Findings from ACL s Process Evaluation of the Chronic Disease Self-Management Program (CDSMP) Introduction Susan Jenkins, PhD Social Science Analyst with the Administration for Community Living
Who is ACL? What is CDSMP? Why is Chronic Disease such an important issue? 2
Who Were The AoA CDSMP Grantees: Funded through the American Reinvestment and Recovery Act (ARRA) Grant period March 2010 - March 2012 47 Grantees (45 states + DC and Puerto Rico) > 900 workshops offered Almost 80,000 completers 3
The Process Evaluation of AoA s CDSMP Program: 1. Who do AoA CDSMP grantees serve? 2. How are local sites implementing the CDSMP? 3. What are program completion rates, in general and by important sub-groups? 4. What data are AoA CDSMP grantees collecting and what is the state of their records systems? 5. Have these grantees built sustainable statewide distribution and delivery systems? 4
Measuring Outcomes of AoA s CDSMP Program: ACL s partnership with CMS ACL s new CDSMP funding announcement 5
Building Sustainable Delivery Systems for Evidence-Based Programs: Findings from the Chronic Disease Self Management Program (CDSMP) National Process Evaluation 2012 National HCBS Conference September 11, 2012, 2:30 pm 3:45 pm Daver Kahvecioglu, PhD IMPAQ International Holly Korda, PhD Altarum Institute
Presentation Overview Process evaluation data sources CDSMP participants Completion rates Delivery system organization Strategies for sustaining CDSMP
Process Evaluation Data Sources Conference calls with ACL regional and program staff Data from Sustainable Infrastructure and Delivery System Survey Program data from CDSMP technical assistance contractor Site visits 6 ARRA grantees Telephone key informant discussions 47 ARRA grantees (state staff, partners, host sites)
CDSMP Participants April 2010 March 2012 Gender Age 21% 7% 72% Female Male Unknown 8% 20% 11% 25% 11% Under 60 60-64 65-74 75-84 85+ Unknown Total Participants = 89,861 26% Source: IMPAQ International. Preliminary data.
CDSMP Participants: Average Number of Chronic Conditions Gender Male 2.08 Female 2.42 Age <60 1.95 60-64 2.60 65-74 2.65 75-84 2.60 85+ 2.43 Source: IMPAQ International. Preliminary data.
Participants Completing CDSMP April 2010 March 2012 Gender Male 74% Female 76% Age <60 75% 60-64 77% 65-74 78% 75-84 77% 85+ 73% Source: IMPAQ International. Preliminary data.
# of Grantees Delivery System Organization 25 CDSMP Delivery System 20 15 10 5 0 Centralized Hybrid Decentralized Source: IMPAQ International. Preliminary data.
Strategies for Sustaining CDSMP Organizational Strategies Partnerships: Marketing and Program Delivery Partnerships: Providers Partnerships: Public and Private Funders Reimbursement for CDSMP
Organizational Strategies to Sustain the Delivery System Infrastructure Leaders embedded in state and local agencies Champions University partnerships Contractors for guidance on program development, sustainability, fidelity Workshop support: Training/toolkits/ centralized online marketing and registration Aligning CDSMP with state HHS, health reform Policy
Partnerships: Marketing and Program Delivery Networks with Networks (AAAs, AHEC) Hospitals Senior housing Universities, Community colleges YMCA/United Way Evidence-based program agencies, departments Other departments: Corrections, Parks and Recreation Other (libraries, fire stations, mental health systems)
Partnerships: Providers Department of Veterans Affairs (VA) Commercial health plans Medicare Advantage plans Medicaid health plans and information/ referral services Federally Qualified Health Centers (FQHCs) electronic medical record Hospitals
Partnerships: Private and Public Funders Health care conversion, other foundations Health plan foundations Federal grants: AoA, CDC, CMS
Reimbursement for CDSMP Medicare reimbursement for Diabetes Self Management Program (DSMP) Medicaid HCBS waiver service Other Medicaid reimbursement
Contact Information Daver Kahvecioglu, PhD dkahvecioglu@impaqint.com 202.696.1032 Holly Korda, PhD holly.korda@altarum.org 207.358.2792
New York State Quality and Technical Assistance Center (QTAC) September 2012 Lisa A Ferretti QTAC@albany.edu
What is the QTAC and what do we do? Quasi-state organization focused on expansion of evidence-based programs/practices in health/human services Support statewide infrastructure development Manage data Marketing and development Monitor Continuous Quality Improvement
How is the QTAC funded? State allocations Grants Contracts Program income Partner in-kind
How does the QTAC support sustainability and scalability Quality assurance/improvement strategies and indicators Workforce development/maintenance Marketing Resources/funding Data collection and management
Opportunities forward Partnership development Systems Integration Project NYSOFA Arthritis/Disability/Diabetes Prevention and Control NYS DOH Self-management alliances Third party payments
Building Sustainable Delivery Systems for Evidence-Based Prevention Programs September 11, 2012 2012 National HCBS Conference
EB Prevention in Ohio Statewide Infrastructures CDSMP and DSMP (Healthy U in Ohio) Healthy IDEAS Reducing Disability in Alzheimer s Disease Care Transitions Regional Infrastructures Pain Management and Tomando Matter of Balance Tai Chi for Better Balance
EB Prevention in Ohio Key Statewide Partners Ohio Department of Health Coordinated Chronic Disease Program and SHIP Area Agencies on Aging Regional Site Coordinators Alzheimer s Association Chapters Regional Hub for RDAD Office of Health Transformation and Sister Cabinet Agencies Reach and Implementation Partners
Sustainability Principles Generate Demand Build Capacity Ensure Quality Measure Impact Approach Statewide Reach (all adults) Develop Turn-Key Partners Embed in Reimbursement Streams Engage Volunteers and Communities
Sustainability Initiatives National Church Residences VA Medical Centers Patient Centered Medical Homes Department of Rehabilitation & Corrections Commission on Minority Health/Churches Medical/Health Care Education Senior Corps RSVP Golden Buckeye Community
Sustainability Initiatives Ohio Public Employees Retirement System Rehabilitation Services Commission HCBS Medicaid Waivers and ICDS Duals Managed Care Organizations/Health Plans Showcase Three Initiatives
VA Medical Centers In September 2011, five VA Medical Centers in Ohio had 18 staff members trained as Healthy U Master Trainers, and asked to partner with ODA to conduct community workshops in Columbus, Cleveland, Dayton, Chillicothe and Cincinnati VAMC s champion had Healthy U article published in Ohio Veterans Health magazine VA Master Trainers now planning leader trainings, recruiting vets as leaders Platform for other interventions
Patient Centered Medical Homes In 2011, AAAs in Cincinnati, Columbus & Cleveland worked with PCMHs to make Healthy U available to their patients Promoted three delivery models Turn-Key, Collaborative and Referral Paralleled practice certification process Referral model most attractive at that time. Continue promoting Healthy U with PCMHs Pain Management and DSMP generating interest Need to show how impacts outcomes and bottom-line Decisions made at the practice/providers level
ODA/RSC VRP3 Pilot The Ohio Department of Aging & Rehabilitation Services Partnership Leverage federal Vocational Rehabilitation funds Empower VR consumers with disabilities to better manage their chronic health conditions to support successful employment and independence This Fall implementing a series of six Healthy U workshops with wrap around employment supports through SCSEP, CILs, Goodwill, etc. If pilot is successful workshops could be embedded in VR reimbursement stream
AoA Systems Integration Prevention related activities: Expand our existing statewide EB offerings to new populations Expand falls intervention statewide Fill voids in existing menu of interventions: physical activities, caregiver support, pain management, in-home and on-line options Expand reach by embedding in assessments and decision tools, Benefit Bank, etc.
Marc Molea Contact Information mmolea@age.state.oh.us 614-752-9167 Diane Beaty-Cargile dbeatycargile@age.state.oh.us 614-644-2184 Ohio Department of Aging 50 W. Broad Street/9th Floor Columbus, Ohio 43215-3363 www.aging.ohio.gov
National Home and Community Based Services Conference Utilizing Medicaid in Delaware for Integrating, Embedding and Sustaining the Diabetes Self-Management Program An evidenced-based program developed by Stanford University Delaware Division of Public Health s Diabetes Prevention and Control Program
Four chronic diseases.. heart disease, cancer, chronic lower respiratory diseases and diabetes account for more than half of all deaths among Delawareans Delaware Division of Public Health s Diabetes Prevention and Control Program
Diabetes Self-Management Program Started March 2010 Chronic Disease Self-Management Program Started August 2012 Delaware Division of Public Health s Diabetes Prevention and Control Program
Very high risk population Established infrastructure Large membership base with multiple chronic diseases Universal quality of care measurements Services provided statewide Provider of in-kind contributions Program sustainability Common goals, especially with containing and reducing healthcare cost Delaware Division of Public Health s Diabetes Prevention and Control Program
Delaware Division of Medicaid and Medical Services Delaware Physicians Care An Aetna Medicaid Plan United Healthcare Community Plan Targeting Medicaid members who have an A1c (quarterly blood glucose reading) 9 or greater Delaware Division of Public Health s Diabetes Prevention and Control Program
Identify the host site via Lay trainer External request Confirm date, time and lead and co-lay trainer Lead lay trainer submits a logistic form Medicaid Managed Care Organizations are provided the logistic form for marketing to membership Promotional materials provided to host sites Lead lay trainer provided supplies to conduct DSMP (Central Distribution Site) DSMP implemented at host site Medicaid referral follow-up after first and second session Contractor reviews fidelity of the lay trainer s implementation of the program Certificates are created, food arranged (Medicaid) and awards ceremony session conducted Paperwork collected, data entered and analyzed Delaware Division of Public Health s Diabetes Prevention and Control Program
Serves on the Strategic Planning & Implementation Committee Oversight of the two Medicaid Managed-Care Organizations Lay Trainer/Master Trainer Medicaid membership attendee analysis Process review and approval internal to the Medicaid System Delaware Division of Public Health s Diabetes Prevention and Control Program
Serves on the Strategic Planning & Implementation Committee Referrals to the program Participant Follow-up Direct Mailings Outcome evaluation on behavior change Promotional marketing In-kind contributions $50 cash incentive for DSMP completion (pending approval) $50 cash incentive for testing every three months showing A1C less then 9 and LDL less then 100 Participating members entered into a drawing for a free 1-yr YMCA membership Delaware Division of Public Health s Diabetes Prevention and Control Program
Serves on the Strategic Planning & Implementation Committee Referrals to the program Participant Follow-up Outcome evaluation on behavior change Promotional marketing In-kind contributions Direct Mailings $50 cash incentive for DSMP completion $40 dilated eye exam $40 A1c test Delaware Division of Public Health s Diabetes Prevention and Control Program
Identifying Medicaid participants of the DSMP High-risk population being targeted Elevated no-show referral rate Organization and administration of in-kind resources Delaware Division of Public Health s Diabetes Prevention and Control Program
Don Post Program Manager Delaware Division of Public Health Bureau of Chronic Disease Diabetes Prevention and Control Program Thomas Collins Building Suite 10 Dover, DE 19901 Phone: 302-744-1020 Fax: 302-739-2544
Conclusion: Insights from NCOA Kristie Patton Kulinski, MSW A nonprofit service and advocacy organization 2012 National Council on Aging 47
Sustainability Resources Online Learning Modules Creating a Business Plan for EBHP Programs Assuring Program Quality A nonprofit service and advocacy organization 2012 National Council on Aging 48
Sustainability Resources QA Recommendations and Planning Recommendations for quality assurance programs Quality assurance planning template A nonprofit service and advocacy organization 2012 National Council on Aging 49
Sustainability Resources Monthly Webinars Sustainable infrastructure best practices from grantee network New Jersey, Wisconsin, Vermont, Ohio, Delaware Comprehensive webinar on DSMT initiative A nonprofit service and advocacy organization 2012 National Council on Aging 50
CDSMP National Database Houses data on 100,000+ CDSMP participants Major updates in January 2013 Open to all organizations offering Stanford suite of programs A nonprofit service and advocacy organization 2012 National Council on Aging 51
CDSMP Cost Calculator Interactive tool to help organizations better understand and manage the costs associated with offering CDSMP Per participant and per workshop cost A nonprofit service and advocacy organization 2012 National Council on Aging 52
Other Resources CDSMP Weekly Update Online Healthy Aging Group A nonprofit service and advocacy organization 2012 National Council on Aging 53
Visit Us Online! www.ncoa.org/cha A nonprofit service and advocacy organization 2012 National Council on Aging 54