NCOA presentation, May 2018 · NCOA presentation, May 2018. Improving the lives of 10 million older...

Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 1

NCOA presentation, May 2018


NCOA’s Center for Benefits Access

• Funded through cooperative agreement with ACL

• Help low-income Medicare beneficiaries access benefits

through community & online solutions

• Resource Center for state Medicare Improvements for

Patients & Providers Act (MIPPA) grantees (SHIPs -

Pennsylvania’s APPRISE, AAAs, ADRCs,).

• Support network of community organizations and state

agencies serving as Benefits Enrollment Centers (BECs)

• BenefitsCheckUp® online screening tool


State Health Insurance Assistance Program help with:

Understanding Medicare Eligibility

and Benefits

Enrolling in Medicare, Extra Help

and Medicare Savings Programs

Navigating the Medicare Program

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Find Your Local SHIP

https://www.medicare.gov

1-800-MEDICARE

Locate a SHIP at

1-877-839-2675

www.shiptacenter.org

https://www.medicare.gov/


Role of APPRISE in 10 Keys to Healthy Living

• Partnered with University of Pittsburgh’s Graduate School of

Public Health

• Promoted the 10 Keys to Healthy Aging to individuals

attending outreach/enrollment events and Medicare health

and wellness events

• Attended all 10 Keys to Healthy Living workshops to provide:

o Counseling on Medicare preventative benefits that coincided with the

Healthy Key for that day, and

o Information on the programs that reduce Medicare health and drug

costs and assist with eligibility and enrollment


Key – Lower Systolic Blood Pressure

• Obesity = body mass index (BMI) ≥

30 kg/m2

• Intensive behavioral therapy

consists of

o Screening for obesity using BMI

measurement

o Dietary (nutritional) assessment

o Intensive behavioral counseling

and therapy

o In primary care setting


Key – Lower Systolic Blood Pressure (cont.)

• Coverage includes

o One face-to-face visit every week for the first month

o Then every other week for months 2–6

o Then every month for months 7–12

▪ Must lose 6.6 lbs. in first 6 months to continue

• No cost if primary care doctor/practitioner accepts

assignment


Key - Participate in Cancer Screenings

Breast Cancer Screenings (Mammograms)

• Covered for all women with Medicare

o One baseline mammogram ▪ Between 35 and 39

o Once a year starting at 40

• No cost if provider accepts assignment


▪ Financed by Medicaid; help pay Medicare premiums and cost-

sharing for those with low income/assets

• Three programs: QMB, SLMB, QI

• Apply through Medicaid office

▪ Qualify with income up to 135% Federal poverty level and

resources below established asset test

• Several states have more generous income and asset

thresholds

▪ Eliminate Medicare late enrollment penalties

▪ Annual value of the benefit estimated at $1,608

Medicare Savings Programs (MSPs)


Extra Help/Part D Low Income Subsidy (LIS)

▪ Administered by Social Security Administration and Medicare

▪ Helps pay Medicare Part D (drug plan) costs for people with limited income/resources (income below 150% FPL and resources below established asset test)

▪ People pay between $1.25 and $8.35 for drugs at pharmacy

▪ Eliminates the drug coverage gap (“donut hole”)

▪ No late enrollment penalties

▪ Annual value of the benefit estimated at $4,000


Closing the Enrollment Gap


APPRISE Contribution to the 10 Keys to Health Living

✓ Explained and confirmed Medicare’s coverage for preventive benefits

✓ Provided strategies to limit Medicare’s out-of-pocket costs

✓ Introduced a trusted partner to help overcome obstacles

✓ Eased access to Medicare Savings Programs

✓ Recognized Medicare beneficiaries as multi-faceted consumers

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Director and Core Research Project PI: Anne B. Newman, MD, MPH

Co-Director: Steven M. Albert, PhD

Core Research Project Co-Investigators: Elizabeth M. Venditti, PhD; Steven M. Albert, PhD; Robert M. Boudreau, PhD; Michelle E. Danielson, PhD

Deputy/Program Director: Michelle E. Danielson, PhD

The mission of the CAPH-PRC is to promote healthy aging by addressing preventable disability and mortality in older adults in our region via

interdisciplinary research, teaching, and practice.

University of Pittsburgh CAPH-PRC

Major Initiatives

• Mobility & Vitality Lifestyle Program (core research project)

o Aimed at reducing obesity & improving mobility in adults ages 60-75

o 32-session behavioral activation program lead by trained CHWs at 26 community-based sites

o Outcomes include weight loss and physical function

• “10 Keys”TM to Healthy Aging (center core project)

o Online training modules

o Collaborators: State & local health depts.; PA Dept. of Aging (APPRISE); UPMC for Life; Arthritis Foundation Exercise Program

• Healthy Steps in Motion

o Falls prevention – PA Dept. of Aging

• Other Partnerships

• UPMC Aging Institute, Jewish Healthcare Foundation, Alzheimer’s Disease Research Center

NCOA presentation, May 2018

Assumptions Inputs Activities Outputs Short Term Outcomes

Long Term Outcomes

• Many older adults are unaware of disease prevention targets

• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care

• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk

• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits

• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation


Long Term Outcomes






• Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA)

• 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders

• PA PrimeTimeHealth (PA Department of Aging)

• APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services)

• County Area Agencies on Aging (PA Department of Aging)


Long Term Outcomes











• PA PrimeTimeHealth coordinates delivery of APPRISE/10 Keys programs in senior centers

• 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website

• 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components

• Completion of demographic form and pre- and post-test prevention knowledge; 6-month telephone follow-up to track behavior change


Long Term Outcomes















• Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites

• APPRISE/10 Keys programs offered in 15-20 counties annually, with 500-600 older adults enrolled each year

• >70% participants completing >80% of APPRISE/10 Keys sessions

• Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition


Long Term Outcomes















• Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites

• APPRISE/10 Keys programs offered in 15-20 counties annually, with 500-600 older adults enrolled each year

• >70% participants completing >80% of APPRISE/10 Keys sessions

• Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition

• Increase in prevention knowledge: 20% increase in correct answers between pre- and post-test (13-item quiz)

• Increase in prevention behaviors and health outcomes:

(i) Reduce hypertension through diet, regular assessment, and antihypertensive use;

(ii) reduce sedentary behavior through increased exercise;

(iii) empower older people to discuss prevention with physicians to receive clinical prevention services

• Lower risk of hospitalization and disability in older PA residents

• Disseminate 10 Keys to Healthy Aging to other PRCs

PA APPRISE Regions

Partnership with University of Pittsburgh

CDC Prevention Research Center

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Dissemination Statewide

3/2016 26

Five-week '10 Keys to Healthy Aging' series offered

THE YORK DISPATCH

POSTED: 04/13/2015 12:45:33 AM EDT | UPDATED: A DAY AGO

The Red Lion Area Senior Center, 20-C Gotham Place, will host the five-week program, "10 Keys to Healthy Aging," 9:30 a.m. Tuesdays beginning this week.

Developed by researchers at the University of Pittsburgh Graduate School of Public Health, the classes are designed to help people take ownership of their health. Participants will learn two healthy-aging keys each week.

Admission is free.To register, call Kasie Ream, Program Coordinator, at 244-7229.

If you have had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized prevention plan based on your health and risk factors. This includes:

• Health risk assessment• Review of medical and family history• Develop or update a list of current providers and prescriptions• Height, weight, blood pressure, and other routine measurements• Detection of any cognitive impairment• Personalize health advice• List of risk factors and treatment options for you• A screening schedule for appropriate preventative services

Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index of 30 or more.

Who’s covered?All people with Medicare may be screened for obesity. Counseling is covered for anyone found to have a body mass index of 30 or more.

How often is it covered?Medicare covers 15 minute face-to-face individual behavioral therapy sessions and 30 minute face-to-face group behavioral counseling sessions

Your cost if you have Original Medicare?You pay nothing!

Who’s covered?Adults with Medicare (including pregnant women) who use alcohol, but do not meet the medical criteria for alcohol dependency.

How often is it covered?Medicare covers one alcohol misuse screening per year. If your primary care doctor determines you are misusing alcohol you can get 4 brief face-to-face counseling sessions per year in a primary care setting (i.e., doctors office)

Your cost if you have Original Medicare?You pay nothing!

Initial Research: 2013-2016

3/2016 35

Successful roll out in counties?

- Increase in reach (sites, counties) Acceptable to participants?

- Increase in numbers and

completers (80%+ sessions) Increase in prevention knowledge?

- Increase in knowledge between

pre- and post-tests

- Adoption of behaviors?

Program Uptake: PA 10 Keys-APPRISE, 2013-16: Tracking Partnership

2013 2014 2015 2016 Total

Sites, n 7 15 23 38 83

Counties/AAA

regions, n 5 12 14 11 14

Participants, n 93 217 530 694 1534

Participants

completing 8+

Keys, n (%)

60 (64.5) 129 (59.5) 391 (73.7) 464 (66.9) 1044 (68.1)

10 Keys-APPRISE Participants, 2013-2016

93

217

530

694

60

129

391

464

0

100

200

300

400

500

600

700

800

2013 2014 2015 2016

Par

tici

pan

ts

Participants

Completers, 80%+ sessions

Participating in 10 Keys-APPRISE

workshops, 2013-2016, n=1534

Completed pretest

prevention quiz, n=1085

Matched pretest and posttest

prevention quiz, n=736

Provided prevention behavior at

baseline, n=339

Followed in Monthly Telephone

Contact, n=147

PA 10 Keys-APPRISE, 2013-16: Tracking Outcomes

Baseline Prevention BehaviorPrevention Behavior Reporting, %

Not smoking 95.6

Flu immunization, prior 12 months 80.2

Pneumonia immunization, ever 76.1

Able to give systolic blood pressure value 74.9

Colon cancer screening, ever 73.3

Bone density screening, ever 68.7

Able to give blood glucose value 47.8

Exercise 2.5+ hr each week 38.7

Able to give LDL cholesterol value 29.8

Prevention behaviors, mean (SD) 5.8 (1.8)

Appendix “10 Keys”™ to Healthy Aging Exam, with Key

What is the minimum number of hours of regular physical activity an older adult should get per week? Circle One

6 hours1 hours5 hours2½ hours

What is a normal blood pressure level? Circle One

160/90 mmHg120/80 mmHg150/85 mmHg142/72 mmHg

Boosting Prevention KnowledgePre-Test, % Correct Post-Test, % Correct

Physical activity 27.0 60.7

Blood pressure level 82.1 94.6

LDL cholesterol level 33.2 69.7

Colonoscopy screening 29.5 61.8

Mammography 77.8 87.4

Smoking 92.0 95.0

Blood glucose 44.9 71.1

Pneumonia immunization 37.6 59.6

Annual flu shot 72.4 81.0

Results• Mean (SD) age, 75.4 (8.5); 84.1% female; 89.8% white. Baseline

mean 5.8 of 9 prevention behaviors reported

• Correlation of baseline prevention knowledge and reported prevention behaviors, r = 0.30, p < .001

• In 13-item prevention quiz, increase from 61.5% to 78.5% correct, p < .001, across all behaviors

• In monthly follow-up, people completing more than half the Keys were more likely to report weekly muscle strengthening exercises (76.0% vs. 63.0%, p = .02) and blood pressure monitoring (84.1% vs. 72.6%, p = .06)

Conclusions Translation partner: PA Department of Aging. Infrastructure to field

and track dissemination of 10 Keys: Host webinar training, conduit for MIPPA funding, quality assurance

10 Keys: Workshops can be fielded remotely through website training and regional AAA and APPRISE network

PA Department of Aging seeks prevention programming: scalability

Implementation products: Spanish translation (external funds), website training (PRC), linked Medicare counseling/10 Keys instructional materials (PRC/PA APPRISE)

Lessons learned in planning for translation: Simplicity, consistency!

University of Pittsburgh, Graduate School of Public Health

Department of Behavioral and Community Health Sciences (BCHS)

Research on the dynamics of behavior change to improve the health of communities

Contact: Steven M. Albert, [email protected]

mailto:[email protected]

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NCOA presentation, May 2018 · NCOA presentation, May 2018. Improving the lives of 10 million older...

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