Kick-Off Webinar: Prevention and Public Health Fund CDSME Grantees (2015)
November 2, 2015
Overview
• Welcome: Laura Lawrence
• Background and Grant Goals: Kristie Kulinski
• NCOA Report: Cora Plass
– Considerations and Key Learnings from the Field
– Technical Assistance Resources
• Q&A
History………………………
2010
2007
2006
2003
Evidence-Based Prevention
Program
24 AoA grants3 Atlantic
Philanthropiesgrants
Hispanic Elders Grants
9 communities
CDSMP
Collaborativeeffort of:
AoAAHRQCDCCMSHRSA
Putting Prevention to
Work:CDSMP
Recovery Act Grants
45 statesDistrict of Columbia
Puerto Rico
Affordable Care Act
Prevention and Public
Health Fund
CDSME Grants
22 states
SecondYear
ofFunding
For 2012PPHF
CDSMEGrantees
FinalYear
ofFunding
For2012PPHF
CDSMEGrantees
2012
2013
2014
Evidence-Based Program (EBP)
Pilot
14 grants
And Now ……………
ARE THENEW
2015CDSME
Cohort!
YOU
Individuals Served to Date
• Since 2010, nearly 260,000 participants enrolled in CDSME workshops!
% of Participants Reporting Relevant Data
Female 75.9%
Living Alone 44.1%
Hypertension 41.4%
Arthritis 37.3%
Diabetes 31.6%
Multiple Chronic Conditions 59.1%
Disability 45.8%
2015 CDSME Grant Goals
• Significantly increase the number of older adults and adults with disabilities who participate in CDSME and self-management support programs
• Implement innovative funding arrangements to support CDSME beyond grant period, embedding programs into an integrated, sustainable network
Grantees Awarded
• Health Foundation of South Florida (Miami, FL)
• AgeOptions, Inc. (Oak Park, IL)
• MAC Inc. (Salisbury, MD)
• Mississippi State Department of Health (Jackson, MS)
• University of North Carolina at Asheville (Asheville, NC)
• Health Promotion Council of SE Pennsylvania (Philadelphia, PA)
• South Dakota State University (Brookings, SD)
• Community Council of Greater Dallas (Dallas, TX)
CDSME Programs Offered
• Chronic Disease Self-Management Program
• Tomando Control de su Salud
• Diabetes Self-Management Program
• Chronic Pain Self-Management Program
• Cancer: Thriving and Surviving
• Better Choices, Better Health® (online CDSMP)
• EnhanceWellness
• HomeMeds
• PEARLS
Increasing CDSME Participants
• $6.47 million awarded to eight grantees
• 36,445 participants and 19,280 completers* proposed
• Expanding geographic reach (statewide or regional)
• Targeted retention rate (74% national average)
*EnhanceWellness, HomeMeds, and PEARLS do not have completer targets
Components of an Integrated, Sustainable Network
• Business plan, contracts, or other means to secure financing
– Sustainability partners include Accountable Care Organizations, Patient-Centered Medical Homes, large employer groups, health insurance plans, etc.
• Aging, public health, disability, and Medicaid networks engaged
• Strategic partnerships with organizations with the capacity to embed CDSME into routine operations
Components of an Integrated, Sustainable Network (cont.)
• Delivery infrastructure/capacity to increase access to CDSME statewide
• Coordinated processes (marketing, recruitment, enrollment, etc.)
• Ongoing quality assurance and fidelity monitoring efforts
Six Key Program Sustainability Elements
•Business plan; diversified funding (DSMT, fee for service, contracts)
Business Planning and
Financial Sustainability
•Strong Public Health and Aging; State/ regional management and support
Effective Leadership
•Embedded into health systems/ reform and “turn-key” delivery system partners
Partnerships
•Right-size workforce/ sites to ensure programs are consistently available
Adequate Delivery Infrastructure
•Ongoing marketing, referral, registration, ADRC integration to build demand
Centralized, Coordinated Logistical Processes
•Being data driven with CQI and fidelity monitoring to ensure quality and promote value
Quality Assurance
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Considerations and
Key Learnings from the Field
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Business Planning and Financial Sustainability
What are you going to sustain?
What human resources are needed/available and who
will do what?
• Leadership
• Staffing
• Partners
What will it cost?
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Reimbursement or Payment from Health Plans
and Providers
The Affordable Care Act (ACA) and related health reform
create new opportunities for reimbursement and payment.
A number of states are pursuing reimbursement for
CDSME from Medicare, Medicaid, and other health plans.
Partnerships with ACOs, PCMHs, and other providers are
being formed as referral networks and also being pursued
as potential avenues for payment for CDSME.
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Medicare Reimbursement Opportunities
Health Behavior and Assessment Intervention (HBAI) – A
Medicare psychosocial benefit to help overcome barriers to
self-management of one or more chronic diseases.
Diabetes Self-Management Training (DSMT) – A benefit to
teach people with diabetes to manage their condition.
Medical Nutrition Therapy (MNT) – Individual and group
nutritional services provided by a registered dietitian or
qualified nutrition professional. DSMT can be provided and
billed in conjunction with MNT.
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Business Planning: A Step At A Time
• Which health care organization will you approach
• Find a champion
• Articulate your value proposition
• Nurture the relationship
• Discuss sharing the risk
• Forge partnerships with other CDSME providers to respond
to the need—consider forming a network
• Think carefully about the recruitment and referral process
• Decide how you will monitor quality and show results
• Develop a contract with the health care organization
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Other Sustainability and Business Planning
Strategies and Partners
CDSME as part of employee wellness plans
United Way or other employee giving campaigns
Community support and funding
• An AAA in Washington solicited 43 local businesses to donate
workshop supplies necessary for program delivery
Older Americans Act Title IIID –
• Beginning October 1, 2016, Older Americans Act, Title IIID funds will
only be able to be used on health promotion programs that meet the
highest-level criteria
Foundations
Federal grants, e.g., CDC, HRSA
Other grants – state and regional level
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Effective Leadership:
Collaboration between Aging and Public Health
Strategies to support CDSME or other evidence-based
programming are included in state plans for Aging and Health
State unit on aging and state health department work together
to identify and target underserved geographic areas
A management structure (e.g. steering group, coalition, partner
team etc.) to provide overall direction and leadership for CDSME
in the state
Other key organizations that can take a leadership role, such as
academic partners
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Effective Leadership:
Collaboration with Public Health
State Health Department
• State Public Health Actions to Prevent and Control Diabetes,
Heart Disease, Obesity and Associated Risk Factors and Promote
School Health
• Prevention and Wellness Trust Fund (MA)
• Arthritis Program (12 states)
• State Innovation Model grant through Center for Medicare and
Medicaid Innovation (NY)
• Cancer Prevention and Control Program, including WISEWOMAN
• Tobacco Control Program
Support from district and local public health departments
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Health Care Partnerships
Most, if not all, CDSME grantees for 2012 and 2015 have built
partnerships with health care providers into their plans for
sustainability
Many national insurers have a core mission to improve health
outcomes through health promotion and education efforts
ACOs receive “shared savings” for improving their quality and
lowering their costs
ACA is opening doors for reimbursement and payment, e.g.,
PCMH
Some health plans offer financial incentives to their members
for completing a CDSME program
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Health Care Partnerships: Health Care
Transformation Models
Accountable Care Organizations (ACO)
• Doctors, hospitals, and other health care providers working together
• High quality care
• Lower costs/shared savings
Patient-Centered Medical Homes (PCMH)
• NCQA standards require care coordination, self-management,
community resource referrals
• Federally Qualified Health Centers and other physician practices
Care Transitions Programs
• Help patients transition from hospital to home safely and prevent
hospitalization readmissions
• Improve health outcomes while lowering costs
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Adequate Delivery Infrastructure
A delivery structure capable of delivering CDSME programs
throughout the state
An appropriate number of active CDSME master trainers
An adequate number of lay leaders to provide CDSME
workshops across the state
A mechanism or system to track CDSME master trainers or
leaders statewide
Ongoing communications, support, and other retention
strategies
Appropriate licensing
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Training: Do the Math
IF your target is 5,000 participants:
Scenario 1:
30 MTs pair off to offer
2 LL trainings with 15
participants= 450 LLs
450 LLs pair off to offer
2 CDSME workshops
with 12 participants=
5,400 CDSME
participants
Scenario 2:
10 MTs pair off to offer
3 LL trainings with 15
participants= 225 LLs
225 LLs pair off to offer
4 CDSME workshops
with 12 participants=
5,400 CDSME
participants
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Centralized or Coordinated Processes
Statewide name
Statewide website with listings of workshops and training
opportunities
Statewide toll-free number
Support for leader trainings
Marketing and recruitment
Participant enrollment
Data collection, tracking, and reporting
Workforce training and development
Payment
Fidelity/quality assurance
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Centralized or Coordinated Processes: Benefits
Efficiency for providers and payers
Economies of scale via centralized systems
Increases access to/for commercial market and public
employees
Statewide attention to equity and access
Monitor and maintain integrity and fidelity of the programs
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Quality Assurance – Value Over Volume
Quality assurance plans describe, measure, and evaluate
program delivery
• Ensure effective, quality services for participants
• Ensure program delivery consistent with established standards
Funders/contracting organizations want assurance that the
programs are delivered with quality and fidelity
ACA directs use of a star rating system to offer incentives to
Medicare Advantage plans for providing quality services
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Resources – www.ncoa.org/cha
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Resources – www.ncoa.org/cha
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Resources – www.ncoa.org/cha
Questions, TA