Sustaining Evidence-Based Health Promotion Programs

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Sustaining Evidence-Based Health Promotion
Programs

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

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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)

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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

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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

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Evidence Based Model
Evidence Based Model
Promising Practice
Best Practice

• 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).

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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

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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

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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)

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AoA Approved Evidence-based Programs

• 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 to view
  additional evidence-based programs
• that meet AoA criteria

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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
• How to deal with frustration, fatigue, pain and
  isolation
• Exercise
• Medication useage
• Communicating with family, friends, and health
  professionals
• Nutrition
• Evaluating new treatments

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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

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Californias Evidence BasedHealth Promotion
Grant

• Brief Overview

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Californias Size Shapes Implementation Strategy
and Potential Impact
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Participating California Counties
Original County
New County
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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

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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

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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

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California Grant Overview

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Coordinating for Successful Implementation

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

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• 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  

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Sustaining Evidence-Based Health Promotion
ProgramsThe California Perspective

• June Simmons, CEO

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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

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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

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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

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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

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Sources of Shared LeadershipBringing Vision
Expectations

• AoA and NCOA
• State Departments of Aging and Public Health
• 4 As and AAAs
• Aging Network
• Funders
• Associations
• Other Partners with Aligned Incentives
• 80/20 Rule

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Target Sectors For ADOPTION/ENGAGEMENT
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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

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Selection Criteria

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

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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

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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

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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

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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-KeachCA Department of Health Services
• Jerry Kozai
• St. Francis Medical Center
• Mary Ellen Kullman
• Archstone Foundation
• Mary Odell
• UniHealth Foundation

• Kate OMalley
• CA HealthCare Foundation
• James Philipp
• Pacific Business Group on HealthBarry 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

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California Sustainability Example for CDSMP

• Merge CDSMP expansion efforts into the following
  3 networks to produce the greatest impact and
  reach major populated areas
• Leading Physician Groups
• Community College Older Adult Programs
• County Public Health Departments

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Physician GroupPartnering 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

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California Association of Physician Groups (CAPG)

• Nations largest state physician association -
  150 leading physician groups
• Physicians under CAPG provide care to over 15
  million Californians more than 50 of
  Californias health care

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Physician GroupSustainability 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

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

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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

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Sustaining Evidence-Based Health Promotion
Programs

• South Carolina Perspective
• Terri Whirrett, Deputy Director
• Lt. Governors Office on Aging
• Cora Plass, Director of Healthy Aging
• South Carolina Department of Health
• and Environmental Control

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National Climate Ripe for Evidence-Based
Prevention

• AoAs reauthorization of Older Americans Act
  places new emphasis on prevention by promoting
  EBPPs 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

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Building the Foundation

• Working relationship between State Unit on Aging
  and State Health Department stems back to 1980s
• 2005 - present, relationship strengthened through
  collaboration on EBPPs 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)

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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 EBPs through State Health
  Dept, funded by CDC

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Strategies for Sustainability

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

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Partnerships

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

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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 EBPs
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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

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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

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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

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Financial Resources

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

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Financial Resources

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

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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 EBPs
• Pay for state license

Joint Support of CDSMP Master Training
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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

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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

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IIID Scope of Work

• Measurable Outcomes
• Specialized qualifications of leaders
• Maintenance the fidelity of the evidence-based
  programs

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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

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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?

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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

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