Health Care Provider, Health Plan

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Health Care Provider, Health Plan Aging Network
Partnerships

• Nora Barkey, Area Agency on Aging of Western
  Michigan
• Christopher Minnick, Albert Einstein Healthcare
  Network
• Todd Osbeck, Priority Health
• Tianna Pettinger, Senior Services of Albany

National Council on the Aging - American Society
on Aging 2006 Joint Conference March 18, 2006
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From Research to Practice

• Administration on Aging
• Evidence Based Prevention Programs
• Funding for 12/14 Partnerships
• National Council on the Aging
• Goals of Selected Projects
• Improving chronic disease self management
• Increasing physical activity
• Preventing falls
• Improving nutrition
•     

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Three Projects

• You will hear
• AOA- Evidence Based
• Overview of 3 projects
• Original research,
• Partners
• Clients served and outcomes
• What we learned
• Health Partners-benefits and challenges
• Aging Network benefits and challenges

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Issues for all

• Reachtarget audience
• Effectiveness research based
• AdoptionGetting things up and running
• Implementation Fidelity
• Maintenance

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Partners on the P.A.T.H. Chronic Disease Self
Management Grand Rapids, MI

• Partners
• Area Agency on Aging of Western Michigan
• Grand Rapids Community Foundation
• Priority Health (Health Plan)
• Community Aging Service Providers
• Senior Neighbors, Gerontology Network, United
  Methodist Community House, ACSET- Latin American
  Services
• Grand Valley State University

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Evidence Based Stanford Chronic Disease Self
Management Program

• Stanford Research Recommendations are
• Creation of an informed patient
• Peer led learning experience
• Social support for change
• Skill building for decision making and follow
  through
• Intervention- Core elements
• Six 2½ hour sessions,
• Leaders trained by Stanford Master Trainers,
• Stanford questionnaire
• Scripted curriculum including use of Living a
  Health Life with Chronic Conditions workbook and
  relaxation tape
• http//patienteducation.stanford.edu/programs/cdsm
  p.html

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Partners on the P.A.T.H. Participant Profile

• Referrals
• 50 Priority Health
• 289 Community

• 339 participants
• 78 female
• 15 African American
• 10 Latino
• Average Age 73
• Perceive financial need 14

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Partners on the P.A.T.H. Outcomes

• Our follow-up at 6 months (vs. 4 mos. in
  original)
• Our participants (145-150 per analysis) reported
• Reduced pain
• Less health distress
• More ability to manage symptoms
• Less intrusion of illness in life
• More minutes of aerobic activity

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Harvest HealthChronic Disease Self
ManagementPhiladelphia, PA

• Partners
• Philadelphia Corporation for Aging (AAA)
• Center in the Park (Community Aging Service
  Provider)
• Albert Einstein Healthcare Network (Health Care
  Provider)
• Center for Applied Research on Aging and Health,
  Thomas Jefferson University (Academic Research
  Organization)

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Harvest Health Goals, Objectives and Outcomes

• Goal
• Improve the ability of older African Americans to
  manage their chronic health conditions.
• Objectives
• Demonstrate effectiveness of CDSMP intervention
  for this population
• Expected outcomes
• Improved health status
• Behavioral change
• Improved self efficacy
• Reduced healthcare utilization

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Harvest Health Participant Profile

• Target enrollment over three years - 500
• 394 recruited
• 266 enrolled
• 88 completed the program
• 85 Female 15 Male
• 100 African American
• Age range 56 93 mean 72.5

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Harvest Health Participant Recruitment

• Participant Recruitment
• Center in the Park
• Local churches
• Senior social clubs
• Senior apartment complexes
• Primary Care Physician Offices

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Harvest Health Outcomes

• Increased physical activity
• Increased self-efficacy for symptom management
• Reduced health distress
• Reduced illness intrusion
• 95 report continued use of strategies
• Increase in overall health care utilization
  (increase in physician visits)

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Women take PRIDEChronic Disease Self
ManagementAlbany, NY

• Partners
• Senior Services of Albany (private non-profit)
• Northeast Health (health provider network)
• Blue Shield of Northeastern NY (insurer)
• Albany County Department for Aging (AAA)
• State University at New York at Albany, School of
  Public Health

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Evidence Based University of Michigan Heart
Disease Self Management Program

• Developed by Noreen Clark and colleagues at
  University of Michigan
• Four-week education and behavior modification
  program for women aged 60 with heart disease
• Based on Social Cognitive Theory
• Taught by health educator and peer leader
• Clark NM. et al. (2000) Journal of
  Gerontology, 55B S117-126.

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Women take PRIDEParticipant Profile

• Albany WTP (N61)
• Age 62-91, mean age 75
• All female
• 0 Less than h.s. education
• 31 High school graduate
• 69 Some college/degree
• 97 White
• 3 African American
• 0 Other

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Women take PRIDEOutcomes

• Pre-post outcome evaluation design with baseline,
  4-month and 12-month measurements
• Preliminary results resemble those of original
  research
• Walk further in 6-minute walk
• Number of cardiac symptoms, frequency of symptoms
  and bothersomeness of symptoms are reduced.

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Health Plan Partnership Why Would a Health Plan
Want to be a Partner?

• Health Outcomes are Important
• NCQA accreditation depends on it (HEDIS)
• Employer purchasers are demanding quality
• NBCH eValue8 RFI
• Good health results in lower cost

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Health Plan PartnershipChronic Care Model
Wagner EH. Chronic disease management What will
it take to improve care for Chronic illness?
Effective Clinical Practice. 199812-4.
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Health Plan Partnership How does Priority
Health Focus on Quality?

• Members
• Nurse Case Management
• Member Education Mailings
• Web Site Health Management Tools
• Personal Health Records

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Health Plan Partnership How does Priority
Health Focus on Quality?

• Doctors
• Monthly Quality Outcome Reports
• On-Line Patient Lists (Diabetes, Asthma, etc.)
• Incentive Programs based on Quality Outcomes
• Public Reporting of Doctor Performance
• Consulting on Delivery System Design

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Health Plan Partnership Why is PATH Important?

• Patient Self Management Good Outcomes
• Many Patients do not have skills
• Many Doctors do not teach skills
• Not enough time
• Focus on task list
• Self Management Educational Resources are limited
  or have limited focus

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Healthcare PartnershipUnderstanding the Health
Care Partner

• What are the benefits for the health care
  partner, why should they be interested in
  promoting, what measurable outcomes can be
  marketed to them?
• What is the appropriate entry point for the
  program in the health care organization?
• What factors need to be understood about the
  health care system?
• HMO
• Hospital owned practices
• Chain of command
• Champions

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Healthcare PartnershipUnderstanding the Health
Care Partner

• What factors need to be understood about the
  practice?
• Challenges in patient referral
• Short visits
• Problem-focused v. preventative interaction
• Who makes referral physician, office staff?

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Healthcare PartnershipBenefits of Partnership

• Primary Care Physician (PCP)
• Facilitates treating patient holistically
• Improves quality of service delivery
• Patient more compliant
• Improved healthcare outcomes
• Patient retention
• Increased referrals to practice by WOM

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Healthcare PartnershipBenefits of Partnership

• Albert Einstein Healthcare Network
• JCAHO Accreditation through the Ambulatory Care
  Review Process
• Establishment of Standardized Clinical Measures
• Physician Incentive Program based on Quality
  Performance
• Improved operations
• Better patient care
• Increased competency of staff

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Aging Network PartnersUnderstanding Aging
Partners

• What are the benefits for the agency?
• Does the program fulfill agencys mission?
• What funding is available to support the program?
• Factors to understand
• Diversity of staff (i.e. education level,
  experience)
• research or intervention may be intimidating
• Interested in individuals, promoting
  independence, supporting other programs
  (cross-referral, they stay for the congregate
  meal etc.)
• Good at being flexible, adaptable, resourceful,
  working in community settings
• Understand seniors

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Aging Network PartnersBenefits of Partnership

• Complimentary expertise
• Access multiple networks, funding streams
• Two heads are better than one multiple
  perspectives
• Lend credibility to each other, have pull with
  different audiences/individuals
• Referrals from medical system
• Brings strong evidence-based programming to
  senior offerings, develops staff skills

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Lessons Learned

• Challenges engaging PCPs
• Theyre busy!!!!
• Limited time per patient
• Many demands during the visit
• Mindset towards non-compliant patients
• Understanding motivations of PCP
• Patient progress and satisfaction
• Third Party focus on prevention, wellness and
  education
• Quality Incentives

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Lessons Learned

• Challenges for the Network
• Physician Champion
• Senior Management Support
• Consistent marketing and presence with PCP
  offices
• Finding the right contact in the PCP office
• Make it easy and simple

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Lessons Learned

• Referrals from health partners
• Talks by nurse educator in the community on
  related health topics (sign-up sheet in addition
  to printed materials)
• Front desk staff asked to distribute brochure to
  target population upon signing-in for appointment
• Health insurer, able to do mailing to targeted
  members (have health info)

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Dissemination You can do this.

• Replication Manuals
• Tool Kits
• How Tos
• Welcome to our network
• www.healthyagingprograms.org 

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How to reach us

• Nora_at_aaawm.org
• todd.osbeck_at_priority-health.com
• minnickc_at_einstein.edu
• tpettinger_at_seniorservicesofalbany.com