findings from acl’s process evaluation of the chronic disease … 2012... · 2013-03-12 · 3 who...
TRANSCRIPT
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
202.696.1032
Holly Korda, PhD
207.358.2792
Lisa A Ferretti
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
614-752-9167
Diane Beaty-Cargile
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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A nonprofit service and advocacy organization © 2012 National Council on Aging
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
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www.ncoa.org/cha