francisco sfgtv meeting of the san francisco neighborhood services and safety committee occurring march 19, 2014, will begin shortly.

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>> good morning, everyone, happy thursday and welcome to the march 20, 2014 meeting of the board of supervisors, neighborhood services and safety committee my name is david campos and i am the chair of the committee and we are joined by norman yee and vice chair eric mar is in route. i would like to thank the clerk of the committee derek evans

and sfgtv staff who are covering the meeting today, jim smith and john ross, mr. clerk, do we have any announcements? >> thank you, mr. chair, please be sure to silence all cell phones and devices, copies should be submitted to the clerk, items acted upon today will appear on the april first agenda unless otherwise stated. >> call item one. >> item one is a hearing requesting presentations for member of the long term care integration design group and the department of aging and adult services on the long term care integration strategic plan and the report to process of the developing of the plan and the challenges objectives and recommendations. >> this has been called by supervisor yee and so i will turn it over to supervisor yee. >> thank you, chair campos. >> good morning, the development and the implementation of california's coordinated care initiative, the state has begun the process

of integrating healthcare and supportive social services while looking to reduce escalating healthcare costs. from that, the desired results are a more well coordinated healthcare system, bitter health out comes for consumers and greater control on spending, in december of 2011, care, coordinating council in collaboration with the department of aging and adult services appointed the long term care integration design group. and the purposes for them was to explore the potential for long term care integration in san francisco. number two, determine what is required to improve the provision of long term services and supports that will benefit adults and adults with disabilities, and number three, give a long term care integration strategic plan that includes recommendations. i asked for today's hearing for

several reasons, number one, this was presented to my office a few months ago, and i was thoroughly impressed with not only the recommendation, but as i understand the process, i was pretty impressed with the process also in terms of how they were working with many, many departments in the city, and the state corridors and so forth to come up with these recommendations. and not only as we take on the legislation that we just passed and as we move forward with the amendment and public education and the funds, and when we

reduce the integration and we want to work with the city departments. and the other reason why i wanted to highlight this was because in san francisco we are getting older in san francisco, and the percentage of the population of people that are seniors have grown, and will continue to grow. so, it is funny these issues were ahead of the curve some what on this. because this is going to come and is coming fast. and then, the other reason is, i am getting to the age where i have to worry about this stuff too, so this is all personal for me. so today, presenting will be ann hilton from the department of aging and adult services who is the director there, elen from the life works and long term care coordinating council.

and maury, long term coordinating council member, and so to start it off we are going to have tracy famp arona. to kick this off, okay? >> thank you, supervisor, yee for that, great introduction. >> thank you, supervisors for having this hearing today. i am one of the co-chairs of the long term coordinating council and i have a very long name and so no one ever gets it right. >> on behalf of the council i want to thank you for holding this meeting. it is an advisory body to the mayor of 40 minutes and the city departments and community agencies and the community and our goal really is to make recommendations about the long term care, delivery system, in san francisco. and make recommendations for improvement and that is kind of where the long term integration plan came out of. and so we are very pleased to be able to have the opportunity today to present you with the

long term care strategic integration plan and i thank you for that opportunity and i am going to turn it over to ann and eileen. >> and good morning, i just wanted to take a moment before we get into the depths of the plan to talk a little bit about the why. and so just to, i think, think about san francisco, and the community and it is really, i think very gratifying to hear supervisor for you to talk about the process, because i think that is one of the things that makes the council pretty unique. the council's work really is again, as tracy said, we are made up of 40 folks, with about 6 departments being part of the over all council and in san francisco, i think that what we know is that one of of the things that older adults and younger adults really have in

common is this you know really wanting to be at home. and in our world we call that living in the least restrictive environment but what it boils down to as most of us want to cage in our homes and have that, what you know, the flexibility and the control of our environment and that is where we have it most. and so what we have that as an understanding of the population that lives here and really that is the truth for people whether they are in south dakota or knee or wherever they are and we hold that in common, san francisco has really been unique in the sense that it is formed much of its public policy around what its citizens want in this area, and so what we have seen over, i think that probably over the last 20 years is any number of initiatives where, the council and others, have come together to say, how do we move what people want forward. and so, we have things like the

community living fund and we have the deversion and the community integration program. and we have a number of things where we look at people who are in institutions and say, if you can't live in the community, let's help you come back into the community and if you are living at home, let's help you be successful there as possible. so, we have both an understanding and our public policy fits with that. and because of the affordable care act, what the president has put into place, that became this new opportunity for us to move even father into the direction that we have been going as i have said for 20 years any way. so eileen is going to walk you through our process and then i will come back and talk a little bit about the recommendations, and give some time for questions. i think that we will turn it over to you.

>> thank you, my name is eileen and in addition with being with lock ways and i am a council member and also a co-chair for the long term integration, design along with tangerine brinham from the department of health and if i could ask for the slides to be on the screen, i am going to talk about the long term integration and some of the changes that are happening at the federal and state level that are fueling this effort and i think that it certainly has been san francisco's history and as she mentioned really to look at the needs of the community and build very innovative systems in this process of the design group, really gave us an opportunity to look at what we have that have been a strength of our system and what are some opportunities that we needed to prepare for with the transitions that are coming in the future with the changes of the federal and the state level. and what is long term care integration? it is really the integration of

primary medical care and acute care services with long term services and support including both community based home and community based services and institutional services. and the target population is older and older adults and younger adults with disabilities. the glofrn's coordinated care initiative was introduced in january of 2012, but it really was fueled by the affordable care act being passed in 2010, and as we know, the affordable care act included a number of provisions to cover the uninsured but it also included projects that would initiatives that would better coordinate care, and also, achieve the cost savings, for the different public payer's programs. and the purpose of the cci, this is to improve the care delivery and to improve the health out comes for medical

and to better coordinate care by enrolling the individuals in managed care programs and also the goal was to achieve cost savings, the coordinated care initiative has two parts, one part is called cal mediconnect which is targeted for medical beneficiaries who are eligible for medicare, or also an initiative to put the long term services and supports in managed care, which is called managed long term services and supports. what is cal medi connect? as i mentioned cal, medi connect is really a partnership between the federal and the state government to coordinate the care for medicare and medical beneficiaries who are elible for both programs. and the full range of health services and long term services will be included in a single benefit package and managed by the benefit care programs and one of the reasons that it was

created in the federal and state level is because medicare and medical and medicaid at the federal level have a lot of financial misalignments that result in poor quality care for consumers and misalignments that make institutional care, being reimbursed sometimes when the home based services are not reimbursed so not only will it result in poor quality but also higher cost so this program is really designed to better coordinate care for these very many of whom are very frail and eligible and also includes a broad range of individuals, they will be cap taited payments that will provide, two managed care plans to fund these services. cal medi connect is a voluntary program and so the people that are medicare eligible, can choose to keep their medicare benefits the same and not enroll in cal medi connect and it is a three year pilot demonstration, and however, the second part of the coordinated care initiative is what is being called managed long term

services and supports. and for this, all medical beneficiaries in the future will reach their long term services in supports through managed care and we talk about the long term services and supports we are including the ones that we see listed are the ones that at a minimum are going to be delivered through the managed care programs and in-home services and the multiservices program and the community based services program which is the new name for adult and healthcare which is already part of the managed care system and then, skilled nursing, care, funded by medical. so with that program, that is actually will be required for beneficiaries to choose. call medi connect is authorized to begin in eight counties and you can see the counties here listed. the counties can begin for sooner than april of 2014, but each county in the managed care plans that will be options in

those counties have to meet the readiliness standards, for example, the mateo county which has been working on integration for a long time will begin in april, and then, the other counties will begin when they are ready and so for example, santa clara is not slated to start until january of 2015. so, in terms of the intent, and certainly it is an intent by the state to expand these coordinating care initiatives state wide. and at this point, the legislation only authorizes eight counties in addition legislation is needed to expand to additional counties and i think that there is no question that the legislature wants to see that the program was working for beneficiaries before expanding it and i think that there is a desire to expand it and so we are anticipating that it could be expanded to san francisco as early as 2016 possibly and then

certainly the goal is to expand it state wide. the health plans that are the target for the cal medi connect options across the state is really focusing on the health plans that have traditionally cared for the beneficiaries and so the options for san francisco would include the san francisco health plan, which is a public health option and anthem blue cross, which is the commercial plan, these two have enrolled medical beneficiaries first with children and families that are eligible and more recently for senior and people with disabilities who are only eligible for medical and historically only covered medical services and with the coordinated care initiative, they will be covering long term services and supports. in addition, the statute allows for all care for the elderly to be an option and the pace is

different because it is not a mandatory option and it is only a voluntary option, because it targets the people that are eligible for nursing home care and so it is a different model. those are the programs that we will anticipate with the options in san francisco. you can see on this start that it is 45,000 individuals but i want to under score that this is a diverse population that includes people with disabilities and disabilities and people who happen to be low income and we are talking about a diverse population that requires centered care. and i am going to turn it back over to ann to talk about the recommendations of the long term care integration. >> before you do that, sure.

>> with the group of 65 and up, i don't know if you will have it in your head or not. >> i don't have that information off of the top of my head, but we certainly could get that information, because what we do know is that the numbers of people that are 85 and above is certainly growing, as a proportion to the older population, which also kind of, you know, really emphasizes the need for developing these services. >> yeah, i think, that is i guess, that... >> i could follow up and get you that information. >> right. because i assume that once you most of the 65, to 70 may not need as much a...

>> exactly. >> thank you. >> thank you. >> so the next slide in that you have in your packets, really talks about the design group and who was on it. and so just to or for me to think back, the coordinating council, this is actually i think the fourth strategic planning document that they have put together. and then, very much involved in. and so the way that the work has always been done was done in this case is, an oversight on this case and the design committee was formed in depth thinking and who are the players that you need at the table if you are going to have this kind of conversation about managed care in san francisco. and regardless of what day it is coming to our community.

the departments that were involved and the broad strokes and we will have all three of the health plans and ihs because it is one of the four programs slated into the managed care and we had consumer advocates and a member of and there were actually probably several members of the council on the oversight committee, it was a relatively small group but from that group, six work groups were formed and so we had a data group and service and coordination work group and finance committee and so those, as those folks met and did their work, and they brought it back to daoet sign group for really that group to understand and to move forward to get to the final recommendations so the work was done and that is how the coordinating council

has operated since it became into existence. >> may i ask a quick question? >> could you talk about the involvement of the community, the folks who are directly impacted by these policies? >> right. so, i think one of the difficult things for the council is something that they grapl, with a lot is that a lot of the things that we work on together, are topics that you know you really have to take what the people say a dive deep into it and immerse yourself in it and so the council is fortunate that it has advocates on it and it was harder in the design group to have that kind of involvement. although there was certainly a lot of out reach done.

what was this work all about and why were the people working on this and it really was to have the people who did some of that work to hear from the people about what was working for them now and what was not working for them and so if we are going to move forward and we are going to create something better than what exists now, then tell us, what are the things that you would want to secluded. and we had very interesting things and the people talked about pedietry and dental and vision and a lot of the things living in our community don't have access to and so all of that was incorporated into the larger that you see in front of you. >> was there involvement by relative and family members, and the people that are that you served. >> in the focus groups that we did in the neighborhood, yes, there were a lot of families who attended those, i did four of them and there were a lot of folks who were involved in that. >> which was great. >> thank you very much. >> great way to get the word out to or across the general.

>> i think that this is part for how the systems work and how in san francisco we are taking advantage of different federal and state programs and coordinating a really, really strong community-based organizations that serve our senior and people with disabilities. i think that it is an incredible model and i think that sandy is here and many others, and my office has been working on aging friendly city policy and we are working with the checklist and i am working with the health services and the community parts and i think that they and it looks like we are doing a lot of what... >> yes. >> the world health organization is recommending and other cities like new york are as well and i was going to ask a couple of the bullets and

adequate health and services offerd for promoting and maintaining and restoring health and it looks like we are tying everything together from the community to the government. there is another one that the health and social services are located and accessible to all means of transport and i think that with the community based programs there is a lot of examples of that and clear and accessible information is provided for the health and services for the older people and the digital makes it difficult for the people without computers but i know that we have people without systems and the delivery is coordinated and simple and i think that simplifying and then the last one, economic barriers and impending access to the services is minimized and it looks like we are doing a lot of those couple of bun elpoints from the suggestions but i am really glad about this system development and strategies and it is wonderful to see it all laid out so well. >> it is nice to see the various initiative and how they pull together, that work is another key component of what

the long term care coordinating council is working on and they do, they all really fit together. yeah. >> so, with you, we get to the recommendations we are going to see that as much of what you were just talking about is right in these recommendations. so the first one is really better access to long term care services and supports. and i think that this is one that is especially important to me because this very much highlighted dos's role of moving into the coordinated initiative, dos has for some years now attempted to have a central door for things like ihss and adult protective services and things like that. and we are also the central door for the transitional care program hospital, to home. but, at the same time, that we want a strong central door, we really