California scenery

California Health and Human Services Agency

California Community Choices Project

CalCareNet Business Case
Study and Analysis

March 2008

Table of Contents 
1.  Executive Summary......... ......... 3
2.  Project Background......... ......... 5
3.  Project Description......... ......... 9
4.  Environmental Analysis......... ......... 15
5.  Business and Operational Elements......... ......... 16
6.  Technology Assessment......... ......... 18
7.  Risk Management Approach......... ......... 18
8.  Project Organization......... ......... 20
9.  Project Management......... ......... 21
10.  Project Schedule and Implementation Strategy. 21
11.  Conclusion......... ......... 23
Appendix A: CAL ADRCs......... ......... 24
Appendix B: CalCareNet Steering Committee Members. 25
Figures and Tables
Figure 1: Community Choices and CalCareNet Process Flow……….………….…….…13
Figure 2: Phase III CalCareNet Project Organizational Chart……….………….…….…20
Table I: Phase III CalCareNet Goal 1. ..........................……………….…….……10
Table II: Phase III CalCareNet Goal 2. ….…………………………………….……..11
Table III: Phase III CalCareNet Goal 3. .…………………………………………….12
Table IV: Phase III CalCareNet Goal 4.  ….………………………………………….12
Table V: Phase III CalCareNet Goal 5…………………………………………………13
Table VI: Phase III CalCareNet Project Schedule and
Implementation Strategy…………………………………………………………………22

Monique Parrish, DrPH, MPH, LCSW
California Community Choices Contract Staff


California is a national leader in addressing the needs of its residents.  The State has forged pioneering policy in the area of environmental protection and consumer rights and is currently advocating health insurance for all Californians, an endeavor that has the potential to influence the delivery of healthcare throughout the United States.  Yet, California has struggled for many years to address its confusing and silo-driven long-term services and supports system.  Several compelling trends have recently added urgency to the state’s commitment to reduce fragmentation within this system.  First, California is girding for the onslaught of older adults, age 65 and older, expected to flood the public and private service sectors over the next several decades.  Second, California is committed to implementing the principles of the Supreme Court’s Olmstead decision and the California Olmstead Plan.  Both affirm the right of individuals with disabilities, including older adults, to receive public benefits and services in the most integrated setting appropriate to their needs.  Despite significant gains in reducing system fragmentation, Californians are still without a comprehensive statewide and state-sponsored long-term support information system, accessible by Internet, phone, or other alternative means.  The lack of such a system is the central business problem facing the state with respect to informing its residents about and increasing their access to the wide range of long-term services and supports.  State support for Phase III of CalCareNet, California’s long-term support website, which implements two piloted versions of a comprehensive, easily accessible long-term support Web-based system and architecture to expand CalCareNet statewide, would powerfully underscore California’s commitment to meeting the long-term health, social service, and support needs of Californians in the most integrated setting possible.

Launched in January 2001, Phase I CalCareNet enabled Californians to go to a single website to search for state-licensed facilities and programs for adults in need of long-term services and supports.  Since the Olmstead decision in 1999, there has been growing emphasis on consumer-centered, home and community-based, long-term support options, a direction unsupported by the original CalCareNet architecture because many key community-based supports and services (e.g., In-Home Supportive Services) are not licensed.  Over time, the website equally suffered from outdated technology architecture, poor upkeep, inaccurate and ineffectual information, and limited accessibility.  To address these disconnects, Phase II CalCareNet, entitled the CalCareNet Portal Enhancement Project, was initiated in May of 2005.  Funded by the California Wellness Foundation and administered by the California Health and Human Services Agency (CHSS), the CalCareNet Portal Enhancement Project focused on developing new standards and a prototype model for CalCareNet.  Phase II accomplishments included an examination of the accessibility and functionality of the Phase I CalCareNet website, a list of potential website modifications and enhancements, and a summary of successful Internet information technologies for consumers and providers in California and around the country.  It also identified various potential technology architectures for a fully developed CalCareNet.  Phase II terminated with its key deliverable of a model prototype in September 2006.

Phase III CalCareNet, a central component of the California Community Choices Project, builds on the prototype model and requirements developed under the Portal Enhancement project.  The federal Centers for Medicare and Medicaid Services awarded CHHS a grant to support the California Community Choices Project.  California Community Choices is a seminal five-year pilot project (2006-2011) dedicated to increasing consumer access to home and community-based long-term services and supports, and diverting persons with disabilities and older adults from unnecessary institutionalization, through development of California’s long-term support infrastructure. Phase III CalCareNet represents the beginning business solution to the absence of a comprehensive statewide and state-sponsored long-term services and support information system, accessible by Internet, phone, or other alternative means.  The key deliverable for Phase III CalCareNet is a comprehensive, easy-to-use, accessible website prototype to be test-piloted at two California Aging and Disability Resource Centers, CAL ADRCs (see Appendix A for more information about CAL ADRCs).  The long-term business solution entails expansion and replication of the prototype statewide – Phase IV CalCareNet.  To position the state to achieve this outcome, the selected technology vendor responsible for developing the pilot prototype will concurrently develop a viable system maintenance model and the basic model architecture to expand the pilots statewide.  Additionally, the vendor will meet all designated performance measures, a critical project management tool necessary to ensure project success in Phase III CalCareNet.  

California has been busy preparing for an aging California and one in which any individual with long-term support needs has access to the full-range of home and community-based service options.  A significant risk for the state though, is missing the opportunity to lead development of an Internet-based statewide LTSS information system – the CalCareNet system.  Should this happen, California can expect growing frustration from an ever-expanding cohort of long-term support consumers and caregivers relegated to a county-by-county “hit or miss” network of long-term support information systems.  The state may also experience financial and administrative systems challenges, if large numbers of older middle-class Californians prematurely spend-down personal savings to become Medi-Cal beneficiaries, because of the absence of information about long-term support options.  To counter these outcomes, the state can and should seize the opportunity to direct resources and attention to further developing CalCareNet, beginning with support for Phase III, followed by rollout of the system statewide. 

Consumers of long-term support services require ready access to a variety of long-term support resources, especially home and community-based resources.  They also need comprehensive information.  Similarly, health and social service providers require accurate up-to-date information to provide long-term support services information to consumers.  Meeting all of these needs with a Web-based aging and long-term support information system, complete with complementary technologies, would increase access to health and social services, promote choice and independence, and improve quality of life for Californians with long-term support needs.


Business Problem

California has struggled for many years to address its confusing and silo-driven long-term services and supports (LTSS) system.  Several compelling trends have recently added urgency to the state’s commitment to reduce fragmentation within this system.  First, California is girding for the onslaught of older adults, age 65 and older, expected to flood the public and private service sectors over the next several decades.  Second, California is committed to implementing both the principles of the Supreme Court’s Olmstead decision and the California Olmstead Plan.    Both affirm the right of individuals with disabilities, including older adults, to receive public benefits and services in the most integrated setting appropriate to their needs.  Despite significant gains in reducing LTSS system fragmentation, Californians are still without a comprehensive statewide and state-sponsored long-term support information system, accessible by Internet, phone, or other alternative means.  The lack of such a system is the central business problem facing the state with respect to informing its residents about and increasing their access to the wide range of aging and long-term supports. 

All too often persons seeking aging and long-term support information receive fragmented, disorganized, and incomplete information.  Aside from feeling frustrated, another byproduct of these information disconnects is that consumers may neither be aware of nor have access to publicly funded long-term services and supports for which they might be eligible.  These information gaps affect middle-class Californians too.  Many middle-class individuals requiring long-term supports have incomes and assets that make them ineligible for public benefits.  Because of misinformation however, this population all too frequently engages in premature spend-downs of personal resources to meet public benefits eligibility limits.  A fully accessible, comprehensive, centralized Web-based long-term support information system would allow California to address these information problems and meet a key goal of the California Olmstead Plan: to provide comprehensive information regarding services to persons with disabilities in order to make informed choice and for service planners for planning purposes.

Business Opportunity

The State of California has dedicated numerous projects and efforts to the creation of a more seamless aging and long-term support system.  Despite ongoing challenges, the State has made substantial gains in developing strategies to respond to the growing need for community-based service options for consumers requiring long-term supports.  As noted, California has produced a State Olmstead Plan.  Under the auspices of the California Health and Human Services Agency (CHHS), the State also sponsors an active Olmstead Advisory Committee responsible for advising CHHS on its efforts to implement the California Olmstead Plan.  CalCareNet, California’s long-term services and supports information website, represents another opportunity for the State to strengthen its long-term services and support infrastructure.

Launched in 2001, Phase I of the CalCareNet Portal Internet application enabled Californians to go to a single website to find help for adults in need of care or services from a licensed care facility.  The site enabled the public to search for state-licensed health, social services, mental health, alcohol and other drug, and elder care services and facilities.  The website also provided mental health, alcohol and other service information, as well as links to various department sites.  Since the Supreme Court’s Olmstead decision, there has been growing emphasis on consumer-centered, home and community-based, long-term support options. Many key community-based supports and services however, such as In-Home Supportive Services (IHSS) and the Independent Living Centers (ILCs), are not licensed and thus were not highlighted in Phase I of CalCareNet (the Phase I CalCareNet website is no longer Internet operational, pending further development).  In addition, in recent years the website suffered from outdated technology architecture, no mechanism to update information and data, and limited accessibility.

To address these disconnects, Phase II of CalCareNet, entitled the CalCareNet Portal Enhancement Project, was initiated in May 2005.  Funded by the California Wellness Foundation and administered by CHHS, the CalCareNet Portal Enhancement Project focused on developing new standards and a prototype model for CalCareNet to promote the following long-term outcomes:

  • A coordinated system of support that includes but is not limited to, Care Navigation (a construct referencing a system for providing information, assistance, support, case management to consumers of long-term support services) and CalCareNet.
  • Individuals better able to receive support in the least restrictive environment.
  • Consumers better able to connect with the appropriate services necessary to meet individual needs.
  • Improved coordination and delivery of long-term services and supports (e.g., leveraging resources already in place).
  • Long-term support services delivered in a more cost-effective manner.

 

Phase II accomplishments included: an examination of the accessibility and functionality of the Phase I CalCareNet website; a list of potential website modifications and enhancements; and an evaluation of successful technologies for consumers and providers in California.  It also yielded reports on best-practice integrated information systems around the country and key findings from surveys of California consumers and providers regarding optimal aging and long-term support information technology.  Finally, Phase II identified various potential technology architectures for a fully developed CalCareNet.  Phase II terminated with its key deliverable of a model prototype (not implemented) in September 2006. 

Business Solution

Phase III of CalCareNet, a central component of the California Community Choices Project, builds on the model prototype and requirements developed under the Portal Enhancement project.  It is the beginning business solution to the identified business problem – the absence of a comprehensive statewide and state-sponsored long-term support information system, accessible by Internet, phone, or other alternative means.  The key deliverable for Phase III CalCareNet is a comprehensive, easy-to-use, accessible website prototype to be test-piloted at two California Aging and Disability Resource Centers, CAL ADRCs (for more information on CAL ADRCs, see Appendix A).  The long-term business solution entails expansion and replication of the prototype statewide – Phase IV CalCareNet.  To position the state to achieve this outcome, the selected technology vendor responsible for developing the website prototype will concurrently develop a viable system maintenance model and the basic model architecture to expand the pilots statewide.

The California Community Choices Project, funded by a Real Choice Systems Transformation Grant awarded by the federal Centers for Medicare and Medicaid Services (CMS) to CHHS, will provide oversight for Phase III CalCareNet.  The five-year Choices project (2006-2011) is dedicated to increasing consumer access to home and community-based long-term support services and diverting persons with disabilities and older adults from unnecessary institutionalization through development of California’s long-term care infrastructure.  The mission and vision of the Community Choices grant support the state’s commitment to a viable long-term services and supports infrastructure for all Californians.

California Community Choices Mission Statement
We are a statewide partnership committed to developing an infrastructure that will increase access to, capacity of, and funding for home and community-based services to provide all Californians with greater choice in how and where they receive long-term care services, in accordance with the Olmstead Principles.

California Community Choices Vision Statement
California will have strategies and recommendations for its long-term care system, featuring replicable and sustainable models that empower individuals through enhanced opportunities for choice and independence.

Three strategic goal areas define California Community Choices: (1) improved access to long-term support services: development of one-stop system; (2) transformation of information technology to support systems change; and (3) creation of a system that more effectively manages the funding for long-term supports that promote community living options.  Implementation of two CalCareNet pilots meets the California Community Choices Project’s second goal of Transformation of Information Technology to Support Systems Change and represents an essential and integral element in the project’s overall strategy of further developing California’s long-term services and supports infrastructure. 

California without a Comprehensive CalCareNet System

Californians, age 65 and over, are projected to reach 4.5 million by 2010, far exceeding the national growth rate.  The state’s population age 85 and over, those most likely to need long-term supportive services, will grow by 200% in the next 40 years.  Equally important, more than 40 percent of the state’s baby boomers are African American, Latino or Asian, and one-third were born outside the United States.  By 2040, the majority of California’s older adults will be from groups now considered ethnic minorities.   Caregiver statistics signal additional seismic demographic shifts.  Approximately 3.4 million caregivers in California provide care to a loved one.  Finally, following the principles of the Olmstead decision, persons with disabilities have the right to live in the most integrated setting possible.  To meet the information and support needs of all these groups, in addition to service providers, California must provide a fully developed, comprehensive, easily accessible long-term support Web-based information system, with complementary technologies – CalCareNet.  Without such a system, California can expect growing frustration from consumers and providers relegated to a county-by-county “hit or miss” network of long-term support information systems. 

The Internet is ubiquitous.  Leveraging growing interest in and use of the Internet makes good policy and good financial sense.  While Information and Referral (I & R) services will continue to play a key role in the delivery of information, the presence of a twenty-four hour electronic information system allows consumers to access information when they want it and when they need it.  Although information technology is frequently assessed as “value-neutral,” providing a complementary electronic system to traditional phone-based I & R programs has the potential to reduce I & R staffing costs.  It may also provide new opportunities to standardize information across the spectrum of long-term support resources, bringing California closer to its strategic goal of a coordinated point-of-entry for long-term services and support.  Last, a comprehensive information system would allow older middle-class Californians to choose other long-term support options in lieu of prematurely spending-down personal savings to become Medi-Cal beneficiaries, incurring additional potential cost-savings for the State.

The state can and should seize the opportunity to direct resources and attention to developing CalCareNet, beginning with support for Phase III followed by rollout of the system statewide.  A viable statewide and state-sponsored Internet-based long-term support system will equip consumers, as well as health and social service providers, with the tools they need to effectively navigate the world of long-term services and supports and make informed decisions.    

3.  Project Description
Phase III CalCareNet, under the Community Choices grant, has two primary deliverables: to produce a piloted version of the Web-based information system for roll out at two CAL ADRCs; and to develop baseline architecture for statewide replication. 

Internet-based technology today has facilitated communication and created unparalleled opportunities for consumers to exercise choice and independence in the selection and delivery of goods and services.  Phase III CalCareNet embraces the opportunity to present consumers with technology that allows them to direct their own services in the area of long-term services and supports.  Specifically, the piloted versions of CalCareNet will help the public access long-term support information that is comprehensive, integrated, universally accessible, and client-centered.

To oversee Phase III CalCareNet, the Community Choices Project team established a Steering Committee comprised of key stakeholder groups: consumers, providers, advocates, and State Department personnel.  The primary purposes of the Committee include guiding development of the CalCareNet web portal, identifying the vision and business goals for the project, and providing both content and technical feedback on web portal content and design during the development phase of the prototype pilots.  The Steering Committee identified the following mission and vision for Phase III CalCareNet:

Phase III CalCareNet Business Mission
Develop an integrated information website portal to provide up-to-date information and long-term care services and supports, particularly home and community-based services

Phase III CalCareNet Business Vision
Californians are fully informed about long-term services, supports, and options

Business Goals

Development of business goals is an essential ingredient in project success.  Without a vetted process for evaluating priorities, project development and project methodology run the risk of derailment.  To ensure the success of Phase III CalCareNet, the CalCareNet Steering Committee identified the following ten business goals for CalCareNet Phase III, the first five (in bold) are ranked as priority goals:

  1. Provide access to information and tools that empower individuals and families to remain independent through consumer-directed decision-making, planning and support
  1. Use universally accessible web design (i.e., accessible by persons with disabilities, culturally/linguistically accessible, etc.)

Continue

Long-Term Services and Supports (LTSS) is now the accepted terminology for the phrase, Long-Term Care.

The 1999 U.S. Supreme Court Olmstead Decision affirmed the right of individuals with disabilities to receive public benefits and services in the most integrated setting appropriate to their needs. The California Olmstead Plan, published in 2003, provides a blueprint for an improved long-term care support system in California and identifies the steps needed to move towards achieving a system that will provide services in the most integrated setting appropriate for persons with disabilities. 

Long-Term Services and Supports (LTSS) is current accepted terminology for the phrase, Long-Term Care.

The 1999 U.S. Supreme Court Olmstead Decision affirmed the right of individuals with disabilities to receive public benefits and services in the most integrated setting appropriate to their needs. The California Olmstead Plan, published in 2003, provides a blueprint for an improved long-term care support system in California and identifies the steps needed to move towards achieving a system that will provide services in the most integrated setting appropriate for persons with disabilities. 

U.S. Bureau of the Census. (2001). Profile of selected social characteristics: 2000. Census 2000 supplementary survey summary tables, United States. U.S. Bureau of the Census [2004, 11/05/2004].

Arno, Peter, S., Estimated Prevalence and Economic Value of Family Caregiving, by State, Family Caregiver Alliance, National Family Caregivers Association, 2006.