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Study of Successful Partnerships: SupplementalInformation Request

Please complete the survey questions (see link to the survey below) and provide the requested information. Wewould be grateful if you'd send the requested information, using the survey link and uploading any supplementaldocuments, to us or before Wednesday, January 8, 2014. If you could provide it sooner, that would be great.

If you would like to discuss these questions or if we can assist in any way as you compile it, please contact our StudyManager, Ann Kelly, at 859.218.2317 or via email at [email protected] or the Principal Investigator, Larry Prybil,PhD, at 859.218.2239 or via email at [email protected].

As you complete the survey, use the "tab" key to advance to the next question.

I. ID INFO

SID 39

Time Oct 28 2013 - 11:34am

II. PARTNERSHIP BEING NOMINATED:

1. Formal Name or Title of the Partnership [California Healthier Living Coalition]

2. Primary Contact Person for this Partnership

Partnership Contact: Name and Title: Lora Connolly - Director

Partnership Contact: Mailing Address: 1300 National Drive, Suite 200, Sacramento CA 95834

Partnership Contact: Email Address: [email protected]

Partnership Contact: Phone Number: (916) 419-7500

3. Partnership Description

http://www.project-redcap.org



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Partnership Description (approx. 400 words): Since 2006, the California Department of Aging(CDA), California Department of Public Health(CDPH), Dignity Healthcare (Dignity), and KaiserPermanente of Southern California (Kaiser), haveworked closely to develop a strong, statewidecollaboration focused on the delivery andsustainability of evidence based self-managementprograms for individuals with chronic disease.Largely supported by a series of grant fundingawards from Administration on Aging and Centersfor Disease Control and Prevention, CDA and CDPHhave provided state based leadership tostrengthen and expand an integrated, sustainabledelivery system for chronic diseaseself-management programs throughout California. Critical to the success of this multi-sector,multi-agency partnership is the development of aTechnical Assistance Center (TAC), administeredby Partners in Care Foundation (PICF). PICFfacilitates seamless coordination between state,local, and community based organizations toimplement and expand program offerings whilemaintaining high fidelity standards. PICFprovides technical assistance that appropriatelyrepresents the various grant objectives,maintains databases of Master Trainers, Leaders,workshop, and participant information, createsuniversal marketing materials to brand evidencebased programs throughout the state, and providesadministrative support to maintain the HealthierLiving Coalition. The Healthier LivingCoalition provides the platform for statewidecommunication and networking between individualsand organizations involved in chronic diseaseself-management programs in California. Themission/vision of the Coalition is to 'supportagencies planning or actively involved inimplementing evidence-based programs for peoplewith chronic disease'. For materials related tothe Coalition, including a current roster, visit: www.cahealthierliving.org . From 2006 - 2012,CDA led a Statewide Steering Committee thatevolved into the Healthier Living Coalition in2013. This evolution recognized the expandingmembership and cross-departmental stateleadership. The Coalition is co-lead byrepresentatives from CDA and public health.Current public health leadership includes bothCDPH and representatives from CA4Health, aCommunity Transformation Grant initiative awardedto the Public Health Institute. CA4Healthimplements activities in 43 small Californiacounties and is currently funding 12 counties toenhance linkages between clinical settings,community based organizations, andself-management programs. Partnerships withhealth care organizations are critical toCalifornia's success expanding access toself-management programs. Their leadership andvision has enabled the Healthier Living Coalitionto reach beyond the traditional state-basedpartnerships. Support from Kaiser and Dignity hasincluded: providing Master Trainers to conductLeader trainings, providing materials to newsites interested in hosting workshops, marketingsupport, technical assistance to assure fidelity,and active support of the Healthier LivingCoalition.




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4. Organizational Partners:

Hospital Partner(s) Name Dignity Health ; Kaiser Permanente of SoCal(If none, write "none")

Hospital Partner(s): Key Contact Person Name: Eileen Barsi

Hospital Partner(s): Contact Person Title: Senior Director, Community Benefit

Hospital Partner(s): Email Address: [email protected]

Hospital Partner(s): Phone Number: (415) 438-5571

Health Department Partner(s) Name California Department of Public Health, projectmanaged by Public Health Institute; 16 localhealth departments participating (unnamed)(If none, write "none")

Health Department Partner(s): Key Contact Person Name: Pamela Keach

Health Department Partner(s): Contact Person Title: Strategic Lead - CA4Health

Health Department Partner(s): Email Address: [email protected]

Health Department Partner(s): Phone Number: (916) 996-6031

Other Partners (Check all that apply) Local government agency(s) in addition to healthdepartment (e.g., social services)State health departmentOther state government unit(s) (e.g., Medicaidoffice)Local school system(s)University(s) or college(s)Nonprofit community-based organization(s) (e.g.,United Way)Community health center (including FQHCs)Other primary care provider(s)Multi-specialty physician clinic or grouppractice(s)Health insurance company(s) or health maintenanceorganization(s)Private business firm(s)Charitable Foundation(s)Other organization(s), please specify:

Other organization(s), please specify: CA4Health PublicHealth Institute (CTG Project)

III. NOMINATION SUBMITTED BY:

Nominator: Name and Title: Pamela Keach, Strategic Lead, CA4Health

Nominator: Mailing Address 1284 Hawthorne Loop, Roseville, CA 95678

Nominator: Email Address: [email protected]

Nominator: Phone Number: (916) 996-6031




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IV. DOCUMENTS UPLOADED BY NOMINATOR

Attachment 1 [document]

Attachment 2

Attachment 3

Attachment 4

Attachment 5

Attachment 6

V. UK PROJECT STAFF RE-CODING




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Partnership State Alabama AlaskaAmerican Samoa ArizonaArkansas CaliforniaColorado ConnecticutDelaware District of ColumbiaFlorida GeorgiaGuam Hawaii IdahoIllinois Indiana IowaKansas KentuckyLouisiana MaineMaryland MassachusettsMichigan MinnesotaMississippi MissouriMontana NebraskaNevada New HampshireNew Jersey New MexicoNew York North CarolinaNorth Dakota Northern Marianas

Islands Ohio OklahomaOregon PennsylvaniaPuerto Rico Rhode IslandSouth Carolina South DakotaTennessee TexasUtah Vermont VirginiaVirgin Islands WashingtonWest Virginia WisconsinWyoming

Nomination sources Self-nomination CPH FormUK Staff nominated CPH FormASTHO/Duke Project nominationAligning Forces for Quality projectCDC Community Transformation GranteeAward winners -- Foster McGaw, AHA Nova, HospitalCharitable, RWJF Roadmaps, NACCHO Achieve

(check all that apply)

First Screening Decision Retain in Part 1 DatabaseAdvance to Part 2 Database

(Screening in late Nov 2013)

Is this nomination linked to other nominated partnerships?

YesNo

If yes, please enter record number of linked 32partnership.



If yes, please enter record number of linked __________________________________partnership.

If yes, please enter record number of linked __________________________________partnership.




Page 1 of 2

Supplemental Information Request Part 2

Please complete the survey below.

Thank you!

1 In what year did the partnership you nominated or are associated with move from initial planning and organizationalsteps into actual operations?

Has not yet begun operationsDuring 2013During 2012During 2011During or before 2010

2 What is your partnership's current organizational model?

It is a corporate entity related to but separate from its sponsoring organizationsIt involves a formal affiliation agreement among its sponsoring organizationsIt involves a memorandum of understanding among its sponsoring organizationsIt is an informal consortium or "coalition" of interested partiesOther (please describe briefly)

If other, please describe briefly.

It involves a combination of MOUs and informal agreements. The California Department of Aging and CaliforniaDepartment of Public Health have formal agreements with Partners in Care Foundation. Dignity Health and theUniversity of California, San Francisco (CA4Health initiative) have more informal operational agreements.

3 Please state (or upload) your partnership's mission, goals, and current operating objectives. Type "X" and tab to openupload link.

Our mission is to expand the availability of evidence-based chronic disease self-management education (CDSME)programs proven to significantly help individuals living with a chronic disease. Goal 1: Significantly increase the number of older and/or disabled adults with chronic conditions who completeevidence-based Chronic Disease Self-Management Education (CDSME) programs to maintain or improve their healthstatus. •Major Objective 1: 8,771 older and/or disabled adults, particularly Californians who are low income, rural, or havelimited English speaking capabilities complete a CDSME program.Goal 2: Strengthen and expand integrated, sustainable service systems within California to provide evidence-basedCDSME programs. •Major Objective 1: Provide effective cross-agency leadership to statewide network of CDSME delivery partners.•Major Objective 2: Sustain capacity to delivery CDSME programs on an ongoing basis.•Major Objective 3: Provide effective technical assistance to CDSME delivery partners.•Major Objective 4: Develop sustainable delivery models with health care delivery systems.•Major Objective 5: Disseminate findings and lessons learned to influence broader statewide program adoption.

Upload your mission, goals, and operating objectiveshere.

4 Please list (or upload) the key measures ("metrics") your partnership's leadership team currently employs to monitorits performance in relation to these goals and objectives. Type "X" and tab to open upload link.

Goal 1 Measureable Outcome(s): 8,771 older and/or disabled adults complete CDSME programs by September2015.Goal 2 Measureable Outcome(s): Increase in system delivery partners; Increase in program delivery sites; Increase innumber of workshops offered at delivery sites; Achieve reimbursement for CDSME delivery from 1 health caresystem;

Upload the description of the metrics yourpartnership employs to monitor performance.




Page 2 of 2

5 To date, has the partnership produced any evidence of impact on the health of the population(s) that it serves?

YesNo

If yes, please briefly describe this impact (e.g. numbers of people served, the nature of the impact, etc.).

Our partnership contributed to a national study* completed by Stanford University Patient Education in 2010-2012 toinvestigate the change in health outcomes, lifestyle behaviors, and health care service utilization over a 6 monthperiod for CDSMP participants. The study included 1,170 adults (average age of 65.4 years), with six-monthassessments available from 903 participants. Results showed a significant improvement in social/role activitieslimitations, depression, and communication with physicians from baseline to 6-month follow-up. Participants reportedmajor improvements in more physical activity and fewer emergency room (ER) visits and hospitalization during thatperiod. *Ory MG, Ahn SN, Jiang L, Lorig K, Ritter P, Laurent DL, Whitelaw N, Smith ML: National Study of Chronic DiseaseSelf-Management: Six Month Outcome Findings. J Aging Health: 2013,25:1258

In Los Angeles between 2008 and 2010, Partners in Care Foundation collected data from CDSMP workshops atSession One and Session Six with a 6-month follow up. Measures included demographic information, self-reportedhealth measures and a 13-item Patient Activation Measure (PAM). The PAM score assesses the confidence, skill andcommitment integral to managing one's own health and healthcare--vital to understanding how participants caneffectively manage their own health and ultimately reduce cost and burdens on the healthcare system.

The study included 21 workshops serving 267 participants, 229 of whom completed the program (attended four ormore of the six sessions). A total of 247 participants were given the 6-month follow up survey which yielded a 90percent completion rate (223 participants completing). The most commonly experienced chronic conditions werehypertension (52 percent), arthritis (48 percent) and diabetes (33 percent). Additionally, 73 percent of participantshad two or more conditions. Participants showed a significant decrease in physician visits, emergency room visitsand hospitalizations after participating in CDSMP. Participants reported a significant increase in bringing a list, askingquestions and discussing concerns with their physicians. Finally, the PAM scores found that that 75 percent ofparticipants reported maintaining or improving their health after participating in CDMSP.

6 Please list (or upload) a full list of the organizations and groups that are affiliated with your partnership at this time.Type "X" and tab to open upload link.

X

Upload a list of your partnership's affiliated [document]organizations and groups.

Additional Document #1





Communication Notes:

In the initial submission, I erroneously referred to Eileen Barsi's affiliation as something other than Dignity Health.Please correct. Thanks!


Name Affiliation Address Phone Number Email

Eileen Barsi Community Benefit/ Dignity Health185 Berry St. Suite 300

San Francisco, CA 94107415-438-5571 [email protected]

Sydni AguirreProgram Manager - Healthier Living/ Dignity

Health

3400 Data Dr.

Rancho Cordova, CA 95670916-851-2793 [email protected]

Vickie Fung Arthritis Foundation, Pacific Region800 W. 6th St., Suite #1250

Los Angeles, CA 90017-2721323-954-5760 ext. 234 [email protected]

Isela Monterrosas Arthritis Foundation, Pacific Region800 W. 6th St., Suite #1250

Los Angeles, CA 90017-2721949-585-0201 ext 206 [email protected]

Dianna Gonzalez Napa/Solano AAA

P.O. Box 3069

400 Contra Costa St.

Vallejo, CA 94590

707-643-1797 [email protected]

Anne Payne Napa/Solano AAA

P.O. Box 3069


Vallejo, CA 94590


Leanne Martinson Napa/Solano AAA

P.O. Box 3069


Vallejo, CA 94590


Karen GrimsichCity of Fremont Human Services

Department

P.O. Box 5006

Fremont, CA 94537510-574-2062 [email protected]

Audrey A. UhringCity of Fremont Human Services

Department

P.O. Box 5006


Ray GrimmCity of Fremont Human Services

Department

P.O. Box 5006


Muriel GuzziKaiser Permanente, Southern California

Public Affairs/ Community Benefit

393 E. Walnut St. 2nd Floor

Pasadena, CA 91188626-564-3629 [email protected]

Cody RuedafloresKaiser Permanente, Southern California




Barbara PhiferKaiser Permanente, Southern California




Lura Hawkins California Association of Physician Groups915 Wilshire Blvd. Suite 1620

Los Angeles, CA 90017213-239-5046 [email protected]

Paul Hepfer The Health Trust1400 Parkmoor Ave., Suite 230

San Jose, CA 95126408-961-9845 [email protected]

Lori Anderson The Health Trust2105 vS. Bascom, Suite 220

Campbell, CA 95008408-879-4111 [email protected]

Lori HoladaySonoma County AAA, Human Services

Department

3725 Westwind Blvd. Suite 101

Santa Rosa, CA 95403707-565-5984 [email protected]

Deb Harris Northern California Center for Well Being365 B Tesconi Circle


California Healthier Living Coalition Evidence-Based Health Promotion Project

mailto:[email protected]


















Tracy ReppSonoma County AAA, Human Services

Department

3725 Westwind Blvd. Suite 101


Mary Lange

Mt. San Antonio College/ California

Community College Educators of Older

Adults

1100 N. Grand Ave

Walnut, CA 91789909-594-5611 ext. 5117 [email protected]

Linda C. LauSan Francisco Dept. of Aging & Adult

Services Office of the Aging (AAA)

1650 Mission St. 5th Floor


Ken Wong

San Francisco Dept. of Aging & Adult


Representative On-Lok

30th Street Senior Cntr,

225 30th Street San

Francisco, CA 94131


Jean Grady

San Francisco Dept. of Aging & Adult


Representative On-Lok

30th Street Senior Cntr,

225 30th Street San

Francisco, CA 94131


Cheri HoolihanCDSMP Coordinator - Sharp-Stealy Medical

[email protected]

Elizabeth StillwellOffice of Women's Health/ Los Angeles

County Dept. of Public Health

3400 Aerojet Ave. 3rd Floor El

Monte, CA 91731626-569-3818 [email protected]

Ellen EidemOffice of Women's Health/ Los Angeles

County Dept. of Public Health

3400 Aerojet Ave. 3rd Floor El

Monte, CA [email protected]

Melissa JonesAligning Forces for Quality California Center

for Rural Policy Humboldt County

1124 16th Street, Suite 204

Arcata, CA 95521707-445-2806 ext. 5 [email protected]

Michele ComeauAligning Forces for Quality California Center

for Rural Policy Humboldt County

1124 16th Street, Suite 204

Arcata, CA 95521707-445-2806 ext. 4 [email protected]

Elizabeth PopeDivision of Aging & Adult Services Marin

County AAA

10 N. San Pedro Rd. Suite 1028

San Rafael, CA 94903415-473-3756 [email protected]

Frank HernandezOCCS- Office on Aging (Orange County's

AAA)

1300 S. Grand Ave. Building B

Santa Ana, CA 92705714-648-0116 x101 [email protected]

Erin UlibarriOCCS- Office on Aging (Orange County's

AAA)

1300 S. Grand Ave. Building B

Santa Ana, CA 92705714-836-3331 [email protected]

Tamar SemerjianSilicon Valley Healthy Aging Partnership/

San Jose State University

One Washington Square

San Jose, CA 95129408-924-3069 [email protected]

Jennifer SchachnerSilicon Valley Healthy Aging Partnership/

San Jose State University

One Washington Square

San Jose, CA [email protected]

Kristen SmithAging & Independence Services/ San Diego

County AAA

P.O. Box 23217

San Diego, CA 92193858-495-5061 [email protected]

Charlotte TenneyAging & Independence Services/ San Diego

County AAA

P.O. Box 23217

San Diego, CA 92193858-495-5230 [email protected]

Adrienne StokolsWorking to Enhance Care & Resources for

our Elders (WECARE), Orange County

3832 Hemingway

Irvine, CA 92606714-404-8130 [email protected]

Sue Tatangelo Camarillo Health Care District3639 Las Posas Rd

Camarillo, CA 93010805-388-1952 ext. 106 [email protected]

Lindsey Nibecker Camarillo Health Care District3639 Las Posas Rd

Camarillo, CA 93010805-388-1952 ext.209 [email protected]

Lori Weathers Riverside County Office on Aging 760-771-0501 [email protected]






















Megan Johnson Shasta Public Health2650 Breslauer Way

Redding, CA 96001530-229-8431 [email protected]

Linda HellandMendocino City, Health & Human Services,

Community Health

1120 S. Dora St.

Ukiah, CA 95482707-472-2727 [email protected]

Cassandra TaaningMendocino City, Health & Human Services,

Community Health

1120 S. Dora St.

Ukiah, CA [email protected]

Margaret Weiss Sansum Clinic 805-737-8754 [email protected]

Eryn Eckert [email protected]

Luz Torres Mercy and Memorial Hospitals in Kern

[email protected]

Felicia Barraza Mercy and Memorial Hospitals Kern County [email protected]

Juan Vega Jr. Mercy and Memorial Hospitals Kern County [email protected]

Mariel Mehdipour Mercy and Memorial Hospitals Kern County [email protected]

Victoria Bruno Arthritis Foundation, Great West Region657 Mission Street


Jonathan Demers PIH Health12401 Washington Blvd.

Whittier, CA 90606562-698-0811 x 14691 [email protected]

Ricardo Lopez PIH Health12401 Washington Blvd.

Whittier, CA [email protected]

Kate Feiertag PIH Health12401 Washington Blvd.

Whittier, CA [email protected]

Melisa Acoba Master of Public Health Student - USC 1315 Hepner Avenue 323-793-8818 [email protected]

Laura Trejo City of Los Angeles Area Agency on Aging3580 Wilshire Blvd. Suite 300

Los Angeles, CA 90010213-252-4023 [email protected]

Sue Lachenmayr NCOA, Center for Healthy Aging1901 L. Street NW 4th Floor Washington

DC 20036202-600-3144 [email protected]

Lora Connolly California Department of Aging1300 National Drive 2nd Floor

Sacramento, CA 95834916-419-7500 [email protected]

Barbara Estrada California Department of Aging1300 National Drive 2nd Floor

Sacramento, CA [email protected]

Andrea Bricker California Department of Aging1300 National Drive 2nd Floor

Sacramento, CA [email protected]

Jessica Nunez de YbarraCalifornia Department of Public Health

Chronic Disease Control Branch

P.O.Box 997413, MS 7210,

Sacramento CA 95899-7413916-552-9877 [email protected]

Majel Arnold

California Dept. of Public Health, California

Arthritis Partnership, California Heart

Disease & Stroke Prevention Program

P.O. Box 997413, MS 7210 Sacramento,

CA 95899-7413916-322-5336 [email protected]

Pamela KeachUniversity of California, San Francisco /

Public Health Institute

1284 Hawthorne Loop

Roseville, CA 95678916-996-6031 [email protected]

Jackie Tompkins

California Dept. of Public Health, California

Arthritis Partnership, California Heart

Disease & Stroke Prevention Program



Melissa MalloryCalifornia Dept. of Public Health, California

Arthritis Partnership,



























June Simmons Partners in Care Foundation732 Mott St. Suite 150

San Fernando, CA 91340818-837-3775 ext.101 [email protected]

Dianne Davis Partners in Care Foundation732 Mott St. Suite 150


Natalie Zappella Partners in Care Foundation732 Mott St. Suite 150


Kathryn Keogh Partners in Care Foundation732 Mott St. Suite 150


Bertha Sandoval Partners in Care Foundation732 Mott St. Suite 150


Cassandra Manfree Partners in Care Foundation732 Mott St. Suite 150








1

TITLE PAGE – FINAL REPORT

Project Title:

California Initiative to Empower Older Adults to

Better Manage Their Health

Project Director/Principal Investigator:

Lora Connolly, Chief Deputy Director

of California Department of Aging (CDA)

1300 National Drive

Sacramento, CA 95834

(916) 419-7500

[email protected]

Report Authors:

Gina Fleming, Partners in Care Foundation

Natalie Zappella, Partners in Care Foundation

Beth Stern, Partners in Care Foundation

Janet A. Tedesco, Grants Specialist, CDA

Title IV Grant Award Number:

90AM3122

Project Period:

September 30, 2006 – May 31, 2011

Date of Report September 14, 2011

AoA Program Officer:

Michele Boutaugh, Program Specialist

Center for Planning & Development, AoA

AoA Grants Management Specialist:

Heather Wiley, Grants Management Specialist

Office of Grant Management, AoA


2

TABLE OF CONTENTS

TITLE

PAGE

EXECUTIVE SUMMARY

3

INTRODUCTION

3

ACTIVITIES AND ACCOMPLISHMENTS

6

Measurable Outcomes

6

Challenges

8

Project Impact 10

Sustainability/Replication After Project Ends

18

Publications, Communication, and Products

24

CONCLUSION 25

APPENDICES

26

3

EXECUTIVE SUMMARY

The California Department of Aging’s (CDA) Initiative to Empower Older Adults to Better

Manage Their Health was created to build a sustainable network to provide evidence-based health

promotion/disease prevention (EB) programs to older adults in California. Over the course of this five-

year initiative, in collaboration with Partners in Care Foundation (Partners), CDA’s Project Office, we

have been able to fund and/or provide technical assistance to Area Agencies on Aging (AAAs) and many

other organizations to implement and expand the delivery of EB programs throughout the state. This

report describes the activities and accomplishments California has made in achieving a committed

infrastructure to provide EB programs for older adults in California.

The overall success of this initiative stemmed from our project strategy, which focused on

building partnerships and integrating EB programs within both the public and private sectors including

aging service networks, healthcare organizations, the educational sector, and other types of organizations.

This initiative began in 2006 with funding from the U.S. Administration on Aging (AoA) to support the

implementation of one or more of four EB programs in five regions. During the following four years, our

EB initiative expanded to include other regions. In the final grant year we focused on expanding the

Chronic Disease Self-Management Program (CDSMP) throughout California. By the end of this five-

year grant period (May 2011), we had exceeded the performance goals proposed to AoA. EB programs

were being offered in over 50 percent of California’s 58 counties; and these programs had improved the

lives of over 17,000 older Californians. Despite the challenges that state and local governments currently

face, we are confident that the dedication, support, and experience of our partners will continue to

advance this work and increase the availability of EB programs throughout the state.

INTRODUCTION

Original Grant

In October 2006, the California Department of Aging (CDA) received its first Evidence-Based

Disease and Disability Prevention (EBDDP) Grant from AoA. Subsequently, we received two

4

supplemental EBDDP grants. The goal of this program was to create an effective California

infrastructure that included collaboration at both the state and local level to implement sustainable EB

programs for older adults. CDA used the initial three-year EBDDP grant to support implementing at least

one of four EB programs (A Matter of Balance [MoB], CDSMP, Healthy Moves, and the Medication

Management Improvement System [now known as HomeMeds]) – with seed funding given to Area

Agencies on Aging (AAAs) serving five counties (Fresno, Los Angeles, Madera, San Diego, and

Sonoma). Over time, several other AAAs and many non-profit organizations in other counties joined

this initiative with their own resources.

The target population for the original and supplemental grants has been older adults, particularly

those who are low income, ethnically diverse, and/or limited non-English speaking and have historically

had less access to these types of health promotion programs and higher levels of chronic diseases. Upon

receipt of the first grant award, CDA established a Project Office to coordinate these efforts. Partners in

Care Foundation (Partners) was selected as the Project Office and continues to serve in this capacity,

providing technical assistance to organizations delivering EB programs, collecting and reporting required

data to AoA, and working with CDA to ensure the success of this initiative.

During the initial grant period, CDA also established a Statewide Steering Committee (Steering

Committee) for this initiative. The Steering Committee includes the California Department of Public

Health (CDPH), Partners, and representatives from participating counties and regional/statewide

organizations sponsoring EB programs, including those in the health care sector, community colleges, and

the aging network. The Steering Committee provides a forum to effectively coordinate the efforts of key

state, regional and local partners – in sharing information, advice, resources, and expertise from diverse

perspectives – with the mutual goal of sustaining and expanding the availability of these EB programs.

The group meets quarterly via conference call and once a year in person. Currently, there are 28

Steering Committee members, excluding CDA and Partners.

5

Supplemental Grants

In 2009, CDA received its first AoA supplemental one-year grant, which helped to continue

building the infrastructure and partnerships needed to effectively expand these programs. The targeted

areas for this expansion included our five original counties and two of the four original EB programs –

CDSMP and MoB. With this additional funding we were able to gain more experience in all of the

aspects involved in implementing and sustaining these programs and in testing new expansion strategies.

These efforts specifically focused on (1) involving physician groups in patient referrals, (2) retaining

effective and committed workshop Leaders, (3) creating an infrastructure for public web access to class

schedules to facilitate enrollment, and (4) developing new strategies for targeted participant recruitment.

In 2010, CDA received its second AoA supplemental one-year grant to complement the CDSMP

expansion efforts (including the arthritis and diabetes versions of the program) funded under the

American Recovery and Reinvestment Act (ARRA). The supplemental grant had three objectives:

(1) leveraging ARRA funding to continue to provide statewide technical assistance to counties

implementing CDSMP, with an emphasis on the seven AoA ARRA-funded counties (Los Angeles, Napa,

Orange, Solano, Sonoma, San Diego, and San Francisco); (2) conducting a pilot project to obtain Medi-

Cal reimbursement for frail elders participating in a Home and Community-Based (HCB) Waiver who

attend the CDSMP workshops; and (3) strengthening the monitoring of program fidelity within the seven

ARRA-funded counties. CDA, in partnership with CDPH, AAAs, and public health departments in

participating counties worked closely with the local sponsoring community-based organizations to

implement/expand the availability of CDSMP workshops and to achieve all of the grant objectives.

In all of these implementation and expansion phases, AoA’s support was essential in California’s

efforts to build a sustainable infrastructure for these EB programs. CDA is proud to submit this final

report detailing California’s progress and success in achieving our EBDDP initiative goals. This report

also describes our activities to foster the collaborative relationship needed to meet and sustain our

proposed performance goals.

6

ACTIVITIES AND ACCOMPLISHMENTS

1. What measurable outcomes did you establish for this project and what indicators did you use to

measure performance? To what extent did your project achieve the outcomes?

California’s goal in pursuing this initiative was to build a sustainable network for EB programs

across the state. Our strategy relied on (1) encouraging the development of strong partnerships in the

participating counties and across regional organizations/networks to implement these programs; and

(2) developing a Project Office that would leverage the funding available to most effectively provide

technical assistance, training, and other resources to the participating counties and other organizations

involved.

Specific outcomes were established for each of the three grant awards. They included:

(1) creating a sustainable network to provide community education and EB programs for diverse older

adults, (2) conducting outreach to successfully recruit high-risk seniors to participate in EB programs, and

(3) collaborating at the state, regional, and local level in efforts to support the state and local capacity for

expansion and sustainability. The specific measurable outcomes developed for each grant award can be

found in Appendix A.

Section 2 of this report documents our success in creating an implementation strategy and

infrastructure in over half of the state’s 58 counties that we believe is sustainable and can be used to bring

CDSMP and other EB programs to a scale capable of reaching the 2.2 million older Californians with two

or more chronic health conditions. California remains committed to sustaining and expanding these

proven interventions that can not only improve the quality of life for older adults, but can significantly

help reduce the sizeable projected growth in Medicare expenditures. As the Affordable Care Act (ACA)

seeks to reward providers for keeping individuals well rather than rewarding them for just treating the

sick, we are seeking opportunities to forge partnerships with Medicare health plans and providers who

stand to financially from adopting the CDSMP and other EB promotion programs that have reduced acute

health care use.

7

Table 1 – Program Performance Goals and Accomplishments

Table 1 details the specific performance goals included in California’s original and supplemental

funding requests and our actual accomplishments. Overall, 17,467 individuals benefited from these four

EB programs, exceeding our goal of enrolling 7,000 older Californians by 250 percent.

During this grant period, 11,961 older Californians participated in the CDSMP and 2,119

participated in MoB. Through the collaboration across geographic and aging/health care networks, Kaiser

Permanente of Southern California became aware of and decided to adopt MoB in their health promotion

workshops for Kaiser members, which are also open to individuals who are not enrolled in Kaiser. Kaiser

has also provided free trainings and materials for the program, further expanding the infrastructure and

sustainability for MoB in California.

Implementation of the CDSMP far exceeded our original grant goals through the active

participation and commitment of our many (and expanding number of) state, regional, and local partners

in this effort. We are pleased to report that since our initial 2006 grant through our final AoA

Supplemental grant, CDSMP has become availability in over 32 counties. Through the grant funding,

technical assistance was provided to over 346 implementation sites and 76 host organizations throughout

the state. Currently, over 70 healthcare organizations in California have invested in CDSMP and are

offering it internally, including 22 Kaiser Permanente sites, 17 physician groups and clinics, 12 Catholic

Healthcare West (CHW) hospitals and medical centers, five healthcare districts, and three health plans

(see Appendix B).

Program

Performance Goals

10/1/2006 – 5/31/11

Accomplishments

10/1/2006 – 5/31/11

# of Workshops # Enrolled # of Workshops # Enrolled

CDSMP 237 3,040 864 11,961

MoB 124 1,522 173 2,119

Program Performance Goals

10/1/2006 – 7/31/09

Accomplishments

10/1/2006 – 7/31/09

# Enrolled # Enrolled

Healthy Moves 510 835

HomeMeds 1,928 2,552

8

While AoA funding for HomeMeds and Healthy Moves ended in 2009, both programs continue

to expand within California and in other states. To date, HomeMeds has served over 7,000 older adults in

seven states, including 5,316 in California. Healthy Moves is currently being offered in four California

communities and by approximately thirteen organizations across the country. For more information about

HomeMeds national activity, please see Appendix I.

This grant has also led to new levels of collaboration between CDA and the CDHP and at the

local level between 16 local health departments and the AAAs serving those counties to ensure

coordination in their efforts to expand and sustain their EB programs.

2. What, if any, challenges did you face during the project and what actions did you take to address

these challenges?

Not surprisingly, given California’s geographic and cultural diversity and the difficult economic

times, we did experience some challenges in implementing these EB programs. However, none of these

factors impeded our ability to meet and exceed our grant goals. The following is an overview of the

challenges faced and the actions taken to address these issues during this project period.

Community Colleges

Our initial educational strategies focused on making CDSMP available through California’s

network of community colleges. Significant energy went into promoting this approach and, in some areas

of the state, the workshops are being offered through the community colleges’ older adult programs.

However, two issues delayed our progress. First, we encountered some administrative challenges because

the community colleges required a larger class size than the CDSMP workshop limit of no more than 15

participants. Nevertheless, some of the colleges developed creative strategies for overcoming this

challenge. The more difficult issue pertained to reduced state education funding at all levels due to state

budget cuts. In light of these major cuts, the pressure on community colleges has been to focus on core

required programs. Offering CDSMP through community colleges’ older adults programs still offers a

9

natural network for disseminating this program; however, we had to focus our energies on systems with

sufficient resources in the near term to help ensure the sustainability of our efforts in the long term.

Data Collection

CDA and Partners recognized the crucial role that data collection has in advancing EB programs

in California and nationally; therefore, we wanted to ensure that California’s participant data accurately

reflected program activities statewide. Initially, California experienced challenges in this area and needed

to take several steps to encourage the complete and timely reporting of data from all project partners.

Kaiser Permanente of Southern California, a significant source of Leader trainings, has provided us with a

roster of all newly trained Leaders on a regular basis to reinforce these efforts. Partners has added a

component to their leader training on the data collection process. If the Leader training is not held in LA,

Partners contacts the new Leaders to provide an overview of the evaluation tools and protocols and

distribute necessary materials. In addition, Partners works with all licensed organizations in California on

a quarterly basis to ensure CDSMP activity and evaluation data are recorded.

Recruitment and Retention of Leader

Recruitment and retention of quality workshop Leaders has proven to be a continuous challenge

throughout the five year period of this grant. The issues encountered in retaining Leaders prompted us to

review recruitment strategies and develop additional tools for the Leader selection process. We found

that scheduling workshops one to three weeks after Leader trainings and pairing new Leaders with

experienced Leaders helps hone facilitation skills and increase the new Leaders’ comfort level and

dedication to the program. We also found that prospective Leaders need to have a thorough

understanding of the program as well as knowledge of the expected level of commitment prior to being

enrolled in the training. Two tools were developed and disseminated to aid in the screening of

prospective Leaders for the CDSMP and MoB – an online survey and a Leader Agreement. The online

survey, hosted through surveymonkey.com, assesses the prospective Leaders’ readiness and commitment

levels. The survey outcomes provides Partners with the ability to better identify and recruit Leaders who

promise a true and lasting interest in and understanding of the program and its benefits. A Leader

10

Agreement was also developed that is signed by each prospective Leader expressing their commitment to

facilitate a minimum of two workshops per year. Using these tools, in conjunction with online volunteer

recruitment sites such as Craigslist, Volunteer Match, and Idealist, have been successful strategies for

enhancing the recruitment and retention of Leaders.

The Economy

As a result of the current state of the economy, California has faced many challenges. Some

regions have reported that the financial downturn has challenged their communities’ ability to offer

programs. For example, some AAAs have reported that due to budget cuts, local organizations do not

have the staff resources to become Leaders or the time to facilitate workshops. As a result, some regions

have had to rely more heavily on volunteers. The tools provided for volunteer recruitment and screening,

as well as sharing of information about successful partnerships for leveraging resources, should help to

potentially address this issue.

3. What impact do you think this project has had to date? What are the lessons you learned from

undertaking this project?

Key to our successes and the impact we have achieved in California has been focusing our

energies on infusing EB programs within networks with extensive statewide infrastructures, particularly

healthcare organizations/systems, the educational sector, and associations for community-based

organizations. To use the social networking vernacular, our “friend-ing” selected state level associations

led to their promoting CDSMP and other EB programs within their membership and made it possible for

us to “link up” with members or affiliates already offering the program and others ready to become early

adapters with some degree of support. We believe that this approach will generate the most sustainable

foundation for the continuation and expansion of EB programs in California.

11

Health Care Partnerships

As noted earlier, over 70 healthcare organizations in California that have invested in CDSMP and

are offering it internally including 24 Kaiser Permanente sites, 17 physician groups and clinics,

12 Catholic Healthcare West (CHW) hospitals and medical centers, five healthcare districts, and three

health plans. At the state level, departments, associations, and local champions have been key in

publicizing and promoting the program and encouraging their colleagues to become involved. For

instance, CDA and Partners, working closely with CDPH, have coordinated their activities for expansion

and sustainability of EB programs across the state. Currently, 16 public health departments are actively

participating in CDSMP county coalitions. This includes working with local AAA and community

organizations to offer and expand the local infrastructure for EB programs. Additionally, CDA, Partners,

and CDPH now regularly collaborate through bi-monthly meetings, coordinated sharing of Master

Trainers and other resources, streamlined data collection, and cross-referrals between the programs.

Partnerships with public health departments and healthcare organizations is key in expanding and

sustaining access to EB programs. During this project period, CDPH also formed the California

Collaborative for Chronic Disease Prevention (CCCDP), an integrated chronic disease project of the

California Heart Disease and Stroke Prevention Program. Using funding from CDC, the CCCDP was

expanded to establish EB programs in five new regions: Kern, Mendocino, Nevada, Sacramento, and

Shasta counties. In August 2011, at the annual CCCDP meeting, Partners staff presented on “CDSMP

Session Zero,” an interactive workshop developed through the AoA grant that is typically held one to

two weeks before an EB program workshop begins and serves as a recruitment tool for the program.

Partners and CDPH have also been collaborating with the Arthritis Foundation to implement a

pilot program that identifies best practices in making cross-referrals between the CDSMP and the

Arthritis Foundation’s Walk with Ease program. As part of the pilot, CDSMP participants will be

recruited to participate in Walk with Ease in order to measure participant retention in four different

sequences of the programs. CDPH will use the findings to identify common challenges and develop best

practices for cross referral into multiple EB programs. This will help organizations provide successful

12

program marketing and scheduling information to increase participant retention in various EB programs.

Initial stages of Leader trainings for both programs have been completed and pilot workshops will begin

in Fall 2011.

California continues to work with health plans serving Humboldt, Los Angeles, Orange, San

Diego, and Santa Clara counties. Many of these partnerships have led to the development of pricing

strategies to increase sustainability. For example, The Health Trust in Santa Clara County receives

referrals and compensation for CDSMP workshops from the Santa Clara Family Health Plan. CDA and

Partners continue to work with L.A. Care Health Plan (L.A. Care) and CalOptima, Medicaid (MediCal)

health plans in LA and Orange counties, to provide CDSMP to their members and the greater community.

Kaiser Permanente recently trained twelve of L.A. Care’s health education staff and community partners

to become CDSMP Leaders. L.A. Care now has the staff and volunteer capacity to coordinate, recruit,

market, and facilitate CDSMP workshops and is developing plans to roll this out. L.A. Care is

responsible for 850,000 MediCal eligible members in LA County and the potential impact to expand the

sustainability of CDSMP is great. L.A. Care is expecting more than 60,000 new enrollees during the

current State fiscal year, who will need an individualized health risk assessment as they move into the

new California “Bridge to Reform” Medi-Cal waiver. This is a significant referral opportunity for

CDSMP and other EB programs. Kaiser Permanente of Southern California continues to be a strong

partner, providing both community workshops and free trainings for CDSMP and MoB Leaders. Please

see Appendix B for a complete list of our partnering healthcare organizations.

Working in close collaboration with the California Association of Physician Groups, program

leadership promoted the adoption of CDSMP and established patient referral protocols with health plans

and physician groups. Physician groups expressed a need for site specific referral tools and processes, as

opposed to generic “best practices.” Therefore, we have worked closely with each physician group to

establish unique internal patient referral and enrollment processes for CDSMP. For example, AltaMed

Health Services is using their case management staff to identify high-risk patients and refer them to

CDSMP workshops facilitated by community-based promotoras. Facey Medical Foundation is targeting

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patients diagnosed with depression and at least one other chronic condition, and has hired a staff member

dedicated to coordinating their CDSMP efforts. Sharp Rees Stealy, a well established San Diego

physician group, with more than 400 doctors and specialists and 19 medical centers, has also recently

adopted the CDSMP, training staff and volunteers to make the CDSMP available to their members and

the broader community.

Since each physician group has a unique organizational structure and internal systems, it has been

essential to develop customized protocols that integrate CDSMP referrals and enrollments into their

individual operational structures to achieve successful participant enrollment in the program.

The Educational Sector

Engaging organizations within the educational sector has also been a key strategy in advancing

statewide efforts, promoting program sustainability, and reinforcing continuous quality improvement. As

noted in our response to Question #2, our original strategy targeting community colleges as a major

sustainable network for sponsoring CDSMP workshops, proved to be very challenging. This led us to

developed new approaches in pursuing our educational strategy through partnerships with other

organizations in the education sector in addition to community colleges. Pierce College in Woodland

Hills, City College of San Francisco, and North Orange County Community College District do continue

to offer the CDSMP workshops. Our evolving collaboration with other entities in the educational sector,

described below, will also help lay the groundwork in developing a skilled workforce to provide

consumer empowered health education within the state.

At California State University Long Beach (CSULB), Dr. Maria Claver and Partners have

implemented a pilot EB special topics class in the Department of Gerontology. This collaboration has

helped not only pair trained students with Resident Service Coordinators to co-facilitate workshops at

housing sites, but to recruit and train quality CDSMP Leaders. Unfortunately, in the initial pilot, the

participant completion rate in workshops led by student Leaders was not as high as we had hoped. To

address this, the curriculum was expanded to not only focus on skill building in understanding and

14

leading these types of programs, but also on developing the practical skills required to successfully

coordinate and market EB programs to help ensure successful workshop completion rates. Other

universities have expressed interest in adopting the course after learning about this collaborative effort.

Appendix C provides the poster session presented by Dr. Maria Claver for the 2011 California Council of

Gerontology and Geriatrics Conference. With future funding, we hope to continue to make improvements

to the curriculum based on lessons learned.

Another workforce development collaboration is underway with the University of California, Los

Angeles (UCLA), and two community colleges. Supported by the Fund for the Improvement of

Postsecondary Education, UCLA is developing a new 12-unit community college certificate program

focused on EB programs that include a field internship addressing program coordination, marketing and

recruiting participants for the EB workshops, including CDSMP. The certificate program will be piloted

in two California community colleges: College of the Canyons and Santa Barbara City College. Both the

UCLA and CSULB programs hold great promise for broader replication in other college settings and have

already stimulated great interest during local, regional, and national presentations.

Budget challenges fortunately created the opportunity to form a new local partnership between

the City of Los Angeles Department of Aging and the Los Angeles Unified School District (LAUSD).

Reduced state education funding forced the LAUSD to propose eliminating its Adult and Career

Education Division. This program historically had provided LAUSD teachers who conducted a variety of

educational classes for older adults in Multi-Purpose Senior Centers (MPCs) and other settings. The LA

AAA Director was successful in convincing the Mayor’s Office and the LAUSD Superintendent to

maintain the funding stream but to focus it on providing EB programs, thereby transforming these sites

into wellness and health promotion centers. A joint committee has been established to develop policies to

integrate EB programs into the older adult curriculum and offer programming at the MPCs, senior

housing sites, and other community based locations.

LAUSD instructors, who taught the older adult programs, are being trained to lead CDSMP and

other EB programs. This arrangement will result in skilled and compensated instructors providing proven

15

EB programs at the MPC sites. These instructors already know how to recruit older adult participants for

their classes. They can also help recruit workshop completers to become involved as trained volunteer

Leaders to assist in broader program dissemination in their particular communities. This situation

illustrates how collaboration can leverage existing assets and preserve public funding to support older

adults and EB programs, while simultaneously strengthening a successful and sustainable system.

Community Service Organizations

Community service organizations, such as senior housing, senior centers, and healthcare districts,

have been instrumental partners in the implementation strategy for California’s EB programs, of EB

programs, particularly in reaching ethnically diverse and low-income older adults within urban, suburban

and rural communities.

Since California’s original EBDDP grant, we have successfully recruited over 60 senior housing

communities to offer EB programs throughout California, serving approximately 1,000 older adults.

Many of these housing communities, such as be.group (formerly Southern California Presbyterian

Homes) and Mercy Housing, have adopted CDSMP internally. These organizations have committed staff

and site resources to facilitate and coordinate workshops.

One of our strongest program champions within the healthcare sector, Catholic Healthcare West

(CHW), introduced Mercy Housing California as a new community partner into our collaborative efforts.

Mercy Housing is a nonprofit organization that acquires and develops affordable housing with supportive

programs for a variety of low-income populations including families, seniors, and persons with special

needs. In various areas in California, they are now becoming linked in to our CDSMP network. Mercy

Housing trained staff as Leaders to host workshops and refers residents to workshops being offered in the

community. Having internal and external workshops available is crucial because many of their residents

speak a variety of different languages and the capacity to offer workshops internally in all those languages

would not be feasible or practical. CDSMP workshops offered at Mercy Housing sites are open to

outside participants so this also expands the broader availability of the workshops in the community.

16

Los Angeles City funding issues led to the Mayor’s proposal that was adopted to redirect

Community Development Block Grant (CDBG) funds to save the City’s 15 MPCs and redesign them to

become wellness centers offering various EB programs, including CDSMP, MoB, and Powerful Tools for

Caregiving. As previously discussed, paid LAUSD instructors will provide the workshops at these

centers, thereby helping to increase the sustainability of this city-wide infrastructure. This approach

redirects existing non-grant funding and a readily available pool of instructors to make this program

available in these centers on an on-going basis.

Another community based organization, the Camarillo Healthcare District, was an early adopter

and key champion for CDSMP, and helped to promote the program within other health care districts in

collaboration with the Association of California Health Care Districts (ACHD), which represents 77

healthcare districts. Most health care districts are community-based organizations affiliated with

hospitals, clinics, and physician groups. At this point, healthcare districts now implementing the program

include Antelope Valley, Calexico, Camarillo, Redondo Beach, and Sequoia. They are in both rural and

suburban areas of the state and provide care to some very underserved low-income communities. See

Appendix D for more details about the Healthcare District in Antelope Valley, High Desert.

Lessons Learned

California offers the following best practices and lessons learned based on our experience in

implementing these programs:

Community Coalitions & Partnerships: The state and local community steering committees

and/or coalitions, representing the diverse stakeholders, including representatives from public health,

healthcare plans/providers, education, aging, housing, and community service organizations, have been

vital to our success in delivering and sustaining EB programs. These workgroups/coalitions have been

key in sparking interest in EB programs; helping to solidify stakeholder commitment to the programs;

expanding program availability; making process improvements; and developing program tools to aid in

more effective program implementation and fidelity.

17

Within the first year of our implementing process, we came to realize that to achieve and exceed

our performance goals in a state the size of California, we needed to engage large, well established

networks to adopt and deploy these programs within their systems. Not only was this essential to meet

our performance goals, but also to develop a model with good prospects for sustainability when grant

funding ended.

By first engaging these organizations at the leadership level, we were able to identify decision

makers who were receptive to investing resources in EB programs. Once this executive support was

secured, the next level of management was more willing to engage and had approval to make the needed

resource commitments. The rate of return using this approach was much higher than making direct

outreach to program staff in local agencies who most often needed higher level approval before they

could become involved in sponsoring/offering these programs.

Costs and Pricing: California has been able to advance EB program sustainability through

partnerships, business planning, and support from several public, private, philanthropic, and in-kind

sources. Many of the host organizations have sought and obtained private funding /reimbursement for

workshop participation, which has helped to better understand how to calculate and manage costs

involved in sustaining the program over the long term.

The Health Trust, located in San Jose, is compensated by the Santa Clara Family Health Plan for

each health plan member that participates in CDSMP workshops. The Health Trust receives a $100

reimbursement for any participant who attends the workshop and $300 if the participant attends all six

sessions. The Community Health Alliance of Humboldt receiving $50 from the Humboldt-Del Norte

Independent Physician Association (IPA) for each CDSMP workshop completer and has included

CDSMP in an electronic referral system. This stipend, while not covering the full cost of the workshops,

at least provides some compensation toward the program costs.

Several healthcare organizations interested in CDSMP have selected to offer the program

internally using their own staff and space. Consequently, Partners developed a menu of services and

accompanying fees to help these organizations either develop their own CDSMP program or to contract

18

out to make these workshops available to their plan members/target patient groups. Services range from

contracting to provide and coordinate participant workshops to trainings a cadre of in-house Leaders,

providing technical assistance to the organization, and/or providing a variety of implementation tools and

resources. For instance, L.A. Care contracted with Partners to assist in bringing EB programming to their

two Family Resource Centers. This menu of services also has several bundled options (see Appendix E.)

As major implementation steps in health reform occur and as we continue to work with the

healthcare sector, it will become clear whether these organizations primarily want to implement the EB

programs internally and/or are interested in contracting out. Now Partners has a fee structures available

that can be used in either situation to support program expansion and also compensate for the resources

being provided to these organizations to develop in-house program capability.

Training and Recruitment, On-Line Media, and Technology Use

As discussed in a prior section, California gained significant insights into both the challenges and

potential strategies for effective CDSMP Leaders training and retention. Partners developed two tools to

strengthen the screening and orientation process for prospective Leaders: an online survey and Leader

Agreement. Both tools are provided in the Implementation Toolkit and are being used by a number of

partners across the state.

4. What will happen to the project after this grant has ended? Will project activities be sustained?

Will project activities be replicated? If the project will be sustained/replicated what other funding

sources will allow this to occur? Please note your significant partners in this project and if/how

you will continue to work on this activity.

Significant Partners and Project Sustainability

Prior to receiving support through this grant, many AAAs had limited relationships with their

local hospitals or public health departments. This grant significantly increased those relationships and

forged a whole new level of collaboration at the state and local level between the aging network and

health systems, health districts, and large physician groups, as well as the other sectors, previously noted,

that have been crucial to our success.

19

Given the Affordable Care Act’s (ACA) emphasis on improved chronic disease self management,

avoidance of re-hospitalizations, and better coordinated care for those dually eligible for Medicare and

Medicaid, we project that the relevance of and health care provider interest in making EB programs

available to their patients/members will only increase over the next several years. Developing strategies

aimed at assisting health care providers to either offer the program internally or through a turn-key

contracting out option are among the strategies that we have working in some sites and are pursuing

further in our long-term sustainability plan.

As we move forward, the ACA implementation issues facing the federal and state governments,

the healthcare industry, and the various ancillary sectors involved are momentous and may seem

overwhelming at this point. But, as the pieces come together, the ACA should align fiscal incentives to

bend the healthcare cost curve and transform our delivery system into one focused on prevention and

disease self management. We believe that the timing and energy invested in building the relationships

between the aging network and healthcare leaders in pursuing EB programs at this critical point in health

reform will provide a sustainable foundation to successfully achieve the ACA mandates and continue

these important consumer empowerment models for chronic disease self-management.

In November 2010, the California Department of Health Care Services (DHCS) received CMS

approval for the state’s new Medicaid Section 1115 waiver, called the “Bridge to Reform.” This waiver

will make sweeping changes in the Medi-Cal program’s ability to prepare and invest in the state’s health

delivery system to meet the operational implementation requirements of the ACA. One of the key waiver

provisions includes enrollment of seniors and persons with disabilities who are Medi-Cal beneficiaries

(but not dually enrolled in Medicare) into managed care plans. This enrollment process began in June

2011. California was also one of the states that received a CMS Dual Eligibles grant in Spring 2011.

DHCS has begun the initial steps of procuring managed care plans to participate in this pilot program.

The goals for the Bridge to Reform program include:

Organizing care to improve health outcomes (which includes providing care in settings

that promote community integration)

20

Promoting comprehensive health coverage

Measuring health system performance and rewarding improved outcomes

Increasing accountability and fiscal integrity

Ensuring viability and availability of safety net services

Since a major component of this waiver will include the mandated enrollment of seniors and

persons with disabilities (SPDs) in Medi-Cal managed care, DHCS has been conducting detailed analysis

of service needs and expenditures for this population, which are substantially more complex and costly

than other beneficiaries in Medi-Cal managed care plans. CDA has been an active participant in the two

year DHCS 1115 Stakeholder Workgroup process. Several of the participating managed care plans are

also involved in our CDSMP efforts. Once the pilot plans have been selected by DHCS (Spring 2012),

we will target plans (or enhance our efforts with existing plan partners) to promote their inclusion of EB

programming in their pilot service delivery system.

In a parallel effort, Partners has been attending meetings of the Right Care Initiative, established

by the California Department of Managed Health Care (DMHC) and the National Committee for Quality

Assurance (NCQA), to foster collaboration across managed care plans in implementing prevention and

self-management programs/strategies responsive to the new NCQA HEDIS measures that shift from

mostly process measures to more clinical outcome changes. The Initiative’s initial goal is to collectively

focus on improving HEDIS scores for heart disease and diabetes and CDSMP is one of several

interventions explored to improve clinical outcomes. Partner’s participation has provided an opportunity

to meet with and present the benefits of CDSMP to key decision makers within DMHC and the health

plans and then pursue more detailed discussions with interested plans.

We are also in the process of conducting a pilot test to determine whether clients in the Medi-Cal

HCB Waiver Program for the Elderly are an appropriate target group for participation in CDSMP. The

waiver funds can pay for the client’s participation if it is found that at least some subset of clients could

benefit from the program.

21

Overall, California’s EB health program stakeholders are committed to continuing the integration

of CDSMP and other EB programs into the state’s health care systems, educational sector, and

community-based organization networks. As discussed above, health reform at the federal, state, and

provider level will cause a major redesign in how health care is paid for and delivered. This creates the

perfect opening for plans to experiment with strategies that may lead to improved clinical outcomes. The

healthcare organizations involved in our coalition are already convinced that CDSMP is a powerful tool

in achieving these outcomes.

To sustain this program beyond this grant, we envision two specific state roles:

(1) Continuing to promote CDSMP and other EB programs with key business sectors and

policy leaders, through public outreach to older adults and persons with disabilities, and

by encouraging the local agencies that receive public funding to remain involved in

supporting these programs. The California Older Californians Act specifically grants the

local AAAs autonomy for how they choose to use their federal and state funding so long

as federal OAA requirements are met. Therefore, CDA can encourage, but not dictate

that AAAs use a specific percentage of their OAA Title IIID funding to support CDSMP.

(2) Continuing to maintain a Project Office because having staff resources specifically

focused on this program, with the technical expertise and time to build relationships and

act as “cross pollinators” among organizations implementing the program, has been key

to our success.

California has developed a modest yet powerful infrastructure to support the adoption and

expansion of CDSMP and other EB programs through technical assistance, project management, data

collection, and a Steering Committee. The Project Office has successfully served as the glue in building

our coalition, providing technical assistance, collecting program data, and stretching our modest funding

to achieve the maximum result (in training, material purchases, group licenses, etc.) and acquiring private

matching funds. The Project Office also staffs the Steering Committee and follows up on the

Committee’s proposed action steps.

22

While a number of our partners have access to internal resources to support their individual

efforts on an ongoing basis, it is important that we are able to maintain a core infrastructure and a Project

Office to continue facilitating the collaboration across the state and various organizational sectors,

provide on-going technical assistance to new organizations, help maintain program fidelity, leverage

resources to provide Leader training and materials as cost effectively as possible, collect performance

information to document program growth and for quality improvement efforts, continue to engage new

organizations in these efforts, and to solicit funding from private and philanthropic groups to support

program efforts.

Given the dire state budget reductions over the past decade, CDA has lost all of its discretionary

State General Fund that could be directed to the on-going support of the Project Office. We will be

working with Partners over this quarter to identify the staffing costs associated with the current Project

Office tasks to formulate what the on-going tasks and costs associated with those tasks would be after the

ARRA funding ends. We will need to solicit private funding to support the Project Office

responsibilities.

Future Funding Resources

To sustain our EB program implementation and expansion efforts, we will need to continue to

pursue in-kind contributions and multiple funding streams, including philanthropic support, public

funding, corporate sponsorship, and fee-for-service reimbursement strategies. As illustrated through our

success thus far, strong partnerships within the healthcare and educational sectors have been instrumental

in embedding EB programs into sustainable systems and leveraging in-kind support. As we move

forward, this will continue as one of our most important strategies.

Kaiser Permanente and the Arthritis Foundation have gone above and beyond in providing in-

kind contributions. Southern California Kaiser Permanente has dedicated considerable leadership and

in-kind support for CDSMP and MoB by mobilizing and nurturing new sustainable partnerships and

coalitions, engaging new resources, and providing free Leader trainings and licensing to make it more

affordable for new organizations to begin developing their Leader resources. The Arthritis Foundation of

23

Southern California has been key in expanding the awareness and availability of EB programs in LA

through cross-promotion of CDSMP and Arthritis Foundation EB programs, leveraging community

partnerships, providing training scholarships, and cross-training committed Arthritis Program Leaders to

become CDSMP leaders.

Similarly, philanthropic support will remain critical, particularly to expand into rural areas, reach

specific diverse populations, and support innovative and transformative system changes for EB programs.

Though some philanthropic funding sources may be time limited, many components of the program

infrastructure being built will endure because the parties involved share a mission driven commitment to

empowering older adults to improve their health. A list of philanthropic funding sources received in the

past five years with the help of Partners is found in Appendix G.

Finally, corporate sponsors, public funding, reimbursements, such as payment through

Medicare/Medicaid managed care plans/providers, will be essential to maintaining and expanding the

current program infrastructure in large metropolitan, suburban, and rural areas. Community Development

Block Grant (CDBG) funding has sustained access to EB programs in LA, with a successful model

developed by the LA City Department of Aging that may be an option that can be replicated in other parts

of the state. Also, OAA Title IIID funding is being used in many areas of the state to directly support EB

programs and/or to fund health screenings and other health outreach events for at-risk or high-risk

individuals and make referrals to workshops. As we continue to develop more relationships with managed

care plans, we will be able to further refine a marketable reimbursement structure for providing an EB

start up program to healthcare providers that would include Leader Trainings, tools for program

implementation, and technical assistance, as well as an outsourcing fee structure for plan members to

attend workshops in the community.

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5. Over the entire project period, what were the key publications and communications activities? How

were they disseminated or communicated? Products and communications activities may include

articles, issue briefs, fact sheets, newsletters, survey instruments, sponsored conferences and

workshops, websites, audiovisuals, and other informational resources.

As described earlier, the Steering Committee and its quarterly conference calls were a key

communications device to provide updates, share resources, tools, materials lessons learned, and conduct

short focused discussions on issues – such as Leader retention, submitting data in a timely manner,

monitoring fidelity, etc. During this five-year project, a variety of products were produced that are

available upon request (a list is found in Appendix J). Information about some of these products is

summarized below.

Based on the implementation challenges various organizations have encountered, the strategies

they have developed to overcome these issues, and lessons learned, Partners and participating local

entities developed a set of tools that have been compiled into an Implementation Toolkit (see Appendix

H). These materials will continue to evolve and additional pieces will be added to the Toolkit as this

work continues. Dissemination of these materials occurred through Steering Committee meetings; local,

regional, and statewide presentations; local and regional coalition meetings; and through requested

technical assistance. We have adapted several of NCoA’s marketing research and program materials for

inclusion in California’s CDSMP Implementation Toolkit. The Toolkit contains materials useful in

promoting and facilitating CDSMP workshops that can be easily adapted for use with other EB programs.

An objective included in our first Supplemental Grant was the development of a web-based

calendar for all of our EB workshops (including our caregiver support programs). The goal was to create

a centralized web location that doctor’s offices, public health nurses, Information and Assistance

specialists, senior housing, and other community based organizations could use to identify workshops in

their area and who to contact for more information. This web calendar continues to evolve and improve

based on user feedback. The database includes a description of the programs, class dates, locations,

languages the program is being offered in, and contact/registration information. The database can be

searched by name, date, location, city and/or address, etc. Google mapping functionality has also been

25

added and the workshop sponsors can now be contacted directly via email for more information or

registration. Most recently, the workshop calendar system has been modified to allow a local lead entity

to input and update their schedule information. Previously this had been done by Partners, but the

number of organizations involved required a less centralized strategy.

CDA’s EB web page www.aging.ca.gov/ebph/ also includes a description of each EB Programs,

participant testimonials, key research web links for each program, information on how new organizations

can become involved, and links to NCoA website including the CDSMP video clip. While CDPH has its

own web calendar and targets a different age group and individuals with specific health conditions, our

workshop map notes that in specific counties, there may be other workshops available and a hot link takes

the viewer to the CDPH workshop calendar.

A statewide Listserv for Master Trainers and Lay Leaders is being developed by Partners to provide

and sustain frequent communication with these CDSMP Leaders. This Listserv will allow members to

contact one another, share and leverage resources, and strengthen California’s overall efforts to embed

CDSMP throughout the state.

To encourage new partners and to expand the implementation of EB programs across the state, a

number of presentations were made throughout the grant that have successfully identified new collaborators.

See Appendix F for a complete chart of presentations made at national, state, and local conferences.

CONCLUSION

As this grant ends, California is proud to have exceeded the performance goals proposed to AoA by

establishing sustainable networks across the state and conducting outreach to successfully recruit high-risk

seniors to participate in EB programs. On behalf of the State of California, we extend our appreciation to the

AoA for the funding and guidance involved in implementing these programs. The health and quality of life

thousands of older Californians has been improved through these interventions and we envision many more

seniors throughout the state benefiting from these programs in the years ahead.

http://www.aging.ca.gov/ebph/

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Appendices

Appendix A Measurable outcomes developed for each grant award

Appendix B List of partnering healthcare organizations

Appendix C Poster for 2011 California Council of Gerontology and

Geriatrics Conference

Appendix D The High Desert Medical Group press release

Appendix E Evidence-Based Program Packages

Appendix F Chart of presentations made at national, state and local

conferences

Appendix G List of Private Funding Sources

Appendix H CDSMP Implementation Toolkit Table of Contents

Appendix I HomeMeds activity nationally

Appendix J Products Produced and Available on Request

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