Perspectives: A New Year Brings Fresh Opportunities for California
In this Perspectives, Dr. Chernof reflects on the substantial progress to transform care for older Californians that has occurred over the past 12 months, and highlights some of the key opportunities in 2020.Date Updated: 01/03/2020
As the new year begins, I want to take a moment to reflect on the substantial progress to transform care for older Californians that has occurred over the past 12 months, and to highlight some of the key opportunities in 2020.
In 2019, California launched a historic effort to develop a 10-year Master Plan for Aging. This Master Plan will serve as the blueprint to both rethink and reshape how we approaching aging in this state, fundamentally moving from a provider/program focus to a person focus. The Master Plan is meant to enrich the lives of all older Californians – not just those served by public programs – as well as be responsive to the needs of families and communities.
Also in 2019, the state began efforts to advance and innovate health care specifically for the most vulnerable populations through a sweeping Medi-Cal redesign called CalAIM. With respect to older Californians, the goal of CalAIM is to improve integration and coordination of services across the state with an eye toward helping people thrive in community.
Together, these initiatives can unlock potential in the currently entrenched, complicated, and opaque system that, for years, has challenged most Californians’ ability to learn about, access, and
finance services to meet their individualized needs. Challenges such as a fragmented care delivery system, workforce shortages, housing instability, and a long-term care financing crisis are complex problems mired in numerous policy, programmatic, fiscal, and political roadblocks.
The challenge and the opportunity we collectively face is to ensure that these new planning efforts result in impactful change for California’s older adults, people with disabilities, and family
California’s Master Plan for Aging: Building a comprehensive framework for change
With Governor Newsom’s executive order in June, a clear process and timeline for the development of the state’s Master Plan was defined. Specifically, a Cabinet-level workgroup was charged with delivering a Master Plan by October 2020, which is chaired by Health and Human Services Secretary Dr. Mark Ghaly. This Cabinet workgroup is informed by three formal stakeholder committees under the leadership of Department of Aging Director Kim McCoy Wade. These groups are all off to a productive start. What is even more heartening to see is all the leaders and stakeholders from across the state who have shown a strong commitment to a new vision for aging in California.
The Stakeholder Advisory Committee, of which I am member, is specifically tasked with advising the Cabinet-level workgroup as they develop the Master Plan. The Long-Term Services and Supports (LTSS) Subcommittee requested recommendations from the public, and The SCAN Foundation responded. Our 14 recommendations, taken together, would create a platform for a highperforming system of care for our aging state. Here are the key components:
- State Administration/Leadership: Build leadership, starting inside the governor’s office, to drive cross-agency system change.
- System Financing: Ensure a state and local financing system – along with personal finances – that promotes access to home- and community-based services in line with individual needs and preferences.
- Data: Develop a LTSS data platform to inform state, local, and person-level planning.
- Access: Enhance access to care, services, and supports in all areas of the state.
- Service Delivery: Organize services to ensure seamless access to a statewide coordinated, integrated system of care.
We recognize that there is no “quick fix” and each of these components is necessary to improving our system of care. A comprehensive strategy will ensure all Californians can age in accordance with their own needs, desires, and preferences. Through the Master Plan process, the Stakeholder Advisory Committee has a tremendous opportunity to achieve consensus in identifying thoughtful policies with a clear message articulating the path forward.
CalAIM: Importance of integrated care and lessons learned
As a separate effort in late 2019, the state released its “California Advancing and Innovating Medi- Cal” (CalAIM) initiative draft, which seeks to reduce system complexity and promote a whole-person approach to care in Medi-Cal. CalAIM also has a preliminary strategy to meet the needs of those with Medicare and Medi-Cal coverage. This strategy outlines the transition of the seven-county Coordinated Care Initiative (CCI), (also referred to as the duals integration pilot) to a statewide structure for integrated care that utilizes managed LTSS and Dual Eligible Special Needs Plans (D-SNP) by 2023.
In order to achieve true integration and coordination for individuals with Medicare and Medi-Cal, the state can use new authorities from the federal Centers for Medicare & Medicaid Services (CMS) to develop robust D-SNP standards, applying many lessons learned from its recent duals integration demonstration. It will require fortitude, patience, and steadfastness over the next three years from many sectors to accomplish this transition. We also believe that two additional factors would make a substantial difference: 1) expanded state leadership and in-house expertise on Medicare-related issues, and 2) an Integrated Care Implementation Council comprised of consumers, advocates, health plans, and providers activated to support its transition and full implementation.
I begin 2020 with hopeful optimism. With strong leadership across the public and private sectors, engaged stakeholders, and a commitment to meaningful planning with clear success benchmarks, I am confident that we will look back at this time next year knowing that California made great strides creating impactful change for all older adults, people with disabilities, and family caregivers.
Bruce Chernof, MD, President and CEO of The SCAN Foundation, dedicated to creating a society where older adults can access health and supportive services of their choosing to meet their needs. The Perspectives Series provides opinions and observations about transforming the way in which we age. Follow Dr. Bruce on Twitter @DrBruce_TSF.
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