Engaging Community Participants and Partnerships. Program Fidelity and Sustainability

1. June Simmons, CEO Engaging Community Participants and Partnerships.Program Fidelity and Sustainability

2. Our shared great cause • Wisconsin and California have shared vision • California Departments of Aging and Public Health have designated a non-profit to serve as the program office for the Chronic Disease Self-Management Program • And future evidence-based health programs

3. Partners in Care Foundation: Mission Partners in Care Foundation changes the shape of healthcare and social services so they work better for everyone. With our community collaborators and funders, Partners develops, tests, and disseminates high-impact, innovative and proven models of care that bring more efficient and effective health and social services to diverse people and communities.

4. Our Framework for Change • Identify an issue that is relevant to our mission and strengths: • Impacts a large population • Causes significant suffering and harm • Costly – significant expenditures in place • Promising – opportunity for high impact through innovation • Proving ground available—evidence-based • Sustainable

5. The Strategic Environment – challenges and opportunities U.S. health care system is in crisis Failings of system are profound and widely acknowledged Pressure is building for transformation

6. US lags compared to others! 47th in life expectancy at birth 78 years vs. 82 in Japan #1 in Spending: 16% of GDP Abysmal 4% Improvement in mortality 1998-2003 vs. 21% in UK, 13% in France & Canada, 19% Australia

7. High Costs and Poor Outcomes Spend twice any other developed country Ranked 37th in world on health outcomes 40 million uninsured Little prevention/lots of expensive late care Growing role for community and family caregiving and self-care

8. Shift in Population Causes Major Redesign of Health System • Longer life span – delayed disability • Sanitation and medicine reduce infections • Joint and organ replacements • Medications, cancer treatments, AIDS drugs • Shift from episodes of injury and illness to CHRONIC PROGRESSIVE CONDITIONS

9. 80% of Health Dollars Spent on Chronic Conditions 31% of Americans are obese Adults are not physically active (28-34% aged 65-74; 35-44% aged 75+) Rates of obesity in children (16-33%) Type II diabetes skyrocketing – 40% increase in ’90s. 6.9% of Americans; 20% among 65+ Ethnic health disparities dramatic

10. Ethnic Health Disparities: Diabetes Among Hispanics Admissions for uncontrolled diabetes without complications per 100,000 population, age 65 and over, by ethnicity, 2004 2006 National Healthcare Disparities Report

11. 40% of Deaths in U.S. Due to Modifiable Risk Factors • Smoking was king • Obesity and lack of physical activity • Chronic conditions result: • Diabetes • Respiratory conditions • Cardiovascular • Arthritis • Cancer

12. Source: Stephen A. Schroeder, MD. We Can Do Better. NEJM 357:12

13. The Scope of the Problem • 1.7 million Americans die of a chronic disease each year • Chronic diseases affect the quality of life of 90 million • 87% of persons aged 65 and over have at least one chronic condition; 67% have 2 or more • 99% of Medicare spending is on behalf of beneficiaries with at least one chronic condition.

14. What is a chronic disease? • Arthritis • Chronic lung disease • Diabetes • Heart condition • Cardiovascular disease • Chronic pain • Depression • Cancer • Stroke • Any ongoing health condition Four chronic conditions cause 2/3 of all deaths a year. Heart Disease, Cancer, Stroke and Diabetes

15. Need to work with whole person, family and community Facing complex and fragmented system Need to integrate personal care and medical care Interdisciplinary team needed Fundamental re-design is required – in large, complex system

16. New Models of Care are Needed • Reallocation of existing dollars from care to prevention and promoting health • Strengthen community and home care – reduce use of institutions • Reduce fragmentation – increase integration to address chronic diseases

17. The Expanded Chronic Care Model: Integrating Population Health Promotion 

18. Building a “Health” system • Healthcare must change • The Aging Network must seize the opportunity to partner with primary care • Josefina Carbonnal has provided the great vision – converting aging services to health-building and health empowerment resources • We have the opportunity to lead

19. Changing American Culture • We are in the service of a great vision • Mainstreaming access to powerful tools for health • Building a platform for better quality of life • Less pain • Less illness • Greater mobility and better function • This is a MISSION, not a PROJECT

20. 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

21. Going to Scale • This is challenging work – needs to: • Reach large numbers of people • Maintain fidelity • Be sustainable/cost-effective and consumer-engaging

22. Going to Scale In Wisconsin….. • Over 700,000 people 65 and older • 67% = nearly 500,000 older citizens with 2 or more chronic conditions • California…..even more • Who to target? How many can we reach? • This is a significant dream – to broadly impact quality of life through enhanced self-care…behavior change/lifestyle change

23. 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

24. 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

25. Sources of Shared Leadership:Bringing Vision & Expectations AoA and NCOA State Departments of Aging and Public Health 4 A’s/ AAA’s/ Aging Network Other Systems --- 80/20 Rule Alignable Incentives Funders Associations

26. Focus of Intervention – Behavior Change New Models of Care – Practice Change Systems Organizations New Ways of Living Individuals

27. California Evidence-Based Initiative 2006 • California Departments of Aging and Health awarded 3-year grant from Administration on Aging • Initiative brings evidence- based programming to age-based organizations • Partners in Care is the state program office, California Health Innovation Center

28. AoA Evidence-Based Programs • Matter of Balance: Managing Concerns about Falls • Healthier Living: Managing Ongoing Health Conditions • Healthy Moves for Aging Well • Medication Management Improvement System (MMIS)

29. Target Sectors For ADOPTION/ENGAGEMENT

30. 80/20 Selection Criteria • Potential for Scale/Impact • Directly/Indirectly • Mutual Benefit/Alignable Incentives • Aligned Mission/Vision • Product Champion • Has Relevant Resources

31. Selection Criteria • Organizations with Aligned Mission Who: • Have a heart for it - Care about this movement • Can assign resources for the work • Will Benefit From Engagement Over Time • Obligations • Needs • Outcomes

32. Investments in Local Leadership • Selection is vital • Need to screen for commitment • Need terms of commitment in order to be trained • Need resources to sustain and nurture the network of MTs and LLs • Must anticipate attrition, but design to minimize it

33. Key players • CDA/Public Health – lead Aging Network • Foundations – fund specific elements: sectors/locales/expanded volume served • Health Plans/Physician Groups • Pay for Performance • Marketing • Improve Health/Reduce Health Service Use • Community Sponsors for CDSMP • Education and sites

34. Target Sectors For ADOPTION/ENGAGEMENT

35. California Collaborative Models • Need partners that can: • Identify & connect participants – e.g. physicians • Provide quality, sustainable platform, e.g. community college adult education • Sponsors and sites, e.g. health plans, senior centers

36. State Leadership • Guide strategy development for public/private partnership • Select non-profit program office • Provide key resources through CDA and Public Health – advocacy, website • Encourage private sector funding for shared long term sustainability

37. GIS ensures that programs are available in the most advantageous locations to reach the target population and identify programmatic gaps.

38. Examples of partnerships • Community College Older Adult Programs and K-12 Resources • Disease-Specific Organizations • Public Health and Community Clinics • Physician Groups, especially managed care • Faith Based Settings

39. Kaiser a Vital Partner • Original research site for Stanford • System-wide commitment • Generous community benefit • Experience with the program

40. California’s Community College Older Adult Programs

42. CAPG • Non-profit Trade Association • Represent approximately 150 physician organizations • 59,000* Physicians • 15 million Californians

43. CAPG Mission • CAPG is the Voice of Organized Medicine • Nation’s largest professional association representing physician groups practicing in managed care • Committed to the delivery of coordinated, quality, affordable and accessible healthcare

44. Tools • Physician group readiness assessment • Patient screening and referral criteria • Education tools for office/clinical staff • Referral forms • Fax back form for CBO

45. Partnership with Community Referral Accesses community based network create min-networks Examples Santa Cruz LA Medi-Cal groups Hosted on Site Incorporate into health education or case management Larger groups, some with hospital systems Examples Healthcare Partners Sharp Healthcare Models of Delivery

46. California Examples • Statewide Steering Committee • County Coalitions/Associations • 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

47. 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: Community College Educators of Older Adults • Non-Profit: Partners in Care Foundation • Government: Los Angeles County Public Health Department • Business: Pacific Business Group on Health

48. Catholic Healthcare West: A Leading Not For Profit Health System • FY2007 • 8th largest health system in the nation • Largest hospital provider in California • Hospitals: 41 • Assets: $10.5 billion • Acute Care Beds: 8,539 • Active Physicians: 9,688 • Full-time Equivalent Employees: • 42,845 • General Acute Patient Care Days: • 1.7 million • Community Benefits & Care of the Poor: $922 million* * Including unpaid costs of Medicare

49. 2005 – Five Year System ObjectiveHorizon 2010 • By 2010, reduce hospital admissions by 5% for ambulatory care sensitive conditions by expanding and/or enhancing primary care services for persons with disproportionate unmet health needs. (Revised in 2007)

50. 18 CHW Hospitals Implementing CDSMP (black font)