Ohio Public Employees Retirement System
CDSME Experience
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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 [email protected] Marc Molea Ohio Department of Aging [email protected] Diane Beaty-Cargile Ohio Department of Aging [email protected]
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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
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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 [email protected]
(971) 673-0987
www.healthoregon.org/livingwell