findings from acl’s process evaluation of the chronic disease … 2012... · 2013-03-12 · 3 who...

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

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• Who is ACL?

• What is CDSMP?

• Why is Chronic Disease such an important issue?

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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

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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?

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Measuring Outcomes of AoA’s CDSMP Program: • ACL’s partnership with CMS

• ACL’s new CDSMP funding announcement

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 Holly Korda, PhD IMPAQ International 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

72%

21%

7%

Gender

Female

Male

Unknown

25%

11%

26%

20%

8%

11%

Age

Under 60

60-64

65-74

75-84

85+

Unknown

Total Participants = 89,861

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.

Delivery System Organization

0

5

10

15

20

25

Centralized Hybrid Decentralized

CDSMP Delivery System

# o

f G

ran

tee

s

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

Lisa A Ferretti

QTAC@albany.edu

New York State Quality and Technical Assistance Center (QTAC)

September 2012

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.

Contact Information

Marc Molea

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

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Conclusion: Insights from NCOA

Kristie Patton Kulinski, MSW

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Sustainability Resources – Online Learning Modules

Creating a Business Plan for EBHP Programs

Assuring Program Quality

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Sustainability Resources – QA Recommendations

and Planning

Recommendations for quality assurance programs

Quality assurance planning template

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Sustainability Resources – Monthly Webinars

Sustainable infrastructure best practices from

grantee network

New Jersey, Wisconsin, Vermont, Ohio, Delaware

Comprehensive webinar on DSMT initiative

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A nonprofit service and advocacy organization © 2012 National Council on Aging

CDSMP National Database

Houses data on 100,000+ CDSMP participants

Major updates in January 2013

Open to all organizations offering Stanford suite of

programs

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A nonprofit service and advocacy organization © 2012 National Council on Aging

CDSMP Cost Calculator

Interactive tool to help organizations better

understand and manage the costs associated with

offering CDSMP

Per participant and per workshop cost

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Other Resources

CDSMP Weekly Update

Online Healthy Aging

Group

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Visit Us Online!

www.ncoa.org/cha