Sustaining Evidence-Based Health Promotion Programs

Lora Connolly, California Department of Aging June Simmons, Partners in Care Foundation Terri Whirrett, South Carolina Lt. Governor’s Office on Aging Cora Plass, South Carolina Department of Health

Compelling Statistics

 12 million older adults have chronic conditions like arthritis, diabetes and heart disease  More than 13,700 people over age 65 die each year from fall related injuries (30%-40% of which could have been prevented)

Compelling Statistics

    Older adults are disproportionately affected by chronic diseases These conditions account for 7 out of 10 deaths These conditions account for ¾ of all health care expenditures They negatively impact quality of life & older adults’ ability to live independently

Research to Develop Strategies

   National Center for Disease Control (CDC) investment in research aimed at identifying best practices in treating chronic health conditions Found that these conditions are not “curable,” but can be effectively dealt with through self management & behavioral changes Quantified the associated fiscal & quality of life costs

Evidence Based Model

“Promising Practice” “Best Practice” Evidence Based Model   “Evidence-Based Disease Prevention” program refers to a program that closely replicates a specific intervention that has been tested through randomly controlled experiments with results published in peer-reviewed journals.

Sources of evidence include HHS sponsored research funded by the National Institutes of Health (including National Institute on Aging), the Centers for Disease Control and Prevention (including work in the Healthy Aging Research Network), Agency for Health Care Research and Quality (AHRQ), the Centers for Medicaid and Medicare Services (CMS) and the Substance Abuse Mental Health Services Administration (SAMHSA).

First Round of Community Evidence Based Grants

  National Council on Aging coordinated the development of 4 evidence based health promotion programs: – Healthy Moves (physical activity) – Healthy IDEAS (depression) – Healthy Changes (diabetes) – Healthy Eating (nutrition) Findings evaluated, further replication & second round of grants

2006 AoA Request for Proposal

   Funding opportunity for states to implement evidence based health promotion programs targeting older adults Required partnership between state departments of health and aging services Required Chronic Disease Self-Management Program (CDSMP) & could include other evidence based programs

2006 AoA Request for Proposal (continued)

   Requires a community based partner that received OAA funding Requires involvement of Area Agencies on Aging Grants = $250,000/year for three years to 16 states (now 24 states have grants)

AoA Approved Evidence-based Programs

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Chronic Disease Self-Management Program Matter of Balance

Enhance Wellness Active Choices Enhance Fitness Strong for Life Healthy IDEAS or PEARLS Prevention & Management of Alcohol Problems in Older Adults

Visit www.healthyagingprograms.org

additional evidence-based programs that meet AoA criteria to view

Chronic Disease Self-Management

    Designed to help people manage chronic illnesses Consists of six 2½ hour sessions led by 2 leaders Groups are small (10-20 people) Topics include: 1. How to deal with frustration, fatigue, pain and isolation 2. Exercise 3. Medication useage 4. Communicating with family, friends, and health professionals 5. Nutrition 6. Evaluating new treatments

Matter of Balance:

Managing Concerns About Falls

    Based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University Consists of 8 two-hour courses Designed to reduce the fear of falling and increase the activity levels of older adults with fall concerns Participants learn: – To view falls and fear of falling as controllable – To set realistic goals for increasing activity – – To change your environment to reduce fall risk factors To promote exercise to increase strength and balance

California’s Evidence Based Health Promotion Grant

Brief Overview

California’s Size Shapes Implementation Strategy and Potential Impact

W V V A N C P A N Y M D N J D E V T C T N H M A R I M E State of California Overlay onto the East Coast

Participating California Counties

Original County New County

California Project

    CA Department of Aging is lead agency in partnership with CA Department of Public Health 5 initial counties & respective Area Agencies on Aging participating (Fresno, Los Angeles, Madera, San Diego & Sonoma) Partners in Care Foundation, already implementing two AoA evidence based programs serving frail seniors, acting as project office Statewide steering committee comprised of two departments, Partners, participating counties, major local partners

California Department of Aging Programs

 Older Americans Act & Older Californians Act –33 Area Agencies on Aging  Multipurpose Senior Services Program – home & community based waiver for frail elderly  300+ Adult Day Health Care Centers

California Project

   Participating counties were asked to mentor other interested counties in Years II & III.

Programs are offered in English & Spanish MSSP programs (HCBS wavier for seniors) will introduce two evidence based programs: – Medication Management Improvement System – Healthy Moves for Aging Well

California Grant Overview

Overview of Statewide Steering Committee and Geographic Partnerships

Advisory members of Steering Committee Arthritis Foundation Kaiser Permanente Community Clinic Association

CA Department of Aging Partners in Care Foundation CA Department of Health Services

California Arthritis Partnership Program California Center for Physical Activity CA Fall Prevention Center of Excellence

Los Angeles

· City & County AAAs · Kaiser Permanente · Community Clinic Association · Providence Health Systems · Jewish Family Services · Good Samaritan Hospital · · · Angeles Plaza Arthritis Foundation Multipurpose Senior Services Program

Fresno/Madera

· AAA · Kaiser Permanente · Retired Senior Volunteer Program · Multipurpose Senior Services Program · Senior Community Service Employment Program

San Diego County

· AAA/Aging & Independent Services Health Promotion Unit · Aging & Disability Resource Center ADRC · · · Silver Age Yoga Kaiser Community Clinic Association

Sonoma County

· AAA · Aegis Rehabilitation Therapies · · · Kaiser Permanente Life STEPS No. California Center for Well Being · Santa Rosa Junior College · Dept. of Health Services · Sonoma State University · St. Joseph Health Systems · Sutter Medical Center

Coordinating for Successful Implementation

Successful implementation requires: – Effective Outreach – Coordinated Training Strategies – Involvement of AAA I&A and health promotion activities (& many others!) – Coordination with California Dept. of Public Health network addressing chronic diseases – Sustainable infrastructure & long term committed partners

“Being strategic means we have to be clear about the types of changes we want to advance over the next 10 years, and the role we want to play as a network in implementing those changes.

It means playing to our strengths, and capitalizing on our unique assets and capabilities. It means modernizing our business practices and honing our skills so we can remain competitive in the changing market place and able to keep pace with innovation and the changing needs and demands of our consumers. “ --AoA Assistant Secretary Josefina G. Carbonell

Choices for Independence: National Leadership Summit December 5, 2006

Sustaining Evidence-Based Health Promotion Programs

The California Perspective

June Simmons, CEO

Changing American Culture

 We are in the service of a great vision – Mainstreaming access to tools for health – Building a platform for health and quality of life – This is a MISSION, not a PROJECT

Launching Lasting Change

    Current projects are “seed money” to launch a new movement Need to identify and involve many “investors” in order to take this to scale Scale = creating a new norm for healthy living Scale = new norms for widespread ready access to proven programs and services

Major Assumptions

      Lasting Change Converting Aging Network to a Platform for Health Aging Network Leading Conversion of Other Systems to Platforms for Health Moving From Projects to Tipping Points Cannot Work Alone!!! – Partners Essential 80/20 Rule

Building a “Franchise” For Health

 Essential Forms of Capital to Invest – Mission/Vision – Leadership – Organizational Commitment – A Community of Peers – a Movement – Mandates, competitive forces, glory, accountability – Capital – Money & Other Resources

Sources of Shared Leadership: Bringing Vision & Expectations

       AoA and NCOA State Departments of Aging and Public Health 4 A’s and AAA’s Aging Network Funders Associations Other Partners with Aligned Incentives – 80/20 Rule

Target Sectors For ADOPTION/ENGAGEMENT

Parks and Rec.

Public Health Sector Senior Housing Sites Senior Centers Hospitals Evidence Based Project Office Mental Health Sector Faith Based Orgs Physician Groups Health Plans Community Colleges

Selection Criteria

 Organizations with Aligned Mission Who: – Have a heart for it – Care about this movement – Will Benefit From Engagement Over Time  Obligations  Needs  Outcomes

Selection Criteria

     Potential for Scale/Impact – Directly/Indirectly Mutual Benefit/Alignable Incentives Aligned Mission/Vision Product Champion Has Relevant Resources

Relevant Resources Vary

 Funding for Training, Materials, Staff  Staff Motivated to Lead  Space for Programs  Access to Target Populations  Ability to Outreach/Market  Opinion Leader/Standard Setting Agency

California Examples

  Statewide Steering Committee Expansion & Sustainability Think Tank – Identify Strategic Sectors for Partnership – Identify Funding to go to Scale and Extend Timeframe for Funded Leadership – Identify Lasting Infrastructure to Sustain

Expansion & Sustainability Workgroup

Purpose: Guidance to the CA Depts. of Aging and Public Health to craft a comprehensive expansion and sustainability plan

Members:

– Health Plans: Catholic Health Care West; Kaiser Permanente; St. Joseph Health System; Daughters of Charity – Foundations: Archstone Foundation; UniHealth Foundation; The CA Endowment; CA HealthCare Foundation; Kaiser Permanente Community Benefit – Education: Older Adult Community College Educators – Non-Profit: Partners in Care Foundation – Government: Los Angeles County Public Health Dept.

– Business: Pacific Business Group on Health

        

Sustainability Work Group Members

Eileen L. Barsi

Catholic Healthcare West

Diana Bonta

Kaiser Permanente

Lora Connolly

CA Department of Aging

Lynn Daucher

CA Department of Aging

Ronald DiLuigi

St. Joseph Health System

Pam Ford-Keach

CA Department of Health Services

Jerry Kozai

St. Francis Medical Center

Mary Ellen Kullman

Archstone Foundation

Mary Odell

UniHealth Foundation        

Kate O’Malley

CA HealthCare Foundation

James Philipp

Pacific Business Group on Health

Barry Ross

St. Jude Medical Center

June Simmons

Partners in Care Foundation

Rita Speck

Kaiser Permanente

Janet Tedesco

CA Department of Aging

Lorraine Wicks

CA Community College Educators of Older Adults

Dianne Yamashiro-Omi

The CA Endowment

M. Lynn Yonekura

CA Hospital Medical Center

California Sustainability Example for CDSMP

Merge CDSMP expansion efforts into the following 3 networks to produce the greatest impact and reach major populated areas: 1.

2.

3.

Leading Physician Groups Community College Older Adult Programs County Public Health Departments

Physician Group Partnering Strategy

  Surround physician groups with CDSMP workshops hosted by Community Colleges, Public Health and other community agencies Local community colleges are partnered with each practice to assure close collaboration and effective referral process

California Association of Physician Groups (CAPG)

 Nation’s largest state physician association - 150 leading physician groups  Physicians under CAPG provide care to over 15 million Californians – more than 50% of California’s health care

Physician Group Sustainability Factors

 Have significant numbers of patients under capitation = Financial motivation to promote CDSMP  Once managed care patients routinely referred to CDSMP, will become the standard of practice to benefit fee-for-service Medicare patients as well

California has 109 Community Colleges (62 have older adult programs) The 62 colleges serve 125,000 Californians ages 50+ per week

Community College Sustainability Factors

     Instructors are paid as faculty for leading CDSMP Have relationships with community organizations serving older adults Have strong marketing capacity Familiar resource for aging Boomers Eager for new, evidence-based curricula and have protocols in place to approve it

Long-Term Sustainability

  State leadership committed to sustaining this initiative over the long term.

Once outreach and medical referrals are made through county networks of developed CDSMP providers and sponsors, will be largely self-sustaining

Sustaining Evidence-Based Health Promotion Programs

South Carolina Perspective

Terri Whirrett, Deputy Director Lt. Governor’s Office on Aging Cora Plass, Director of Healthy Aging South Carolina Department of Health and Environmental Control

National Climate Ripe for Evidence-Based Prevention

 AoA’s reauthorization of Older American’s Act places new emphasis on prevention by promoting EBPP’s through aging service organizations  Healthy People 2010 Goals  Increased coverage of prevention and disease management by Medicare  CDC, NACDD, NCOA, and AHRQ focus on evidence-based prevention

Building the Foundation

 Working relationship between State Unit on Aging and State Health Department stems back to 1980’s  2005 - present, relationship strengthened through collaboration on EBPP’s and formation of statewide Healthy Aging Partnership  Common focus on prevention  Common goal - increase the years and quality of life for older adults in SC (Healthy People 2010)

EBP History in South Carolina

 Lowcountry Senior Center - CDSMP and Enhance Fitness prior to grant  3 Master Trainers for CDSMP prior to AoA grant  SENIOR grant through NACDD for implementation of A Matter of Balance in Lee County  Arthritis Foundation EBP’s through State Health Dept, funded by CDC

Strategies for Sustainability

 Partnerships  Financial Resources  Policy Changes  A Quality Product  Change in Priorities/Culture Change

Partnerships

 State - statewide coalition, delivery system partners, support partners  Regional/Local - advisory councils; local health, community and faith-based organizations; volunteers

SC Partnership for Healthy Aging

Convened April 2007 Co-Led by SUA and SHD Serves as Advisory Council for grant initiative Provides infrastructure to support and sustain EBP’s

SC Partnership for Healthy Aging

2007, Wide net cast to form SC Partnership for Healthy Aging with more than 40 organizations :  Universities  SC Hospital Association  SC Primary Care Association  SC Budget and Control Board  Faith-based Organizations  Coalitions  Silver-Haired Legislature  SC Rural Health Association  State Medicaid Agency  SC Academy of Family Physicians  SC Nurses Assoc.

 State Health Dept Chronic Disease Programs And more…

Partnerships

 SC Hospital Association  Health Care Plans - Special Needs Medicare Plan, BC/BS  Osher Lifelong Learning adult education program  Institute for Engaged Aging - training center for community health workers  SC Dept of Vocational Rehabilitation

Partnerships - Contd.

 Conferences/Districts of AME and AME Zion Churches, Progressive Church  SC Primary Care Association and federally funded health care centers  State Diabetes Program and Coalitions  State Employees Association

Financial Resources

 Insurance Reimbursement  Grants - CDC Arthritis Grant, state prevention grant,  Healthcare organizations - Special Needs Plan (CIP), Health Centers, VA

Financial Resources

 Senior Housing - HUD  Employers - EAPs, retired federal and state employees  Charging for Programs

Shared Ownership of Financial Sustainability

DHEC LGOA

 Provide mini-grants to Aging Network  Promote programs and provide training  Promote and deliver Arthritis Foundation and other EBP’s  Pay for state license Joint Support of CDSMP Master Training

Reallocating State Funding Incentive Package

 4 pilot programs in 4 new regions  LGOA pay for training costs/Master Trainers  LGOA purchase state level license  LGOA reimburse 4 pilot sites, $70 per completer (4 classes minimum) using state appropriated funds for home and community-based services

Use of OAA IIID Funds

As of July 1, 2008...

 Must use IIID funds only for EB programs  Must use new Scope of Work for IIID programs  Strict waiver requirements

IIID Scope of Work

 Measurable Outcomes  Specialized qualifications of leaders  Maintenance the

fidelity

of the evidence based programs

IIID Scope of Work

 Evaluation required: Self report of change; pre and post test; other  Can charge a fee if funds used to expand the program vs. voluntary contributions  Documentation required  Monitoring conducted by LGOA

Ensuring A Quality Product

 Partners will not buy in if the program is not a high quality product  Must assure the lay leaders and Master Trainers are of high quality  Must monitor fidelity to the program – who will do this?

Culture Change

 Change is a process  Getting buy-in takes time, planning, patience, and hard work  Find your champions to help you  Build upon small successes  Educate, support, and provide technical assistance  Use motivational strategies to boost morale and maintain momentum

GREEN “HANDOUTS”

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