Ohio Public Employees Retirement System

CDSME Experience

1

Sarah Durfee, RN, Clinical Programs Officer, OPERS

Marc Molea, AICP, Chief Strategic Partnerships, ODA

May 27, 2014

Ohio Healthy U (CDSME) Infrastructure

• Dedicated State Staff

• 12 AAAs/Site Coordinators

• Statewide License, centralized data

• Variety of Workshops: CDSMP, DSMP, Chronic Pain,

Arthritis (aka, Healthy U in Ohio)

• Base of Master Trainers and Leaders

• On-line Workshops - Better Choices, Better Health

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Quick Stats on Healthy U

# of AAA regions with dedicated Site Coordinators to plan, coordinate, promote and report etc.

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# of Master Trainers 65 # of Lay Leaders 425 # of Implementation Sites 414 # of counties with active sites (up from 53 last year)

61

# of Workshops since 2010 623 # of Workshop Participants 7,000+ % of Workshop Completion Rate 78%

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ODA Established Partnerships

• Ohio Department of Health • Ohio Commission on Minority Health • Ohio Mental Health & Addiction – Health Home • OPERS • Department of Rehabilitation and Corrections • Opportunities for Ohioans with Disabilities • Veteran’s Administration Medical Centers • Ohio Patient-Centered Primary Care Collaborative

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OPERS’ Background

• Pension fund for Ohio’s retired public service employees

• Retiree health care is offered, but, not guaranteed

• Focus of recent years has been preservation of retiree health

care into the future

• Major changes to health care eligibility being phased in

• Retirees trust information from OPERS

• Retirees prefer printed communications, although, internet

usage among retirees is growing

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OPERS’ CDSME Experience to Date

• Available to Non-Medicare adult enrollees (~ 80K)

• First workshops offered July 2013

• Expanded to include DSMP (December 2013)

• Participation in 25 workshops offered to date (thru April

2014)

• Around 200 OPERS CDSME/DSMP participants to date

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OPERS’ CDSME Promotional Strategies

Initial Strategies • OPERS retiree newsletter articles (with testimonials) • Personalized mailings

From OPERS One per household plus reminder follow-up letters

(~30K total) Zip codes within AAA service area Robocalls week prior to workshop Yield - < 1%

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OPERS’ CDSME Promotional Strategies

Current Strategies (began April 2014) • Replaced USPS with email

Email households within AAA’s service area by zip code

OPERS-specific

Include more graphics than the prior printed letter

• Reminders via email blasts

• OPERS retiree newsletter articles

• OPERS Web pages

Including videos, testimonials, etc.

• Information also shared by OPERS self-insured plan administrator’s DM vendor

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OPERS’ CDSME Promotional Strategies Future Strategies (TBD) In addition to current strategies… • Include on OPERS’ blog and Facebook pages • Display CDSME video for viewing during OPERS retiree

open enrollment and other educational sessions • ODA/AAAs to man a table at OPERS open enrollment

meetings • Utilize teletown hall format (interactive phone session) • Work with self-insured plan administrator to disseminate to

high volume providers • Extend messaging into contributing employer groups …

OPERS’ future retirees • Consider expanding to online version, Better Choices,

Better Health

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OPERS – Evolution of Reimbursement

• Covered costs of participant books – paid under administrative budget

• Believe in the value of CDSME • Shifting to paying agreed upon fees for CDSME

costs, prorated based upon number of sessions attended

• Claims payment under OPERS’ 401h trust requires electronic claims submission to OPERS’ claims administrator

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Evolution of CDSME Reimbursement

Claims Payment under Commercial Plans • Electronic Claims Submission

EIN by billing entity for AAAs CPT/HCPCs procedure codes

• Use of a Clearinghouse • Claims Administrator Contracting

Recognition as an approved provider May require custom provider contract

• Other processes AAAs (e.g. verify participant eligibility) O4A

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Lessons Learned Don’t Underestimate the Need to Champion the Cause Belief in Non-Traditional Delivery Model is Key Quote Stanford results

Be Prepared to Customize to Meet Your Needs Promotional messaging Participant satisfaction/workshop feedback

Commit to Collaboration OPERS and ODA collaborated on promotional strategies

and operational details Engage AAA site coordinators

Be Flexible/Prepared to Change Processes Charting new territory (open vs. closed workshops) Solicit input and keep everyone informed

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Contact Information Sarah Durfee Ohio Public Employees Retirement Systems sdurfee@opers.org Marc Molea Ohio Department of Aging mmolea@age.ohio.gov Diane Beaty-Cargile Ohio Department of Aging dbeatycargile@age.ohio.gov

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Self-Management Programs for Oregon Public Employees: Progress and Lessons Learned

Laura Chisholm, MPH, MCHES Chronic Disease Self-Management Lead Oregon Public Health Division / Oregon Health Authority

May 27, 2014

Overview

Some background: SM programs in Oregon

Milestones in policy development

Enabling factors

Barriers to policy implementation

Next steps

Stanford Program participants by county of residence, 2012

Participants by program and year, 2006-2012

National Diabetes Prevention Program

Two organizations with master trainers

• Oregon Health & Science University – Schnitzer Diabetes Health Center

• YMCA of Marion/Polk County (Salem)

A dozen other organizations with trained leaders

Moda Health (Eastern OR Coordinated Care Org) grant

Policy Implementation Milestones

Oregon Health Authority formed (1/10) • Consolidated health-related functions: public

health, public employee benefits boards, Medicaid

Medicaid program becomes a champion (7/10) • Disease Management Coordinator attends

national CDSMP ARRA grantee conference

Employee benefits boards offer free Weight Watchers benefit (2010)

Policy Implementation Milestones

Medicaid Health Evidence Review Commission review (2/11) – Initially approved as a Medicaid benefit – Decision rescinded due to budget concerns

re: FQHC encounter billing rates

– Attracted decision makers’ attention, enhanced political will for policy change

Policy Implementation Milestones

State employee benefits boards (PEBB & OEBB) invite presentations on CDSMP (2/11)

PEBB & OEBB promote CDSMP and BCBH to early retirees (winter/spring 2011) • Limited participation • Enthusiastic response & feedback to boards

Policy Implementation Milestones

Health Engagement Model implementation (2011) • Wellness program: HRA and 2 qualified activities

per year

2011/2012 State employee BRFSS improvements • Reduced obesity rate • Increased fruit/veg consumption • Trend toward decreased dx of cholesterol,

hypertension, diabetes

Policy Implementation Milestones

PEBB/OEBB promote CDSMP & BCBH as Health Engagement Model approved activities (2012) • Count toward two required annual health actions

PEBB/OEBB approve CDSMP and NDPP as

benefits (2013) • Available at no cost to all members • Implementation delayed due to contracting

issues • BCBH will be offered as a 2015 benefit

Enabling Factors

Sufficient/growing delivery infrastructure

Champions

Evidence base

Documented burden & cost savings potential

Anticipated system for contracting & billing (Self-Management Hub/Alliance)

Implementation Challenges

Program delivery contracting issues • Many licensed organizations have no billing

capacity • Lack of statewide contracting network creates

administrative barrier for health plans Time constraints

• HEM implementation politics

Inability to measure policy impact • HEM qualifying activities are self-tracked

Purchasers

Oregon’s Current Self-Management Delivery & Financing Structure

Public Health & State Unit on Aging Coordinate training & TA

Collect/reports data Advocate for policy change

(insurance coverage) Coordinate network

Oregon Living Well Network

? ? ? ?

?

Program Delivery

Organizations

Additional Lessons Learned

It takes time – work for incremental change

Contracting & billing infrastructure is crucial

Local data (participation, outcomes)

useful/preferable

Next Steps

Address the need for program delivery contracting networks

Establish billing infrastructure

Continue evaluation

For more information

Laura Chisholm, MPH, MCHES Self-Management Technical Lead

Oregon Health Authority – Public Health Division laura.f.chisholm@state.or.us

(971) 673-0987

www.healthoregon.org/livingwell