Since January 2013, SVILC has been learning about what it means to partner effectively with health plans in providing services. SVILC is one of six organizations, and the only ILC, to participate in the SCAN Foundation's Linkage Lab project designed to assist these organizations in building connections and looking at how best to offer coordinated care services to managed care organizations. Through a series of educational programs and strategy sessions, SVILC has been examining its costs and services to determine the optimal way to package them for the capitated model of managed care and demonstrate readiness.
"The health plans in the eight counties, which for Santa Clara County are Anthem and Santa Clara Family Health Plan, have to show their readiness to provide HCBS," said Teixeira. "In our county, SVILC is the only organization providing transition work from skilled nursing facilities into the community. With our core independent living services and relationships with community-based organizations like the Council on Aging, we can be part of the health plans' readiness, which is one of the reasons the plans are talking to us."
Another element of SVILC's readiness is its participation, since 2010, as a lead organization in California's Community Transitions Project (CCT) or Money Follows the Person Rebalancing Demonstration project. The project is funded by the Centers for Medicare & Medicaid Services (CMS) through September 2016 and is designed to assist with transitioning individuals from health facilities to community living. SVILC provides comprehensive pre-transition coordination and post-transition community living services, including peer support, independent living skills training, housing assistance, assistive technology and more.
"These are exactly the types of services we plan to bundle in working with the health plans," explained Teixeira. "For example, if they identify someone who is a frequent user of high-cost benefits, such as emergency room visits that could result in one- to two-day hospitalizations, we can help by providing peer support, independent living skills when assisting with activities of daily living or self-advocacy skills when working with physicians. And we can do this very cost effectively and cheaper than hospitalizations."