Perspectives: Stalling Care Coordination – California’s Move Backward and the Need for a Blueprint

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In this Perspectives, Dr. Chernof discusses California’s 2017-2018 proposed budget and how scaling back on key components of the Coordinated Care Initiative diminishes the state’s progress toward integrated care for high-need, high-cost older adults.

Date Updated: 01/26/2017

Last week, Governor Jerry Brown unveiled California’s proposed 2017-2018 budget that included proposals to scale back the state’s progress toward integrated care for high-need, high-cost older adults. California’s Coordinated Care Initiative (CCI) created a basic – albeit limited – policy framework for creating a more organized and integrated approach to care and support for California’s most vulnerable adults. It also set out aggressive savings targets.

Key elements of CCI include the following items:

  • A substantial Medicare-Medicaid integration pilot
  • Transition of long-term care services to managed care
  • Creation of formal linkages between home care and the medical delivery system
  • Development of a universal assessment to better understand adults with complex care needs
  • An expectation of substantial state savings

The Governor’s Budget dismantles CCI, arguing that it has not produced as much savings as expected, and costs in the In-Home Supportive Services (IHSS) program, in particular, have grown more than anticipated. While some important programs inside CCI are slated to continue, several key elements that foster a true system of care will not. This is a step backward, perpetuating siloed care that is both inefficient and ineffective for people, while failing to fully address cost drivers…


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