Our Participation in the Community of Constituents



Medicare Regulations Regarding Physicians & Teams

December 27, 2016 – On Jan. 1 2017 a new set of Medicare regulations will go into effect that will compensate physicians for legwork involved in working in teams — including nurses, social workers and psychiatrists — to improve care for “high need” patients with illnesses such as diabetes, heart failure and hypertension. The new rules will also reward efforts to ensure that seniors receive effective treatments for conditions such as anxiety or depression. Click here to read the California Healthline article on this new development.

Home Stretch Launch

July 31, 2016 – EveryOne Home has launched Home Stretch, Alameda County’s collaborative strategy to prioritize permanent supportive housing opportunities to homeless and disabled people with the highest needs in order to maximize the impact that this housing can have in ending homelessness. Home Stretch will establish a county-wide registry of people who are homeless and disabled, and a centralized process for linking high need individuals and households with permanent supportive housing opportunities. It also will provide housing navigation services for people prioritized for permanent supportive housing. For more information, go to: http://everyonehome.org/our-work/home-stretch.

EveryOne Home will be providing trainings on referring, housing match readiness and Home Stretch HMIS entry in the coming months. To put your name on the list to receive training information and dates, click here.

Hotel Oakland Village

July 6, 2016 – Hotel Oakland Village is a new approach to senior living. Find out how this community makes a positive impact for its residents in Oakland. Click the video below to learn more about the project:

San Mateo’s Secret Sauce

May 31, 2016 – In a recent conference call convening of Regional Coalitions in California sponsored by The SCAN Foundation, Maya Altman from Health Plan of San Mateo gave a presentation about HPSM’s Community Care Settings Pilot. The Pilot is an intensive care management program that leverages IHSS, CBAS, Behavioral Health, community-based services, housing and housing services. The Pilot is proving remarkably effective in stabilizing high utilizers and helping them to migrate out of or avoid SNF/LTC Facility residency and homelessness.

This extremely collaborative Pilot is overseen by a multi-disciplinary core group. The program employs extensive face-to- face case management, purchase of services, and a phased approach. One of the Pilot’s most unique elements is its collaboration with Brilliant Corners, an organization that not only develops housing but provides a spectrum of person-centered services to help individuals find and maintain housing.

HPSM is a County Organized Health Plan that is the sole Medi-Cal Managed Care/Cal MediConnect plan for Duals and Medi-Cal- only residents of the county. While San Mateo is differently organized than Alameda County, the Community Care Settings Pilot offers operational and program delivery models that may be relevant to our county. To learn more, click here for Ms. Altman’s presentation, and click here for a Profile of the Pilot by Center for Health Care Strategies.

Study Identifies Keys to LTSS Integration Success

May 27, 2016 – The Long Term Quality Alliance recently released a study looking at the effectiveness of long-term services and support integration among five health plans in different states. The Health Plan of San Mateo took part in the study. The study set out to determine whether integrating medical, behavioral health and LTSS benefits in a single capitated program can achieve better outcomes for a high-cost, high-risk population.

High Level Conclusions: several activities seem to matter the most in affecting outcomes for members and overall costs of care:

  • Anticipating needs and providing enough support in the home and community early enough reduce the risk of an inappropriate use of ER services, hospitalization, or nursing home admission.
  • Arranging for critical supports and services (e.g., housing, employment, personal assistance, medication management) enable medical and behavioral health professionals to earn the trust of the member, address health needs, and elicit positive behavioral responses.
  • Communication, coordination, and a single point of accountability can eliminate the conflicts, gaps, and inconsistencies in treatment that arise when multiple professionals perform their work in individual siloes. When multiple professionals from different siloes interact with an individual, this in fact interferes with a successful response to treatment.
  • Supporting members through transitions of care, particularly in moving from more intensive, higher cost to less-intensive, lower-cost settings, reduces the risk of readmission and relapse.
  • Care management is at the heart of what integrated programs do to integrate LTSS and medical care and is key to achieving results.

The study also concluded that integration of medical care and LTSS is difficult to achieve, and that statutory and regulatory reforms affecting financing and the siloed nature of the service delivery system are needed to remove barriers that make integration difficult. Here is a link to the study: http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images/LTSS-Integration-Working-Paper.pdf.

Village & Wellness Connection

February 16, 2016 – Last week, Family Bridges and the Hotel Oakland launched a new health and wellness program for senior residents of the Hotel Oakland, a historic building in downtown Oakland that is a residential community for 400 low-income seniors. The Village and Wellness Connection will promote healthy aging by encouraging seniors to become proactive about their physical and emotional well-being. By identifying and treating problems before they lead to expensive trips to the emergency room, the Village Connection aims to reduce hospitalizations and health care costs.

Family Bridges is well known for their Hong Fook Adult Day Health Care Centers, located in downtown Oakland around the corner from Hotel Oakland. The Hong Fook Centers help frail elderly and adults with disabilities regain their ability to live independently and ease the need for family care by providing health services and therapeutic activities in a safe and supportive environment.

The program is an expansion of the Hotel Oakland Village, a social outreach and engagement program started in 2011 to reduce isolation among senior residents. The new Village Connection will provide participating seniors with a physical and social/emotional assessment, then help each person develop a long-term health plan. If the senior wishes, the confidential plan can include input from family members, physicians and caregivers. The plan adjusts as a person aging and his/her needs change.

The Village Connection’s Wellness Director will review seniors’ medications for incompatibilities, and each individual’s plan will support dietary guidelines, memory care activities, exercise, fall prevention and emotional well-being. The Director acts as a point person for coordinating each senior’s care, working with the individual’s support network and when needed with hospitals, discharge planners and transitional care providers. All with the goal of helping residents avoid institutionalization and age in place.

New Mandate to Involve Caregivers in Hospital Discharge

January 4, 2016 – Beginning in January 2016, family caregivers could have more support for their role in helping patients discharged from the hospital. A new California law, SB 675, requires hospital staffers to involve family caregivers during the hospitalization and discharge process. The intent is to improve patients’ overall health and reduce their chances of readmission.

Sponsored by State Senator Carol Liu, the law mandates that hospitals give patients an opportunity to identify a caregiver; notify that caregiver when the patient is to be discharged; and provide information and instruction on the patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.

California is one of 18 states to pass such laws during the past two years, part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a patient’s hospitalization.


August 7, 2014 – During the August 7 Regional Coalitions call, Rebecca Schupp and her staff from the Long Term Services & Supports Branch of California Department of Health Care Services presented information on several funding opportunities for housing and supportive services.  Click here for the presentation slides.

March 6, 2014 – The SCAN Foundation has put together a fact sheet on the Governor’s 2014-15 Proposed Budget. The fact sheet goes over the budget’s impact on California’s Seniors and People with Disabilities. It is available by clicking here.


December 12, 2013 – On October 30th, The Home and Community Based Services (HCBS) Universal Assessment Workgroup sponsored a webinar to assist with the Coordinated Care Initiative launch. Entitled Frameworks for Universal Assessment: External Standards and Vocabulary for the Assessment Process, a powerpoint version of the webinar is available here.

During the webinar, two of the organizations’ academic partners, Dr. Debra Saliba and Dr. Lhassa Ray led a discussion of the following two papers:

  1. Memorandum on External Recommendations for Standardized Assessment in the United States
  1. Memorandum Comparing Four States’ Comprehensive Assessment Systems

Both of these papers were commissioned by The SCAN Foundation to support the work of the HCBS Universal Assessment Workgroup. The work is compelling and may serve to highlight areas of focus for the HCBS Workgroup process.

March 7, 2013 – The Community of Constituents convened in Sacramento on February 21 for learning and discussions on a range of state and federal developments concerning LTSS, health care, and community living.  Now you can listen to the speakers, workshops and panels.  Marilyn Moon’s lunch plenary is highly recommended!

February 6, 2013 – Senate Leader Reid appointed Laphonza Butler to the new federal Long Term Care Commission. She is head of both the SEIU-ULTCW and the statewide SEIU council. House Minority Leader Pelosi made three appointments to the Long Term Care Commission, including Bruce Chernof, President and CEO of The SCAN Foundation.

January 31, 2013 – Health Plan Complaint Form is now available online. The California Department of Managed Health Care (DMHC) launched a new secure, easy-to-use online form to allow Californians to file complaints regarding their health plan more quickly and easily from any computer. The new online form is available in both English and Spanish and enables consumers to request an external review of a health plan’s denial of a medical service or treatment. This external review is known as an Independent Medical Review. Previously, health plan enrollees had to submit the required forms and paperwork via mail or fax.

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