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California HealthCare Foundation Announces $3.4 million in Grants to Improve Care for Elders in Managed Care.

OAKLAND, Calif.--(BW HealthWire)--Oct. 14, 1998--The California HealthCare Foundation today announced the award of 13 grants designed to improve care for the 1.5 million elderly Californians enrolled in Medicare managed care plans.

Among the grants given under the statewide Program for Elders in Managed Care are initiatives designed to improve care for persons with Alzheimer's disease, and projects that will test the use of trained patient advocates in serving multi-ethnic elder populations. The intent of the Program is to build coordinated systems of care linking community-level service providers (such as home delivered meals and adult day care centers) with managed care organizations, to help elders continue to live independently in their homes for as long as possible.

"The current system of care for chronically ill and frail elders is really a non-system," said Mark Smith, M.D., President of the California HealthCare Foundation. "We hope through these grants to help fulfill part of the promise of managed care the promise of better coordination of services from different providers at different locations and times."

The Foundation grants will support three full-scale demonstration projects and ten planning projects throughout the state. The demonstration projects will be carried out over a three-year period and will develop new mechanisms for identifying elders who need services; coordinate both the medical care and the supportive services they receive; and expand the roles of existing personnel so they can create comprehensive strategies to serve these elders' complex needs.

These three year demonstration projects will be led by Kaiser Permanente, Tri-Central Region (Los Angeles); Jewish Family and Children's Services (San Francisco); and a collaboration between Sutter Health, Central Area (Sacramento) and the University of California at San Francisco's Goldman Institute on Aging. The latter project focuses on improving care for persons with Alzheimer's Disease; the other two focus on the provision of home and community-based services to multi-ethnic senior populations in Los Angeles and San Francisco. The Foundation is awarding $2,723,133 for the demonstration projects.

Foundation grants also will support 10, one-year planning projects, totaling $749,408, led by a diverse group of community-based service agencies, managed care organizations, and others. Grant recipients will collaborate with other organizations to develop detailed plans for projects including: the establishment, in ethnic communities of San Diego, of "care advisors" who will advocate for community elders enrolled in managed care plans; development of a "one stop shopping" system in Contra Costa County in which elders can be connected to the full range of services to which they are entitled; and development of a coordinated delivery system of medical care and services for elders in rural Sonoma county.

Four of the planning projects will be led by health plans. The remaining six will be led by a hospital system, a medical group, a community-based agency, a university, a county office of aging, and a consulting firm working with the California Public Employees' Retirement System (CalPERS).

About half of the grants specifically target racial and ethnic minority elders. "California is the most ethnically diverse state in the country. Because of that, we felt it was especially important to address language and cultural differences that may be barriers to care for the elderly," said Andrea Gerstenberger, Senior Program Officer. "Many of the grants we are announcing today are designed to address these challenges."

This marks the first cycle of grants in the Program for Elders in Managed Care. The $15 million, five-year initiative will foster comprehensive, systemic improvements in service delivery for Californians in Medicare managed care. By funding innovative and collaborative models within and among community-based agencies, health plans, medical groups, and others; the Foundation is working to fulfill its mission of promoting fundamental improvements in the health of Californians.

The California HealthCare Foundation is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California. The Foundation was established in 1996 as a result of the conversion of Blue Cross of California from not-for-profit to for-profit status. For additional information on the Foundation's programs, visit the Web site at


San Francisco

Title: Expansion and Evaluation of the "Identification and Early Intervention" Program

Lead Agency: Jewish Family & Children's Services of San Francisco

Grant Amount: $740,000 over 3 years

Project Partners: Brown and Toland Physician Services Organization; University of California, San Francisco

Project Description: This project will build upon a pilot project begun in 1993, in which physicians and their staffs identified elderly patients who appeared to be in decline and in need of supportive services, and referred them to Jewish Family and Children's Services (JFCS). JFCS then sent a social worker to conduct an in-home assessment of the patient's overall living situation and needs, and make arrangements for necessary services. The project also trained members of physicians' office staff as Geriatric Resource Persons (GRPs). Initial pilot project data indicate that the costs of these interventions (the social work assessment and in-home supportive services) were more than offset by a reduction in those patients' hospital, emergency room, and nursing home costs.

In this expansion and evaluation, Brown and Toland will refine and expand the model throughout its physician groups, and conduct a comprehensive evaluation of its impact on costs, patient and physician satisfaction, and the process of care. The project will also enhance the Geriatric Resource Person Training Program by converting it into a 10 hour, three-week course at a university, resulting in receipt of a continuing education certificate. Brown and Toland will increase the number of physician groups participating in the demonstration, which now will include primary care physicians at the University of California, San Francisco (UCSF) and Mt. Zion Medical Center.

San Francisco and Sacramento

Title: Northern California Chronic Care Network for Dementia Demonstration Project

Lead Agencies: UCSF/Goldman Institute on Aging, and Sutter Health-Central Area

Grant Amount: $ 993,133 over 3 years

Project Partners: Kaiser Permanente San Francisco; Brown & Toland Medical Group; Alzheimer's Association of Greater San Francisco/Bay Area; Alzheimer's Association of Greater Sacramento Area

Project Description: This project will develop and test new ways of providing services to people with Alzheimer's and their caregivers within three separate managed care systems. The project is part of an eight-site national initiative of the National Alzheimer's Association and the National Chronic Care Consortium, designed to test new models of integrating primary, acute, and long-term care services for people with dementia under managed care. The project will test new instruments for assessing dementia and model treatment protocols recently developed under the national initiative. New mechanisms for sharing patient information will also be created, as will new ways of providing support to family caregivers. The objective of the evaluation will be to assess the effects on costs and outcomes of using the nationally-developed assessment questionnaires and care protocols.

Alzheimer's is a debilitating and multidimensional disease, affecting all aspects of a patient's life and those of his or her family. Costs of care for Alzheimer's patients are high: a recent study found that national Medicare expenditures for persons with Alzheimer's were 70% higher than for those without the disease. The three participating managed care systems represent very different models: Kaiser Permanente is a staff-model HMO; Sutter Health is a major hospital system; and Brown and Toland is an independent practice association (IPA) medical group. It is expected that the diversity of participants will enhance the evaluation given that, to date, no major managed care systems in the nation have implemented comprehensive programs for identifying and caring for patients with Alzheimer's and related dementias. The UCSF Division of Geriatrics will design and carry out the evaluation.

Los Angeles

Title: "Community Partners"

Lead Agency: Kaiser Permanente Tri-Central Continuing Care

Grant Amount: $ 990,000 over 3 years

Project Partners: Visiting Nurse Association Foundation, City of Los Angeles Department of Aging, County of Los Angeles Area Agency on Aging

Project Description: This project will test the addition of a home- and community-based services benefit (up to $2,000 per member, over a three-month period) for elders enrolled in the Kaiser Permanente Tri-Central's Medicare managed care program. The program is implementing a new geriatric screening questionnaire to be mailed to all enrolled elders in order to identify frail elders and those most at risk for adverse events, e.g., falls, hospitalizations, and nursing home placements. Those identified elders will be referred to a geriatric social worker at Kaiser who will assess their needs and arrange for needed home and community-based services, such as transportation, homemaker/chore services, personal care, nutritional counseling, and home modification.

The evaluation will assess whether receiving such services prevents a patient from suffering a decline in their ability to function, promotes optimal health status and quality of life, and minimizes the use of more expensive medical care services. It also will determine which subset of frail elders most benefit from the services, and which specific services have the greatest impact. Finally, elders and their families are often initially reluctant to pay for these services, even when they can afford them. The project will test the assumption that if an elderly person receives three months of needed services as a Kaiser benefit, he/she will recognize the value of the services and be willing to pick up the ongoing costs.


Los Angeles

Lead Agency: Secure Horizons/PacifiCare Health Systems

Grant Amount: $75,000

Project Partners: Medical groups: HealthCare Partners; Cedars Sinai Medical Care Foundation; Harriman Jones, and Facey; Jewish Family Services of Los Angeles; Delta Sigma Theta Life Development Senior Center; and other community agencies to be named.

Project Description: This project will develop a model program to link an established Medicare HMO, four of its affiliated medical groups, and community-based social service agencies into a continuum of care via a network of community-based "care advisors." These advisors will act as patient advocates and care coordinators for elders. The program will serve African-American and Latino Secure Horizons members in Los Angeles who are 75+ years of age with the following conditions: inability to perform one or more activities of daily living, chronic illness, lack of family, and/or difficulty in accessing services.

Lead Agency: L.A. Care Health Plan

Grant Amount: $75,000

Project Partners: AltaMed Health Services Corporation; Huntington Memorial Hospital's Senior Care Network; Jewish Family Services of Los Angeles; SCAN Health Plan; Watts Health Foundation; The Lewin Group; and various medical groups.

Project Description: This project will develop a network of five major nonprofit, community-based social service providers who together will provide a wide range of services to a large and culturally-diverse area of Los Angeles County. These providers, working with LA Care Health Plan, will develop new mechanisms for case management and for managing post-hospital care.

Lead Agency: Southern California Healthcare Systems

Grant Amount: $75,000

Project Partners: Huntington Memorial Hospital's Senior Care Network; Huntington Medical Foundation; Alzheimer's Association of Los Angeles; Center for Aging Resources; Pasadena Senior Center.

Project Description: This project will develop a plan for VitaLink, a program that will make the primary care physician the leader of a care management team that will coordinate care and services for multi-ethnic seniors in the San Gabriel Valley region of Los Angeles County (56% Caucasian, 27% Latino, 14% Asian, and 3% African American).


Lead Agency: Long Term Care Group, Inc. (on behalf of CalPERS, Sacramento)

Grant Amount: $74,848

Project Partners: The California Public Employees' Retirement System (CalPERS); The California Network Inc.; PacifiCare Health Systems; and other managed care plans to be named.

Project Description: This project will be targeted at CalPERS retirees (and spouses) who are enrolled in managed care plans and who also have chosen to purchase long-term care insurance through CalPERS. The project will develop mechanisms to coordinate the provision of medical care with the provision of the home and community-based services to which these individuals are entitled.

San Francisco

Lead Agency: On Lok, Inc.

Grant Amount: $74,681

Project Partners: Chinese Community Health Care Association; Chinese Hospital; UCSF/Stanford Medical Group; UCSF/Stanford Medical Center (hospital); and a medical group serving Spanish-speaking elders (to be determined).

Project Description: On Lok offers a managed care program to low-income frail elders in San Francisco who would otherwise be placed in nursing facilities. It provides the full range of medical and social services necessary to enable frail elders to continue to live at home. The On Lok model has now been replicated across the country, and in all cases it requires patients to leave their current physicians in order to enroll. Many feel that elders have refrained from enrolling due to this requirement. This grant will enable On Lok to develop the relationships, mechanisms, and infrastructure necessary to integrate physicians practicing in independent medical groups with On Lok's existing service system, making this a much more attractive model for both elders and physicians.

Contra Costa County

Lead Agency: Contra Costa County Office of Aging

Grant Amount: $75,000

Project Partners: Contra Costa Health Plan; Contra Costa Long Term Care Coordinating Committee; and community-based service providers.

Project Description: This project will develop an expanded service delivery system to enhance care for the Contra Costa Health Plan's Medicare risk plan members. The County Office of Aging will work with the Plan, and with a network of community-based providers of care management, transportation, home modifications, respite care meals and other supportive services, to develop this new system.

Sonoma County

Lead Agency: Redwood Health Services

Grant Amount: $75,000

Project Partners: Sonoma County Human Services Department; Health Plan of the Redwoods; Kaiser Permanente; Santa Rosa Medical Center; Sonoma County Department of Health Services; Northern California Center for Well-being; St. Joseph's Health Foundation of Northern California.

Project Description: This project will develop a consumer-centered integrated system of services for people 65+ who live in Sonoma County and are enrolled in managed care. The planning group will develop a centralized system that all providers can use to better manage care and services for their clients, including a new information system that combines information from various providers.

San Diego

Lead Agency: Kaiser Permanente San Diego, Continuing Care Services Department

Grant Amount: $75,000

Project Partners: Alzheimer's Association, Inc.; Southern Caregiver Resource Center; University Center on Aging, San Diego State University; Meals on Wheels of Greater San Diego, Inc.; Adult Protective Services; and a variety of community-based providers.

Project Description: The project will develop a new provider network linking community social service providers under a single administrative organization. The new organization will serve as the single-point-of-entry for frail elderly Kaiser members who need community-based services such as adult day care or transportation. The project will: develop new ways of sharing information between Kaiser and service providers in San Diego; survey consumers to determine preferences and needs with regards to community services; and explore financing options for paying for these community-based services.

Lead Agency: University Center on Aging, San Diego State University

Grant Amount: $75,000

Project Partners: University of California, San Diego's Senior Health Plan; Council for Minority Aging; San Diego American Indian Health Center; Chicano Federation; Union of Pan Asian Communities; Catholic Charities; Neighborhood House; Simms Technologies.

Project Description: This project seeks to demonstrate that using "community liaisons" to link a managed care plan to frail elders from San Diego's culturally diverse communities can result in positive gains for both the plan and the communities. The partners will conduct focus groups to identify elders' unmet needs and specific barriers to care. They will then develop a model program to train individuals from the African American, Latino, Asian/Pacific Islander, American Indian, and refugee/immigrant communities to serve as "community liaisons" for minority elders enrolled in the UCSD plan. These liaisons will interface with the managed care plan and the ethnic communities, serving as spokespersons, consumer advocates, home health assessment team members, translators, and cultural experts.

Orange County

Lead Agency: CalOPTIMA

Grant Amount: $75,000

Project Partners: Blue Shield; Blue Cross; Kaiser Permanente; Universal Care; United Health Plan.

Project Description: CalOPTIMA is a countywide Medi-Cal managed care plan, and one of the largest Medicaid managed care organizations in the country. About 35,000 of its low-income members are also eligible for Medicare and receive their Medicare services from physicians outside the plan. For these elders, navigating between two systems to access the full range of health and supportive services is often a confusing and frustrating experience. CalOPTIMA will explore the feasibility of becoming a "dual eligible" demonstration project that is able to integrate Medi-Cal and Medicare services and financing into one system of care.
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Date:Oct 14, 1998
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