CalAIM has the opportunity to improve the ability of managed care plans to transition or divert patients from institutions to lower levels of care, several experts said in a California Health Care Foundation (CHCF) webinar on CalAIM’s institutional long-term care carve-in and alignment of community supports.
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“[We are really] focusing on how community supports can intersect with the long-term care carve-in to promote diversions from and transitions out of nursing homes, and making sure that individuals have the most opportunity to live in the setting of their choice,” said Carrie Graham, PhD, Director of Long-Term Services and Supports at the Center for Health Care Strategies (CHCS).
Graham said that most of the time the preferred care setting is more community-based and deals with lower levels of care.
Starting Jan. 1st, 2023, institutional long-term care will be a mandatory benefit for all Medi-Cal managed care members. The carve-in will be brand new in 27 counties.
Graham discussed recommendations for managed care plans to improve their ability to transition or divert their patients from institutions, as discussed in their recently released report on the topic. These include coordinating with hospital and nursing home discharge planners to establish a discharge plan before admission to a nursing home and proactively identifying members who are at risk of homelessness after a post-acute stay.
“Not only are a lot of people who are on Medi-Cal at risk for homelessness, but just by being put in an institution, a lot of people lose their homes,” she said.
Other recommendations to promote community-based care settings and lower levels of care identified in CHCS’s research are as follows:
- Including members’ preferences for post-acute care before any hospitalizations occur in Health Risk Assessment.
- Using data, such as the Minimum Data Set 3.0 Section Q, to allow skilled nursing facility residents to express interest in learning about possibilities for living outside of the facility.
- Establishing managed care plan review boards with placement criteria to vet placement decisions prior to institutionalization.
- Financial incentives and rate setting.
- Identifying, assessing, and supporting informal caregivers.
Graham particularly highlighted financial incentives for managed care plans, including incentive payments when a member returns to the community from a nursing home due to care coordination efforts by the managed care plan. She also recommended paying managed care plans higher rates for people living in the community who meet a nursing home level of care.
Housing supports, such as requiring managed care plans to have housing specialists to help members transition back into the community, is another way to transition managed care plan members to lower levels of care, according to CHCS’s research.