Role of State Medicaid Agencies in Evidence-Based Prevention Program Delivery and Distribution Systems Jane Tilly, DrPH U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION ON AGING, WASHINGTON DC 20201 PHONE 202.619.0724 FAX 202.357.3523 EMAIL aoainfo@aoa.gov WEB www.aoa.gov
Overview Background and Benefits Jane Tilly, AoA State Examples VA: Steve Ankiel, Department of Medical Assistance Services April Holmes, Department for the Aging Iowa: Joel Wulf, Department on Aging
Stanford Model Self-Management Programs (CDSMPs) Chronic Disease Self-Management Program Diabetes Self-Management Program Arthritis Self-Management Program Tomando Control de su Salud (Spanish CDSMP) Tomando Control de su Diabetes (Spanish Diabetes) Programa de Manejo Personal de la Artritis (Spanish Arthritis)
CDSMP Features 6-week small groups led by a pair of trained lay leaders Standardized curriculum and interactive processes to increase self-efficacy: efficacy: goal- setting/ action plans, practice and problem solving Workshop topics based on needs assessment: Exercise and Nutrition; Medication usage, Stress management, Talking with health providers, Dealing with emotions and depression
CDSMP Benefits Increased self-efficacy Increased behaviors: Aerobic exercise Cognitive symptom management Improved health outcomes: Health distress Social role limitations Depression Energy/fatigue Pain Decreased days in hospital 5
Recovery Act CDSMP Grant Vision $27 million to 45 states, DC and PR 50,000 completers Evidence-based Prevention e Program Distribution & Delivery Systems to assure easy access (like meds) State level partnership between aging, public health, Medicaid Focus on underserved d
Recovery Act CDSMP Grant Progress 56,910 participants ; 42,467 completers (85% of 2-year completer goal) Over 5100 workshops at 619 host organizations and over 3400 sites Average age 67 yrs; 22% males; 68.3% Whites, 19.6% African Americans; 17.6% Hispanics i 58.5 % more than one chronic condition (hypertension (40.9%), arthritis (40.3%) and diabetes (29.6%) 7
Program Reach CDSMP 50,000 CDSMP Participants ii 45,000 40,000 35,000 30,000 25,000 20,000 44,591 15,000 10,000 5,000 0 3,636 PY 1 (8/2006 7/2007) 9,723 PY 2 (8/2007 7/2008) 12,192 PY 3 (8/2008 7/2009) 16,372 PY 4 (8/2009 7/2010) PY 5 (8/2010 7/2011)
(3/31/10 5/31/11)
Medicaid Role Provide referrals (19 grantees) On management team (19) Trained about evidence-based programs (16) Partner on Affordable Care Act initiatives (17) Provide reimbursement for program participation i (2)
State Examples North Carolina Washington Iowa Virginia
North Carolina Partnership to Reach Medicaid id Population Partners: Division of Aging & Adult Services & Community Care of North Carolina (CCNC) CCNC C = Cooperative, e, coordinated care for Medicaid population & dual eligibles Medical Home model /Regional networks of physicians, nurses, pharmacists, hospitals, health departments, social service agencies and other community organizations 1 M patients; estimated $1.5 B savings in 3 years
Partnership Timeline 2007 Began planning collaboration on CDSMP 2008-09 DAAS hosted 2 CDSMP Master Trainer Trainings 12 attendees were CCNC staff from 6 different regional networks and state office 2009-2010 AAAs and CCNC networks begin developing successful partnerships 2010 2011 Two models of partnerships between the AAAs and CCNC networks emerge
CCNC-AAA Partnership Models Collaborative Networks work together with AAAs to plan and implement workshops for a target population Contractual Networks contract with an AAA to manage the administration of workshops that the Networks can refer patients to and/or lead (if they have trained leaders).
Future Goals September 28, 2011 = CCNC champions and AAA CDSMP regional coordinators meeting to review 2 models and discuss additional options, challenges, and opportunities 2011 & beyond = CCNC will be expanding to serve Medicare patients Expand CDSMP role in services provided Expand AAA-CCNC network partnerships
CMS Incentives Grant (PENDING) CDSMP listed as one of the primary selfmanagement interventions in the NC Division of Medical Assistance s proposal for the CMS Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) grant It has been proposed that CCNC networks will collaborate with the 17 AAAs to offer CDSMP The networks will distribute incentives to Medicaid patients who complete the workshop. kh
Washington Home and Community Based Service Waivers Aged, Blind and Disabled (ABD) HCBS Waivers The WA State ABD waiver is titled Community Options Program Entry System (COPES). COPES allows clients to choose to receive home and community based services instead of nursing facility care. Once a client is determined functionally and financially i eligible ibl for the waiver program, the client chooses where to receive services; at home, in a residential setting, or a nursing facility. Waiver services include personal care services and the categorically needy medical program.
Client Training and CDSMP Waiver Authorization ti CDMSP consists of 6 units, one unit per week, for 6 consecutive weeks. The unit rate includes the cost of the 2.5 hour class, leader time and all workshop costs and materials. Providers (individual or agency) must be contracted through the AAA as certified trainers for CDSMP. The service is provided in accordance with a therapeutic goal in the plan of care. The service is provided in a manner consistent with protecting and promoting the client s health and welfare, and appropriate to the client s physical and psychosocial needs. The service is provided within the scope of practice of the contractors license and in compliance with professional rules
Making the Connection with Chronic Care Management CHRONIC CARE MANAGEMENT
The Chronic Care Model
CCM Overview e Targets those with high medical cost and risk criteria (Client lives alone; high risk moods/behaviors; fair or poor self health rating; overall self-sufficiency declined in last 90 days; greater than six medications) Tailored Client Coaching Approach o The client is in charge of the care plan o Nurses encourage client confidence; discuss and offer options and education that allow the client to increase their ability to manage their own care to improve quality of life and/or health outcomes using evidence based programs when available
Future Plans Care Integration for Dual Eligibles from CMS Innovations Center- in development Health Home State Plan Amendment e for Chronic Care Management- in development Medicaid Health Incentives Grantapplication submitted
Joel Wulf, Iowa Department on Aging
Virginia s CDSMP Medicaid Partnership NASUAD Home and Community Based Services Conference September 12, 2011 Steve Ankiel Program Manager Long Term Care Department of Medical Assistance Services April Holmes Coordinator Prevention Programs for Older Adults Virginia Department for the Aging You Can! Live Well, Virginia!
Today s Conversation Leadership Trail A True Partnership Moving Forward Product Samples You Can! Live Well, Virginia!
The Leadership Trail: Slow Beginnings You Can! Live Well, Virginia!
State CDSMP Leadership: Virginia Department of Health Brought CDSMP to Virginia in 2006 Holds multi site it license from Stanford University Oversees program fidelity Provides technical assistance and support Coordinates CDSMP/DSMP programs not offered under AAA leadd You Can! Live Well, Virginia!
State CDSMP Leadership: Virginia Department for the Aging (VDA) Awarded d ARRA CDSMP grant from AoAA Leads and coordinates grant project Subcontracts with 8 Area Agencies on Aging Provides technical assistance and support Integrates into ADRC and referral systems Leads sustainability planning You Can! Live Well, Virginia!
State CDSMP Leadership: Virginia Department of Medical Assistance Services (DMAS) Limited role outlined in proposal: Two mailings to beneficiaries of Elderly or Disabled Consumer Directed Waiver (EDCD) Create mailing database Co author letter to beneficiaries With VDA and VDH, foster partnerships but actually. You Can! Live Well, Virginia!
DMAS expanded involvement and support= Major sustainability champion! j y p Entire postcard mailing Active on project leadership Conference calls Statewide meeting Open to exploring funding options Active participant in AoA grantee meeting AHA! Moment at statewide meeting You Can! Live Well, Virginia!
A True Partnership You Can! Live Well, Virginia!
Overlap, reinforcement on many efforts Support and recognition of programs Program expansion and participant reach Monthly conference calls Developing partnerships Sustainability Planning You Can! Live Well, Virginia!
We help each other so that we can achieve common goals You Can! Live Well, Virginia!
Today s Conversation Leadership Trail A A True Partnership Moving Forward You Can! Live Well, Virginia!
Actual DMAS Partnership Activities Mailed 12,500 Post cards to Medicaid waiver participants Provided transportation for individuals if part of service plan Provided support to a statewide CDSMP conference Contacted MCO s in Virginia to explore inclusion in their Prevention ention Programs. Support Marketing Material Development Power point You Can! Live Well, Virginia!
Remaining Challenges Provide funding No new funds in Virginia MCO s including CDSMP Stanford model in their Prevention Programs. Funding under Medicaid model Need for Licensed Profession trainer You Can! Live Well, Virginia!
Benefits of the Medicaid Partnership It Provides a solid referral partnership With Medicaid contacts, we will be able to reach new delivery systems Medicaid Providers and staff will learn about CDSMP and refer clients You Can! Live Well, Virginia!
Enhanced Evidence Based Reporting Our partnership adds to the performance /evidenced based Conference & Surveys from workshops kh You Can! Live Well, Virginia!
Today s Conversation Leadership Trail A True Partnership Moving Forward Product Samples You Can! Live Well, Virginia!
The best is yet to come and won t that be fine? Frank ksinatra You Can! Live Well, Virginia!
Medicaid Partnership Future Activities CDSMP description added to the annual statewide Medicaid Waiver Provider Trainings Training provided to all LTC staff Health who enroll and support participant p services (50) Add service referral information to 124 DSS agencies who provide referrals for services Include I l d in all LTC training i the availability of CDSMP workshops. (Ombudsmen, Private Provider Associations, & Pre admission Screening teams) Support distribution of Rack cards and Prescription pads You Can! Live Well, Virginia!
Future Activities Explore Parish Nurses Explore ways via Medicaid to Inform Professionals Pharmacists Primary Care Physicians Hospital discharge Planners You Can! Live Well, Virginia!
Today s Conversation Leadership Trail A True Partnership Moving Forward Product Samples You Can! Live Well, Virginia!
Contact Information April, Holmes Virginia Department Aging April.Holmes@vda.virginia.g ov 804 662 7631 Rita Miller Steve Ankiel Virginia Department Health Department Medical Assistance Rita.Miller@vdh.virginia.gov g Services 804 864 77288 steve.ankiel@dmas.virginia.gov 804 371 8894 You Can! Live Well, Virginia!
Any questions? You Can! Live Well, Virginia! 49