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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

14Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging

Considerations and

Key Learnings from the Field


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?


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.


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.


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


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


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


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


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


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


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


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


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


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


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


Resources – www.ncoa.org/cha

Questions, TA

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