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7.1 Prevention: Disparities. IntroductionTechnical ApproachData (Physician Practices and Beneficiaries)Recruitment and Marketing (PPs, Beneficiaries, and CHWs)StakeholdersQuestions. . 7.1 Prevention: Disparities. Introduction. 7.1 Prevention: Disparities Introduction. Delmarva FoundationFounded in 1973Involved with HCFA Quality Improvement through PSRO and PRO1984 1st SOW (2 year contract)2nd-9th SOW 1986- present (3 year contracts)2001 HCFA becomes CMS7th SOW 2002-2005: PRO beco31515
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1. 2008 QualityNet Conference CMS QIO 9th SOW7.1 Prevention: DisparitiesReducing Disparities in Underserved Medicare Diabetics
Nancy Jane C. Friedley, MD
Medical Director
Delmarva Foundation
August 27, 2008
2. 7.1 Prevention: Disparities Introduction
Technical Approach
Data (Physician Practices and Beneficiaries)
Recruitment and Marketing (PPs, Beneficiaries, and CHWs)
Stakeholders
Questions
3. 7.1 Prevention: Disparities
Introduction
4. 7.1 Prevention: DisparitiesIntroduction Delmarva Foundation
Founded in 1973
Involved with HCFA Quality Improvement through PSRO and PRO
1984 1st SOW (2 year contract)
2nd-9th SOW 1986- present (3 year contracts)
2001 HCFA becomes CMS
7th SOW 2002-2005: PRO becomes QIO
7. 7.1 Prevention: DisparitiesIntroduction
Underserved Medicare beneficiaries have a higher incidence of diabetes and are more likely to suffer from disease related complications, such as end stage renal disease (ESRD) and lower extremity amputations, than non-underserved Medicare beneficiaries.
8. 7.1 Prevention: DisparitiesIntroduction CMS has identified three primary reasons for this disparity in outcomes:
Underserved beneficiaries do not have easy access to diabetes self-management education (DSME) programs;
Underserved do not have preventive services performed as frequently as their non-underserved counterparts; and
When preventive services are performed for the underserved, clinical measures such as HgbA1C levels reveal poor control when compared with the non-underserved.
9. 7.1 Prevention: Disparities
Technical Approach
10. 7.1 Prevention: DisparitiesTechnical Approach To reduce disparities, DF will:
Collect, track, and evaluate utilization and clinical measures and prepare reports on relative improvements rates after implementation of a DSME program;
Recruit qualified Physician Practices (PP) and Beneficiaries; and
Provide qualified trainers, a proven training curriculum (DEEP), and American Diabetes Association-approved educational materials.
11. 7.1 Prevention: DisparitiesTechnical Approach DC vs MD
Highest number of underserved are African Americans
Both will benefit from same training, data collection, analysis
In MD, the highest percentage of African American Medicare beneficiaries are in Baltimore City and Prince Georges County
12. 7.1 Prevention: DisparitiesTechnical Approach
13. 7.1 Prevention: Disparities
Data
15. 7.1 Prevention: DisparitiesDataMaryland Medicare beneficiaries
In Peer Group 3
Minimum of 1750 African American beneficiaries must complete DSME
Projected completion rate from DEEP: 60%
Minimum of 3000 African American beneficiaries need to be recruited
16. 7.1 Prevention: DisparitiesDataMaryland Physician Practices
342 physicians in Baltimore City and 130 in Prince Georges County that practice Internal Medicine, Family Medicine or General Practice
Predict 20 Medicare beneficiaries with diabetes will be referred per physician
Need to recruit 3000 beneficiaries
Minimum number of physicians to be recruited: 150
17. 7.1 Prevention: DisparitiesDataDistrict of Columbia Medicare beneficiaries
In Peer Group 1
Minimum of 1500 African American beneficiaries must complete DSME
Projected completion rate from DEEP: 60%
Minimum of 2500 African American beneficiaries need to be recruited
18. 7.1 Prevention: DisparitiesDataDistrict of Columbia Physician Practices
284 physicians in DC that practice Internal Medicine, Family Medicine or General Practice
Predict 20 Medicare beneficiaries with diabetes will be referred per physician
Need to recruit 2500 beneficiaries
Minimum number of physicians to be recruited: 125
19. 7.1 Prevention: Disparities
Recruitment and Marketing
20. 7.1 Prevention: DisparitiesRecruitment and Marketing DF will market the program to practices using:
Print and media promotional materials for practices;
Toolkit for providers including:
Program outline;
DEEP flyer;
Participation application and instructions;
21. 7.1 Prevention: DisparitiesRecruitment and Marketing Contact persons at DF (QIC and Medical Director);
Calendar of events (workshops, conferences, etc.) and
FAQs.
Articles published in provider association print media.
Meetings and conferences to present information about DEEP locally, regionally, and nationally.
22. 7.1 Prevention: DisparitiesRecruitment and Marketing To reach beneficiaries, Delmarva staff will:
Disseminate promotional materials to community sites where seniors congregate including churches, senior centers, libraries, congregate meal sites, retirement communities, senior volunteer programs, beauty salons and barber shops;
Disseminate materials where seniors make contact with the health care system including physician and surgeon offices, dental practices, out patient rehabilitation centers, senior fitness programs;
23. 7.1 Prevention: DisparitiesRecruitment and Marketing Disseminate materials where seniors live including senior apartment complexes, retirement communities, assisted living facilities;
Direct marketing efforts toward beneficiaries family members and care givers and encourage families, friends and caregivers to attend DEEP training with the beneficiary;
Develop a DEEP website that can be linked to existing websites for senior organizations, community groups, public and private agencies and organizations;
24. 7.1 Prevention: DisparitiesRecruitment and Marketing Prepare articles for publication in beneficiary association print media;
Volunteer for public service announcements and discussion groups on radio talk shows and morning television programming when seniors are most likely to be watching;
Volunteer to speak at community organizations, churches, and senior centers;
25. 7.1 Prevention: DisparitiesRecruitment and Marketing Partner with community leaders from the private and public sectors at every level to spread the word about the program and provide materials to distribute;
Approach local celebrities such as athletes and media personalities who have diabetes themselves or in their families to speak to diabetics about their experience with and the benefits of diabetes self-management education;
26. 7.1 Prevention: DisparitiesRecruitment and Marketing Network with local employers, businesses, and business trade organizations to inform the community about diabetes self-management training and provide support for maintaining and sustaining DEEP after the QIO contract has ended.
In the District of Columbia, include a focus on community organizations with primarily male membership since men who are African American Medicare beneficiaries with diabetes have the highest rates of adverse outcomes (ESRD and lower extremity amputations) and are most reluctant to seek health care; and
27. 7.1 Prevention: DisparitiesRecruitment and Marketing Recruitment of Community Health Workers (CHWs)
Partner with programs already training CHWs:
In Maryland: Johns Hopkins Urban Health Institute: Center for Community HEALTH *
In DC: the DC Primary Care Association
28. 7.1 Prevention: DisparitiesRecruitment and Marketing Incentives for Recruitment and Retention of Community Health Workers (CHWs)
DFMC projects a need for from 4-6 part-time CHWs to cover the teaching time of each FTE. In order to recruit and retain these individuals, DFMC is committed to their personal and professional growth and development and proposes the following incentives:
29. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
30. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
31. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
32. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
33. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
34. 7.1 Prevention: DisparitiesRecruitment and Marketing: CHWs
35. 7.1 Prevention: Disparities
Stakeholders
36. 7.1 Prevention: DisparitiesStakeholdersMaryland
37. 7.1 Prevention: DisparitiesStakeholdersMaryland
38. 7.1 Prevention: DisparitiesStakeholdersMaryland
39. 7.1 Prevention: DisparitiesStakeholdersMaryland
40. 7.1 Prevention: DisparitiesStakeholdersMaryland
41. 7.1 Prevention: DisparitiesStakeholdersDistrict of Columbia
42. 7.1 Prevention: DisparitiesStakeholdersDistrict of Columbia
43. 7.1 Prevention: DisparitiesStakeholdersDistrict of Columbia
44. 7.1 Prevention: DisparitiesStakeholdersDistrict of Columbia
45. 7.1 Prevention: DisparitiesStakeholdersMaryland and the District of Columbia
47. 7.1 Prevention: Disparities
Questions?