Kick-Off Webinar: Prevention and Public Health Fund CDSME Grantees (2015) November 2, 2015

Transcription

1 Kick-Off Webinar: Prevention and Public Health Fund CDSME Grantees (2015) November 2, 2015

2 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

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4 History 2003 Evidence-Based Program (EBP) Pilot 14 grants 2006 Evidence-Based Prevention Program 24 AoA grants 3 Atlantic Philanthropies grants 2007 Hispanic Elders Grants 9 communities CDSMP Collaborative effort of: AoA AHRQ CDC CMS HRSA 2010 Putting Prevention to Work: CDSMP Recovery Act Grants 45 states District of Columbia Puerto Rico 2012 Affordable Care Act Prevention and Public Health Fund CDSME Grants 22 states 2013 Second Year of Funding For 2012 PPHF CDSME Grantees 2014 Final Year of Funding For 2012 PPHF CDSME Grantees

5 And Now YOU ARE THE NEW 2015 CDSME Cohort!

6 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%

7 2015 CDSME Grant Goals Significantly increase the number of older adults and adults with disabilities who participate in CDSME and selfmanagement support programs Implement innovative funding arrangements to support CDSME beyond grant period, embedding programs into an integrated, sustainable network

8 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)

9 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

10 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

11 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

12 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

13 Six Key Program Sustainability Elements Business Planning and Financial Sustainability Effective Leadership Partnerships Adequate Delivery Infrastructure Centralized, Coordinated Logistical Processes Quality Assurance Business plan; diversified funding (DSMT, fee for service, contracts) Strong Public Health and Aging; State/ regional management and support Embedded into health systems/ reform and turn-key delivery system partners Right-size workforce/ sites to ensure programs are consistently available Ongoing marketing, referral, registration, ADRC integration to build demand Being data driven with CQI and fidelity monitoring to ensure quality and promote value

14 Considerations and Key Learnings from the Field 14

15 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? 15

16 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. 16

17 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. 17

18 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 18

19 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 19

20 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 20

21 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 21

22 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 22

23 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 23

24 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 24

25 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 25

26 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 26

27 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 27

28 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 28

29 Resources 29

30 Resources 30

31 Resources 31

32 Questions, TA