nancy whitelaw, phd national council on aging jane tilly ......affordable care act: health homes...

Nancy Whitelaw, PhD

National Council on Aging

Jane Tilly, DrPH

Administration on Aging

© 2009. National Council on Aging A non-profit service and advocacy organization

Evidence-Based Change!

Credit to: • Administration on Aging

• Centers for Disease Control and

Prevention

• AHRQ , NIH, SAMHSA and other

federal agencies

• John A. Hartford Foundation

• Atlantic Philanthropies

• Retirement Research Foundation

• Archstone Foundation

• Regional Foundations

• States, localities, regional and

community-based organizations


The Challenge

Chronic Conditions

Impairment

Conditions for Change

Poor Quality

High Costs

Frustration

Evidence of What Works

Self-management

Prevention

Collaboration

Forces Promoting Healthy Aging


Healthy aging is a systems change strategy,

not simply a program or service.

Healthy Aging …More than a program


Healthy Aging – NCOA Perspective

Making a Difference

• Changing the course of chronic conditions & injury

• Changing systems

Working from an Evidence-based Perspective

• Drawing from the evidence

• Contributing to new evidence

Working Collaboratively

• Shaping an inclusive, far reaching agenda

• Creating conditions for sustained improvement


Americans Speak Out about Chronic Conditions and the Pursuit of Healthier Lives, January 2009

National Survey of

Americans with 1+

Chronic Condition,

Aged 44+


Program Reach–All Evidence-Based Programs

14 programs reaching 84,091 older adults in 46 states, DC,

and Puerto Rico

4,773

15,101

25,243

38,974

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2007 2008 2009 2010

Evidence-Based Program Participants


Participant Characteristics (N= 84,091)

Characteristic Percent of Total

Age 70+ 58%

Gender Female 78%

Living Alone 48%

Racial/Ethnic Minority Group 31%


Program Reach – CDSMP Only

Chronic Disease Self-Management Programs reaching 52,436

older adults

2,449

7,545

12,005

30,437

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2007 2008 2009 2010

CDSMP Participants


Program Adoption Over the Years

Years of Growth

2001 4 communities

2003 14 communities

2006 16 states

2007 27 states

2010 46 states, DC, & Puerto Rico

Programs offered via 737 host organizations and 4,070 implementation sites


Program Adoption

Organization Type 700 Lead Orgs 3700 Sites

Aging network; senior housing 40% 58%

Social services, faith-based 15% 25%

Public health, recreation 20% 3%

Health care 25% 14%


Evidence-Based Program Implementation Site Types

12%

24%

26%

30%

8% Faith-Based Organization

Residential Facility

Health Care Organization

Senior Center

Other


Healthy Aging Systems Model


Healthy Aging System – What Works

People: Engaged, Supporting, Learning

Evidence-based Programs: Results are Replicable

Organizational Networks: Capacity & Impact

Research: Evidence, Evaluation & Culture of Inquiry

Multi-sector Collaboration: More is Better!

Policy: Silos of Uncertain Opportunity


Multi-sector Collaboration

Public, Private, National, Regional, Local • Aging

• Public health

• Mental health

• Long-term care

• Health care

• Housing

• Education

• Employment

• Academe

• Philanthropy


Innovations at the State or Regional Levels

Healthy Aging Institutes/Forums

Strong AAA-ADRC connections

Strong health care engagement

Diverse financing and broad-based multi-sector

collaboration

Healthy Aging Regional Collaborative in South

Florida


So Many Opportunities To Expand Impact

Expand engagement and ownership by older adults

Strengthen messaging, link to health campaigns

Promote networks of diverse organizations

Expand program options, including online

Improve interface with clinical care and other sectors

Track costs and improve efficiency

Impact policy – tell your story

More ?


Thank you

Nancy Whitelaw, NCOA

U.S. Administration on Aging

Building a Sustainable

Distribution and Delivery System

for Evidence-Based Health

Programs

Jane Tilly, DrPH

U.S. Administration on Aging

January 18, 2011

U.S. Administration on Aging 20

Federal Perspective: AoA

AoA Mission: To help seniors maintain health and independence in their homes and communities

Aging Network provides variety of programs consistent with a 3-part aim: Better Health, Better Care, Lower Costs. Examples follow.


Federal Perspective: AoA

Better Health: • OAA Title III/ medication management • 2003-2011 Evidence-based Prevention Program (CDSMP,

falls prevention, mental health, exercise etc.) to 24 states • Recovery Act CDSMP grants to 47 grantees • Care transitions grants

Better Care:

• Single point of entry ADRCs/AAAs • Consumer directed programs that support community

living: Money Follows the Person (MFP) and Veterans-Directed Home and Community-Based Services (VDHCBS)

Lower Costs:

• The Senior Medicare Patrol (SMP) • SHIP counselors and Benefit Enrollment Centers


AlzDRD and

Caregiver Support

Care Transitions

Veterans Directed

HCBS

Meals and

Transportation

Medicare

Benefits

Counseling

and Enrollment

CDSMP

DSMP

AMOB

Other EBPs

ADRC/AAA

Intake,

Assessment

Enrollment,

Care Management

I&R

Person and

Caregiver

Person Centered Aging Network


ADRC organizational structure allows partner agencies to align their

goals to provide greater access and new services

Access to

Aging &

Disability

Services

Community

Supports Healthcare

Services

ADRC/AAAs

Focus

ADRCs/AAAs as an Integration Model


Recovery Act CDSMP Grant Vision

$27 million to 45 states, DC and PR

• 50,000 ―completers‖ by March 2012

• Platform for establishing EBP Program Distribution & Delivery Systems to assure easy access (like meds)

• State level partnership among aging, public health, Medicaid

• Focus on underserved


Evidence-Based Prevention Program Distribution & Delivery System

Components

Leadership

Public Education/Awareness

Infrastructure Capacity Building

Enrollment/Registration

Resource Coordination

Quality Assurance

Accounting/Financial

Project Management Data Collection & Reporting

System


Sustainable System Components

Leadership:

• Effective partnership among Aging, Public Health, and Medicaid

• Integrated/coordinated state vision, plan and goals



Infrastructure: Adequate workforce; quality host organizations and implementation sites

Effective partnerships developed to embed CDSMP within a state’s health and LTSS, including agencies that: • Reach underserved populations

• Have multiple implementation sites and/or capable of scaling up statewide

• Coordinate/integrate programs

• Coordinate with chronic care management programs and demonstrations with physician groups and hospitals


Potential Collaborations

Existing partnerships/coalitions (e.g.,rural, minority)

Other Aging Network programs (e.g., options counseling, care transitions, VDHCBS)

Health care system/ demonstration projects (e.g., health homes, FQHCs)

Other state agencies (e.g., mental health, corrections, employment, educational institutions)

Other agencies that serve rural/minority groups



Centralized or coordinated processes:

• Promotion/marketing

• Enrollment/registration

• Access points/referrals (e.g., ADRCs, AAAs)

• Workshop calendar/online website

• Resources coordination (e.g., scheduling sites, bulk

ordering of books & materials)

• Data reporting and entry



Financial sustainability

• Significant role for Medicare & Medicaid (e.g.,risk management program, waivers, incentives, Health Homes, etc.)

• Plan for sustaining evidence-based program system after grant ends (e.g.,

government, foundations, corporations, health plans, partnerships w/ health care providers)


Potential Sources of Support

Government and foundation grants Older Americans Act (Title III including medication

management; SCSEP with Department of Labor)

CMS - Existing Medicare CPT codes: DSMT, Medical Nutrition Therapy, Health and Behavior Assessment (CDSMP), Care Transitions and State Medicaid programs

Hospitals - Readmission reduction programs and ACOs Medicare Advantage Plans/MCOs; Other third party funding

and healthcare organizations (VA, FQHC) United Way/ Charitable organizations Senior housing (state housing funds, HUD-sponsored grants) Corporate sponsorships; Employers/ worksites Continuing education registration fees Advocacy strategies (working to pass legislation, etc…) Fee for service In-Kind support


Affordable Care Act

Addresses 3-part aim of better health, better care, lower cost

Center for Innovations $10B to test models

• RFP due 2/1 design for dual eligible models

Prevention and Public Health Fund/ National Prevention and Health Promotion Strategy • Goals: Expanded community prevention efforts;

empowered individuals


Affordable Care Act

Major shifts in the market happening now

You have to be in it to benefit • Keep informed

http://aoa.gov/Aging_Statistics/docs/AoA_Affordable_Care. pdf; sign up for e-newsletter at [email protected]. Send questions to [email protected]

• Build relationships with key players (e.g., Medicaid, QIOs, Hospitals/ Physician practices, Medicare Advantage Plans)

http://aoa.gov/Aging_Statistics/docs/AoA_Affordable_Care.pdf

http://aoa.gov/Aging_Statistics/docs/AoA_Affordable_Care.pdf

mailto:[email protected]

mailto:[email protected]


Community-Based Care Transition Program

(Title III, Sec. 3026) Funds eligible entities to improve care transition

services to high-risk Medicare beneficiaries Priority to programs administered by AoA and

those serving medically underserved populations, small communities, and rural areas

Opportunities for partnerships with hospitals,

physician practices, skilled nursing facilities – and for linkages between care transition interventions and your CDSMP!

Funding solicitation due out in early 2011


Affordable Care Act: Health Homes

Starts in 2011 (Title II, Sec 2703)

State Medicaid option for beneficiaries with 2+ chronic conditions

Pays for Case management, Care Coordination, health promotion, care transitions, individual and family support, health IT to support case management

Must consult with SAMHSA about mental health aspects


Accountable Care Organizations and

Shared Savings

• Starts January 2012 (Title III, Sec 3022); ACOs= organization of health care providers that agrees to be accountable for quality, cost, and overall care of Medicare beneficiaries

• ACOs can bill for services up front and share the savings at the end

• Focus on health promotion activity for chronic disease and dual eligibles


Hospital Readmissions Reduction

Program (Title III, Sec.3025)

• Begins FY2013 (10/1/12)

• Will adjust payments to hospitals based on their readmissions within 30 days for the same diagnosis or related complication of the same diagnosis

• Care Transitions is essential to maintaining the bottom line for hospitals

• Begin meeting with hospital officials now


Community Transformation Grants

Title IV, Sec 4201

CDC Grants to state and local government agencies to provide range of prevention programs to: • Reduce chronic disease rates

• Address health disparities

• Strengthen evidence-base of programs

Opportunity for agencies to partner


Other Key Provisions Effective 2011

Medicare Coverage for Annual Wellness Visit (Title IV, Sec 4103)

• Includes personalized prevention plan based on comprehensive health risk assessment; Prevention services plan can include referrals to community-based interventions

Incentives to Medicaid enrollees who complete healthy lifestyle programs (Title IV, Sec 4108)


CDSMP/ DSMP: Medicare Benefit

Service must be provided/supervised by approved service provider; need Medicare provider #

DSMP- 1 hour of individual + 9 hours group training provided through ADA/AADE accredited program

DSMP may also be covered through Medical Nutrition Therapy codes (3 hours individual/ group) provided/ supervised by RDs

Health and Behavior Assessment codes (may cover CDSMP initial assessment/―Class 0," mid-course and post course assessments and group sessions)

Annual wellness visit- DSMP/CDSMP may be included in personal plan


CDSMP/ DSMP: Medicaid Benefit

Many states have Medicaid diabetes self-management training programs

May be able to cover CDSMP and DSMP through new incentives for healthy lifestyle programs/ health homes

Possible Medicaid waiver benefit


How to be a Player • Develop a business plan • Know your market penetration; penetration of Medicare plans;

dual eligible population • Package your programs along with the evidence of their

effectiveness • Consider bundling of interventions to market to payors (e.g., health

homes, Medicare health plans, ACOs)

• Services to bundle include: DSMT, CDSMP, Medical Nutrition Therapy, Medication Therapy Management, Depression Screening/ Healthy Ideas, Care Transitions etc.

• Understand your costs and know what you want to be paid and

build in a margin to sustain and enhance your suite of programs.


Key Principles

Be Proactive and Strategic:

• Assure that programs as available as meds

• Think Global/Act Local — Build the system and serve 50,000 people

Build with Sustainability in mind — Workforce, Organizations, Financial

Think systems change — EBPs embedded in multiple agencies/ coordinated, integrated person-centered systems

nancy whitelaw, phd national council on aging jane tilly ......affordable care act: health homes...

Documents