOR MORE INFORMATION, CONT. MnCHOICES Provider Standards and Provider Enrollment initiative Disability Waiver Rates initiative

39 FOR MORE INFORMATION, CONT LTSS Gaps Analysis MIC_CONVERSION&RevisionSelectionMethod=LatestReleased &ddocname=dhs16_141764