brokerage design guide

H O M E & C O M M U N I T Y- B A S E D S E R V I C E S
BROKERAGE DESIGN GUIDE
A ROAD MAP FOR ESTABLISHING A BROKERAGE FOR
HOME AND COMMUNITY- BASED SERVICES
Brenda Schmitthenner
Renée Sherrill
County of San Diego, Aging & Independence Services
BACKGROUND
LANDSCAPE IN SAN DIEGO COUNTY

Fifth most populated county in the US.

3.26 million residents living in urban, suburban,
rural and remote areas covering an area of 4,200
sq. miles.

65+ Years Old = 374,535

Number is expected to double by the year 2030

57% of dual eligibles are living with two
or more chronic diseases

Shift of healthcare delivery and accountability
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CCI/Cal MediConnect
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AN UMBRELLA OF PROGRAMS & SERVICES
Independence
Dependence
Call Center/ADRC
RSVP, Veterans
Senior Dining
Health Promotion
Home Delivery
Info & Assistance
Outreach & Education
Care Mgmt
Adult Day Care
Caregiver Support
Care Transitions
Intergenerational
IHSS
APS
Ombudsman
Project Care
PA/PG/PC
Senior Team
FRAGMENTED SYSTEM OF CARE
THE VISION
COORDINATED, PERSON-CENTERED SYSTEM OF CARE
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TRANSFORMING CARE ACROSS THE CONTINUUM
HEALTHY
SAN DIEGO+
COORDINATED
CARE INITIATIVE
TEAM
SAN
DIEGO
LONG TERM
CARE
INTEGRATION
PROJECT
NETWORK
OF CARE
AGING &
DISABILITY
RESOURCE
CONNECTION
SAN DIEGO CARE TRANSITIONS PARTNERSHIP
A partnership between HHSA/AIS and Palomar Health, Scripps Health, Sharp HealthCare and
UC San Diego Health System (13 hospitals)
CARE ENHANCEMENT PROGRAM
FROM THIS….
TO THIS…
Primary
Care
In-Home
Services
Day
Health
Care
Meals
Service
Medical
Specialty
Acute
Hospital
Skilled
Nursing
Facility
Transit
COORDINATED CARE INITIATIVE
IN SAN DIEGO COUNTY
Medi-Cal Managed Long-Term
Services & Supports (LTSS)
Cal MediConnect
MANDATORY enrollment for approximately
64,000 Medi-Cal recipients into a MediCal managed care health plan for all
Medi-Cal benefits, including LTSS and
Medicare wrap-around benefits.
OPTIONAL enrollment of 18,000 of
eligible 57,000 duals into 3 year
demonstration program for coordinated
Medicare and Medi-Cal benefits through
a single organized delivery system.
(duals demonstration)
COUNTY’S ROLE CCI/CAL MEDICONNECT
In-Home Supportive Services (IHSS) - 25,000


Executed an MOU with the Health Plans to support the provision of
IHSS as a managed care benefit.
Drafted an IHSS Coordination Guide.
Multipurpose Senior Services Program (MSSP) - 550


Executed a contract with the Health Plans for the provision of MSSP
Waiver Services to Plan Members.
Drafted an MSSP Coordination Guide.
Behavioral Health Services (BHS)

Executed an MOA with the Health Plans for the provision of
Behavioral Health Services (specialty mental health and alcohol and
drug services not covered by Medicare and/or Medi-Cal).
Edgemoor DP SNF

Edgemoor provides 24 hour long term skilled nursing care for
individuals having complex medical needs who require specialized
interventions from highly trained staff.
CARE PLAN OPTION SERVICES
BEYOND THE STATE & CMS REQUIREMENTS

Case Management

Care Transitions

Home & Community-Based Services (HCBS)
LOOKING FOR A SOLUTION…
THE AGING & DISABILITY RESOURCE CONNECTION
Extensive
Network of
Community
Partners
ADRC
Core Services
AIS CASE STUDY
Healthcare Provider
1call…
Brokerage
Can include expert assessment
& short term service coordination
HCBS Providers
… Numerous services
THE AIS CASE STUDY
EARLY ANALYSIS: AIS & ADRC

Identified the need

Identified potential consumers

Designed two potential models

Assessed models

Identified requirements to ramp up

Identified and prioritized resolution
of unknowns
BROKERAGE MODELS
Healthcare Provider
1call…
HCBS Providers
Numerous bills…
Brokerage
Can include expert assessment
& short term service coordination
Brokerage
HCBS Providers
… Numerous services
Healthcare Provider
…One invoice
ENGAGING
THE COMMUNITY
IN THE VISION
AN OPPORTUNITY
SCAN FOUNDATION GRANT

The project was supported by a grant from The SCAN Foundation ‐
advancing a coordinated and easily navigated system of high‐quality
services for older adults that preserve dignity and independence.

For more information, visit www.TheSCANFoundation.org.
GUIDING DESIGN
CREATING THE ROADMAP
HCBS BROKERAGE DESIGN GUIDE
THE HCBS BROKERAGE DESIGN DREAM TEAM
AGING & DISABILITY
RESOURCE
CONNECTION
HEALTHCARE PAYORS
HOME AND COMMUNITY
BASED SERVICE
PROVIDERS
AIS REPRESENTATIVES
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EXPERT CONSULTANTS
ON THE CARE
CONTINUUM
HEALTHCARE PROVIDERS
HCBS BROKERAGE DESIGN GUIDE
GUIDE OBJECTIVES

Outline potential models

Provide considerations for brokerage
development and implementation

Use AIS case study to illustrate the
concepts

Not be prescriptive
BROKERAGE DESIGN PROCESS
OVERVIEW
Step 1: Design the Service Model
Step 2: Identify the Requirements
Step 3: Assess Viability
Step 4: Select the Business Model
Step 5: Resolve Unknowns
Step 6: Implement!
BROKERAGE DESIGN PROCESS
STEP 1: DESIGN THE SERVICE MODEL

Existing State

Unit of Service

The Customer Experience – Service Delivery

Model A | Model B

The Value Added - The Early Business Case

Unknowns
BROKERAGE DESIGN PROCESS
STEP 2: IDENTIFY THE REQUIREMENTS

Start Up (workspace & infrastructure)

Workforce

Technology

Finance

Audit and Compliance

Legal and Contracting

Risk Management

Unknowns
BROKERAGE DESIGN PROCESS
STEP 3: ASSESS VIABILITY

Market Analysis of Community Readiness

Environmental Scan of Current Solutions

Financial Viability Assessment

Unknowns
BROKERAGE DESIGN PROCESS
STEP 4: SELECT THE BUSINESS MODEL

Potential Business Structures

Possible Legal Entities

Limited Liability Company (LLC)

L3C

S-Corp

Tax Exemption - 501 (c) (3)

AAA/ADRC
BROKERAGE DESIGN PROCESS
STEPS 5 & 6: RESOLVE UNKNOWNS & IMPLEMENT!

Resolution of Uncertainties

Marketing Strategy

Implementation Plan
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OUTCOMES
ACCOMPLISHMENTS!

Built business case for brokerage together

Growing Interest in concept nationwide

Garnered strong support in San Diego County
for an HCBS Brokerage

Created and distributed HCBS Brokerage Guide

Secured ACL TA Award to support further
analysis and potential implementation
CONTACT
QUESTIONS?
Brenda Schmitthenner
858-495-5853
Brenda.Schmitthenner@sdcounty.ca.gov
Renée Sherrill
858-505-6541
Renee.Sherrill@sdcounty.ca.gov