Building Community Partnerships for Health

June Simmons Partners in Care Foundation

The shift to health – from health care The new demographics of health The Chronic Care Model

Nationwide Statistics:Opportunity for Impact

50% of Americans have a chronic condition◦ 25% have multiple chronic conditions.

7 of 10 deaths in US each year due to chronic disease 7% of Medicaid population but 54% of costs 80% of health care costs go to 20% of patients -- those with

chronic diseases

Chronic Illness in California Largest and most diverse state:

◦ 38 million residents◦ 3.9 million residents ages 65+ (10%)1

62% of all older people report having 2+ chronic conditions2,3

58% of older Californians have some type of arthritis4

14.8% of CA seniors suffer from diabetes5

30% of the state’s elderly minorities are diabetic5 Heart disease accounts for 29% of the state’s deaths6

1 CDC. Population Estimate 2006.2Yen I, Trupin L, Yelin E. The relationship between health and employment. San Francisco, CA: Institute for Health Policy Studies; 2001.3 Partnership for Solutions. Chronic conditions: Making the case for ongoing care. Baltimore, MD: Johns Hopkins University; 2002.4 Lund LE. Prevalence of Arthritis in California Counties, 2001: Center for Health Statistics; December 2003.5 Lund LE. Prevalence of Diabetes in California Counties: 2003 Update: Center for Health Statistics; February 2005. 6 CDC. Chronic diseases: The leading causes of death California. CDC. Available at: http://www.cdc.gov/nccd php/publications/factsheet/chronicDisease/California.ntml. Accessed 8/1, 2006.

Californians Age 65 and OverAge

% 65 years old and over 10.7%

Ethnic Background

% White persons, not Hispanic 44.5%

% Persons Hispanic or Latino 34.7%

% Asian persons 12.1%

% Black persons 6.8%

% Other 1.9%

Socio-economic Characteristics

% Of Medi-Cal beneficiaries 20.5%

% Below Poverty 8.1%

% Near Poor (0-199% of Poverty) 28.6%

% Limited English Proficient 16.9%

Health/Functional Status

Fair or Poor Health 29.6%

Have any disability 42.2%

Sedentary Lifestyle 37.2%

Arthritis/Moderately or highly limited in daily activities 57.7%

Diabetes—Ever Diagnosed 14.8%

Hypertension—Ever Diagnosed 53.5%

Heart Disease—Ever Diagnosed 23.7%

Impaired Activities Due to Emotional Problems Last Month 11.5%

Development of New Evidence-Based Health Promotion Models

Transformation of the Aging Network What is Evidence-Based

Available Programs

A New Vision is Being Crafted◦ Health Care Providers do not have to solve the

problem of chronic disease alone◦ There are powerful, proven programs available

New strategies are being developed and tested to take these new programs to scale

Peer-led, 2-hour sessions for 6 weeks Any chronic disease Focus on goals and action plans Techniques to deal with problems such as

frustration, fatigue, pain and isolation Appropriate exercise for maintaining and

improving strength, flexibility, and endurance Appropriate use of medications Communicating effectively with family, friends,

and health professionals Nutrition How to evaluate new treatments.

After 12 months, significant improvement in:◦ Amount of exercise (ROM & aerobic), ◦ Cognitive symptom management◦ Communication with physicians◦ Self-efficacy – Confidence in coping◦ Health status (fatigue, shortness of breath, pain, role

function, depression, health distress) ◦ Utilization:

Emergency department (ED) visits Physician visits Hospital days

Spanish version available; Effective among minorities

Arkansas Arizona California Colorado Connecticut Florida Hawaii Idaho Illinois Indiana Iowa Maine Maryland

Massachusetts Michigan Minnesota New Jersey New York North Carolina Ohio Oklahoma Oregon Rhode Island South Carolina Texas Washington Wisconsin

Health care cost savings in programs that improve quality of life

CMS working with AoA at national level – Move senior centers from recreation to wellness

Aging Departments working with Public Health at state level – Fall prevention, flu, etc.

Locally, health care and aging/disability service providers pursuing goal of individual responsibility and empowerment in self-care

Many Strategies Being Many Strategies Being Developed and Tested Developed and Tested

How can we reach real scale

Tobacco is a good example of the model of change

How do we engage people in this change?

Physicians are proven most powerful referral source

California as an example 3.9 million older adults Chronic disease summary Strategies to reach evolving Want to build a “distribution system” that is

scalable and sustainable

Parks and Rec.

Senior Centers

Mental Health Sector

Faith-Based Orgs

Community

Colleges

Physician Groups

Health Plans

Hospitals

Senior

Housing

Sites

Public Health Sector

Evidence-Based ProjectOffice

Target Sectors For ADOPTION/ENGAGEMENT

Physicians & Older Adult Education Programs New Partnerships to identify and engage

older adults Physician practices a location where many

elders are seen Physicians can identify those with chronic

conditions Physician referral is the most powerful tool

Emphasize patient responsibility

Empower the patient – You CAN do it!

Know the resources Write the prescription – for

all chronic conditions Follow-up encouragement What changes did you

make?Physician is the most powerful influence in patients signing up for and completing the 6-week program

Sustainable Sources of Support Community Colleges and K-12 offer free

non-credit education to older adults Paid for attendance Can add new curricula Have marketing in place Teach in community settings

Promoting Health and Preventing Decline – the New Imperative Quality of life is at stake The health dollar is at stake With new knowledge and methods, we must

transform community understanding Mobilize the population to rise to the

challenge Take on the leadership