building a kaleidoscope of partnerships · what doctors say . . . • 80% not confident in their...
TRANSCRIPT
Healthy Aging Annual MeetingDianne Davis, MPH
May 23, 2018
10:45 – 11:30 AM
Emergency Medical ServicesPhysician Groups Managed Care OrganizationsSenior Housing Sites
Building a Kaleidoscope of Partnerships
Partners in Care FoundationChanging the Shape of Healthcare
• Partners is a think-tank and a proving ground
• Partners changes the shape of health care by creatinghigh-impact, innovative ways of bringing more effective clinical and social services to people and communities
• Partners’ direct services test, measure, refine and replicate innovative programs and services, and bring needed care to diverse populations
Health Happens in your Community!
Building A Bridge to Better Outcomes
Between Medical Care and Social Determinants of Health
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Impact of Social Factors on Health
Social Factors
SDOH
• Low-Income Status has been proven to have a negative impact on achieving defined clinical outcome goals
• Populations impacted by social determinants of health need support to address social and psychosocial factors impacting health outcomes
• Successful interventions extend beyond the clinical setting and into the community
U.S. spending emphasizes medical expenditures over social care expenditures.
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What Doctors Say . . .
• 80% not confident in their capacity to address their patients’ social needs
• 86% said unmet social needs are leading directly to worse health
• 76% wish the healthcare system would cover cost of connecting patients to services to meet health-related social needs
• 1 of 7 prescriptions would be for social supports, e.g., fitness programs, nutritious food, and transportation assistance
Source: Healthcare’s Blindside, The Robert Wood Johnson Foundation Survey of 1,000 PCPs
Our Service Lines: Overview
Kaleidoscopes are more beautiful than their individual elements. . .
Emergency Medical Services
Physician Groups
Managed Care Organizations
Low Income Housing Sites
National Association - APG
Build partnerships with varying types of systems:
Partnership #1
• Fire Departments & Emergency Medical Services
– ACL Grant
– Provide referrals into fall prevention workshops to individuals who have fallen
• A Matter of Balance
• New Practice/Culture Change
• Need a champion – Fire Chief
– If you know one Fire Department, you know one fire department
• Be flexible, respond to their needs
– Systems’ change is challenging work no matter how much you want to do the right thing
• Difficult to get EMS to enter information into their medical record
• You need community partnership for the site to provide programming
• Lack of staff to reach-out and enroll members in MOB after EMS visit
• Significant community interest!
• Long waiting lists of enrollees can develop
Partnership #2
• Low Income Senior Housing Sites− Required to provide some programming for seniors
living in the residence• 158 low income senior housing sites across LA County• 37 new sites from July 2017 – May 2018• Exercise programs are good “gateway” programming
• New Practice/Culture Change− Work with site-coordinators as best practice
• They have relationships with residents and are very helpful with marketing/retention
− Some have PUPM funds from HUD (specific for programming)
− Wellness Clubs work well at these sites
In-home medication inventory, adherence inquiry, & risk screening, and alerts with pharmacist review of MRP
Sometimes it’s easier to start with what they understand . . .
Key:
▪Duals plan
▪MA, Exchange N=2,146
Feedback to providers . . .
Share Health Outcomes and ROI
• Study of Better Choices, Better Health for Diabetes (on-line and in-person DSMP), being published in Journal of Medical Internet Research demonstrates:
– Improved health outcomes• ED visits by 110 visits per 1,000 member years
• Outpatient visits by 2,350 visits per 1,000 member years
• of 1.27% in average blood sugar at 12 months, for those with a baseline
A1C >= 9
– Return on Investment
• On-line – $3 saved for each $1 spent
• In-person – $2.00 - $2.70 saved for each $1 spent
» More expensive to put on; ROI dependent on local costs
Chronic Disease Self-Management Program (CDSMP) Clinical Outcomes
• Population: 571 union members w/chronic conditions in MCO
• Intervention: CDSMP + monthly meetings + incentives (discounted medication co-pays)
• Outcomes:
– Compared to baseline, after 12 months
• Self-rated health good or excellent: 60% vs. 32% at baseline
• BMI 1 point
• A1C 1 point
• Systolic BP 11 points
• Depression score from 5.8 at baseline to 3.2
• Pain from 3.2/10 to 2.0/10
– Compared to baseline, after 12 months
• aerobic exercise from 51 to 75 minutes per week
• stretching/strength exercise from 21 to 35 minutes per week
5/17/2018
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2013 National Study IMPROVEMENTS:
National Retrospective Study Health Outcomes
*Brady, Teresa J. Executive Summary of ASMP/CDSMP Meta-Analyses. CDC, May 2011. http://www.cdc. gov/arthritis/docs/ASMP-executive-summary.pdf*Ory, Jiang, Lorig, Laurent, Whitelaw, and Smith, 2013.
CDC Meta-analysis of 20 studies: CDSMP contributes to improvements in
Psychological & physical health status
Self-efficacy, and
Selected health behaviors
Depression 21%
Managing Sleep Problems 16%
13% Physical Activity
10% Fatigue Management
11% Pain Management
12% Medication Compliance
9% Communication with Physicians
Reduction in ER and Hospital Stays, resulting in $714 of savings per person
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And Participant Testimonials
“The workshop put me back in charge of my life, and I feel great. I only wish I had done this sooner.”
“It helped me be more conscious of my emotions – I’m meditating now. The workshop led me to that and brought me to the point where I’m not on my anti-depressants any more. It was the catalyst for so many different things for me.”
“I found the interaction with the other students in the class to be most enlightening. I realized that although I have a chronic illness I am not alone.
Thank you for all the lessons in helping me to deal with this.”
“Because I have been afflicted with Parkinson’s for over 20 years, I have suffered a great deal of depression. The skills you've taught me in maintaining positive
thinking and combating depression have really helped to improve my condition.”
• Cedars Sinai Medical Group– AARP grant funding– Direct referral from Geriatric Practice into Community Programs
• Tai Chi for Arthritis• Enhance Fitness
– Jewish Family Services• CDSMP• Arthritis Exercise
• New Practice/Culture Change
– Jump How high?
• Make sure to set clear expectations early on
– Large health systems don’t work at the same pace as a small community based organization – be patient
• Contracting, finance, etc.
Partnership #3
Partnership #4
• Blue Shield of California– Funded by Disease Management Budget
– Outreach and engagement by Contact Center across the state of California offering three modalities of CDSMP• In-person
• On-line
• Tool kit
• New Practice/Culture Change– Quality Assurance
• Measurement, improvement, best practices and systems across the network
– IT savvy
– Sufficient Volume within various regions
Outreach & Engagement for Population Health
• Contact Center: New outreach & engagement strategy– 165,926 referrals received in 28 months
• Choice of three modalities (in-person, online, toolkit)
• 2.7% enrollment rate
• 4.2% enrollment over the past 4 months
– Contract goal 2% enrollment
– 4,605 participant enrollments
• Significant IT investment required– Customer Relationship Management (CRM) platform
• Data reporting requirements are huge!
– Interactive Voice Response (IVR) system
– Auto-dialer
– Motivational Interviewing script development & training
Motivational Interviewing for Engagement
• Intrinsic motivations for change
• Work with Consultant to
develop a Motivational
Interviewing-based script
• Train agents on script, including
role-playing, listening on initial
calls and providing feedback
• Bilingual English/Spanish Agents
5/17/2018
Partnership #5
• Care1st – Medicaid Managed Care Plan– Funded by marketing dollars
– Sponsoring workshops and health education talks in senior housing sites• English & Spanish Workshops
– CDSMP / DSMP
– Arthritis Exercise
– A Matter of Balance
– UCLA Memory Program
• New Practice/Culture Change– Very slow to start . . . Have to hold hands and be persistent
• Sometimes you need to call in the “big guns”
– Provided significant dollars for collateral (t-shirts, bags, etc.)
– Once the kinks are worked out . . . This can be a good way of beginning to work with a plan
Wellness Club
• Free t-shirt and loyalty card upon sign-up
• Colored button for every workshop completed
• Free reusable grocery bag when a three workshop series is completed
Don’t be afraid to brag about what makes you different!
• Accredited (e.g., NCQA, CARF)
• Evidence-based interventions
• Data demonstrating success/ROI
• HIPAA-trained staff
• Systems of care vs. social work
• Formed and launched a CBO provider Network
• Covers entire service area with diversity of language, culture and skills
• Nimble; short response time
• Well insured, including network security & privacy
• Meets IT security standards: Secure email, SFTP, etc.
• Uses certified EHR system
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Partnership #6
• America’s Physician Groups− Strategic Partnership with association representing
physician organizations practicing capitated and coordinated care
− Allows APG members to access Social Determinant of Health focused services• Benefits encouraged in the recently-passed CHRONIC
Care/ACCESS Act− Diet-compliant home-delivered meals
− Home visits
− Transportation
− Home modifications
− Social service that can significantly improve the impact of health outcomes
Working out the details of this national partnership!
