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Commonwealth coordinated care program and long term services and supports across the lifespan blue cross


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Commonwealth coordinated care program and long term services and supports across the lifespan blue cross

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Commonwealth coordinated care program and long term services and supports across the lifespan blue cross

  1. 1. Commonwealth Coordinated Care Program and Long Term Services and Supports Across the Lifespan Virginia Governor’s Conference on Aging Tom Wilfong, VP, Dual Eligible Programs
  2. 2. 2 • Key to serving older adults and people with disabilities is high quality, integrated, culturally-competent service coordination for the member needing long term services and supports • 90 percent of Anthem members surveyed state that they expect to remain in their homes, yet over 65 percent need assistance with ADLs - bathing, dressing, walking, or grooming • Almost half need assistance with IADLs - banking, grocery shopping, managing housework and errands Experience + Expertise
  3. 3. 3 Expand Key Partnerships Standard • Members and Families • Health Plan Expanded • AAAs and ADRCs • Faith- based
  4. 4. 4 Coordination is Integration and coordination of physical health, mental health and substance use disorders with long term services and supports in the community • Holistic approach and Member engagement are key • Access to all LTSS services through a single program, including self-direction • Access to Coordination Support Team for individuals with more intensive needs • Members have direct access to case managers for individualized support needs
  5. 5. 5 Aging = Transitions Periodically, members may need in-patient clinical care or rehabilitation. These experiences should not mean permanent placement which results in loss of home or total loss of independence. A good long term services and support system means • Preserving the ability to live in one’s own home or preferred setting in the community • Access to wide variety of options with varying levels of support to meet emerging needs • Flexibility and focus to transition from facility-based care to support in home and community
  6. 6. 6 Landscape of Transitions Aging is not static – members may experience a variety of transitions • From their own home to a family member's home • From their family home to a smaller home or apartment where space is more manageable • From a nursing facility after an health incident to home or from home to a facility for rehab • From a hospital to home following a health incident • Support for end of life planning
  7. 7. 7 Care Transitions Key elements of coordination during transitions: • Member’s individual plan is central • Transition planning includes family, neighbors, other care givers as a team with the clinicians • Caregiver capacity is assessed and supported • Exchange of critical information and training for care tasks is providing in accessible manner • Warm transfers / and check - ins • Immediate access to coordinator / manager • On-going support
  8. 8. 88 Questions?