Sustaining Evidence-Based Health Promotion Programs

1. 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

2. 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)

3. 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

4. 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

5. 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).

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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

12. California’s Evidence BasedHealth Promotion Grant Brief Overview

13. California’s Size Shapes Implementation Strategy and Potential Impact

14. Participating California Counties Original County New County

15. 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

16. 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

17. 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

18. California Grant Overview

19. 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

20. “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

21. Sustaining Evidence-Based Health Promotion ProgramsThe California Perspective June Simmons, CEO

22. 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

23. 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

24. 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

25. 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

26. 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

27. Target Sectors For ADOPTION/ENGAGEMENT

28. 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

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

30. 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

31. 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

32. 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

33. 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 O’Malley 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 Sustainability Work Group Members

34. 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

36. 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

37. 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

38. 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

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

40. 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

41. 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

42. 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

43. 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

44. 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)

45. 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

46. Strategies for Sustainability • Partnerships • Financial Resources • Policy Changes • A Quality Product • Change in Priorities/Culture Change

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

48. 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

49. 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…

50. 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