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A nonprofit service and advocacy organization © 2012 National Council on Aging

Webinar Instructions

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Embedding CDSME Programs within

Health Care Organizations

Agenda

• Join Ivana Krajcinovic (UNITE HERE HEALTH) and Kim

Wicklund (Group Health Cooperative) to hear first-hand from

two health care organizations that have embedded CDSME

programs into their day-to-day operations. Ivana and Kim will

share information about their implementation models, as well

as speak to recommended strategies for engaging health

care organizations.

• Q&A – All

Los Angeles & Orange County

CDSMP PILOT PROGRAM

February 2012 – February 2013

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• Union health plan serving unionized hospitality workers in the US

and Canada

• Las Vegas, Atlantic City, Chicago, NYC, LA, Monterey, Pittsburgh

plus national plans

• 190,000 covered lives

• Immigrants and the working poor

LA Plan Chronic Health Conditions

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LA & OC Fund

Kaiser participants

So CA Kaiser

average

Diabetes 8.5% 5.7%

poorly controlled 24.6% 21.9%

ER visits (per 1000) 246 199

Hypertension 9.6% 8.5%

LA Plan Participants with 1 or more

Chronic Health Conditions

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• 16.0% of participants

• 2,706 total participants

• 41.6% of costs

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UHH LA and OC program

Recruitment and follow-up

Monthly meetings for graduates

Recruit volunteer leaders

Texting program (Anjna)

Graduates who come to 6 monthly meetings are eligible for up to $100/month in reimbursement for maintenance medication copays each month they attend a monthly meeting

Participation

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At the end of the first year…. 281 entered the program

89% graduated

19 workshops in LA and Orange County

76% come to monthly meetings for graduates

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Goals for 2nd year

Enroll an additional 500 in 35 workshops

Develop 20 trained leaders

Reduce staff

Formal evaluation (Partners in Care)

Expand program to Chicago, Las Vegas, CT and MA

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Veroni ca

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Veroni ca Jef f rey

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Veroni ca l eadi ng her f i rst workshop

LESSONS LEARNED

You have more control over healthcare that you

think

Boots on the Ground

Prove that you’re serious

Leverage existing relationships

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Group Health’s experience

February 19, 2013 | Kimberly Wicklund, MPH

Implementing CDSMP in an

integrated health care system

Group Health

Consumer-governed, non-profit

financing and care delivery

system founded in 1947

Mission: To design, finance and

deliver high-quality health care

623,000 members in

Washington and North Idaho

Integrated group practice: 25

medical centers

Contracted provider network:

9,000 physicians

Patient-centered care and innovation

Core values reflected in initiatives to:

Partner with patients:

Healthier lifestyles

Clinical preventive services

Chronic disease self-management

Activate and engage patients:

MyGroupHealth

Health Profile

Shared decision-making

Provide evidence-based, planned care through:

Coordinated outreach

Opportunistic care

Deliver patient-centered through medical home

Rationale for CDSMP at Group Health

Strong evidence for improved skills, self-efficacy,

outcomes

Patient centered

Low-cost intervention

Enables clinical staff to focus on complex medical

issues instead of self-management skills

Engages consumers, as well as patients

Group Health’s Model

Guiding principals

1. Strive for population impact

2. Enable equal access to CDSMP regardless of where

member gets care

3. Offer program in various ways to respond to patients’

unique needs

4. Maintain ongoing commitment to exploring new and

innovative approaches

Face-to-face CDSMP

Started in1998

58 volunteer leaders

Offered in18 medical centers

Retention: 69%

Maximum reach to date: 632 (2007)

Reach in 2012:

29 workshops

359 people

Current evaluation focus: fidelity

Web-based CDSMP

Funded by Group Health Foundation Partnership for Innovation

Partners: National Council on Aging, Stanford University, Group Health Research Institute

Goal: assess if web-based CDSMP increases uptake by members who are not using in-person program

In health plan network

Younger

473 participants

Retention: 66%

Evaluation:

Administrative data review for utilization and costs

Baseline and 6 month follow-up survey for self-reported health status, health behaviors, and utilization

Web-based CDSMP evaluation results

Expanded reach by 30%

Reached younger population– average age was 55, 10 yrs younger than face to face

Significant improvements in:

Depression

Pain

Fatigue

Health distress

Trend toward more use of primary care and less of specialty

Limited reach in health plan network

Diabetes Self-Management Program pilot

Funded by Group Health Foundation (2012)

Goal: pilot 8-10 DSMP workshops at Group Health medical centers

Actual reach:

14 workshops

208 total participants

Evaluation in process:

Survey: self-management behaviors, blood sugar

knowledge, medication management

EMR review: clinical measures, and health care utilization

DSMP pilot feedback

“Today I received my latest

blood and kidney test

results, and for the first time

in my adult life they all were

within normal ranges. My

A1c was 5.7….”

Employer pilots

Testing 3 approaches:

1. Worksite-based workshops (King County)

4 workshops in 2012- 56 employees

Retention: 87%

Gold status for documented attendance of ≥4 sessions

2. Formal reporting of participation (SHWT)

GH/SHWT reporting process for incentivizing employees

attending ≥4 sessions online or in person

3. Employee self report on participation (Group Health)

≥4 sessions in person or online for 400 wellness points

Reach 1999-2012

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100

200

300

400

500

600

700

800

900

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Total members enrolled in Living Well with Chronic Conditions 1999 to 2012*

*2012 includes Living Well with Diabetes

Online

Total

In person

Recruitment

Strategies

Targeted recruitment mailings

Primary recruitment strategy for in-person workshops

Mailed 6 weeks before workshop

Mailing list criteria:

ICD-9 codes for chronic conditions

(ex: arthritis, heart disease, diabetes, asthma, COPD, fibromyalgia)

visited doctor in past 3 months

patient at clinic where workshop is held

Uptake rate: 10%

Embed in provider tools and workflow

Provider can order brochure to be mailed to patient directly from electronic medical record (EMR)

Insert messages into After Visit Summary from EMR

Point of care prompts in EMR to encourage referrals

Clinic-based champions encourage referrals in team huddles and emails

Built into medical home as a standardized referral

Embed in member tools and resources

MyGroupHealth for Members

Health Profile

www.ghc.org Website

• Workshop locations & schedules

• Register on Website

• Single sign-on to LWCC online

Resource Line

Member publications

Lessons learned and

conclusions

Lessons Learned

Getting buy-in

Involve leadership. Share targets, performance, improvement processes and impact with them to keep them engaged.

Clarify how CDSMP supports strategic goals.

Involve employers

Recruitment through clinics

Make referrals easy and systematic

Embed referrals into standard workflow

Use multiple awareness-raising and recruitment strategies

Look beyond the doc- champions in the clinic are often medical assistants, social workers, clinic manager, nutritionist, or nurse

Keep raising awareness in the midst of competing priorities

Lessons Learned

Roles for community partners

Partner with other organizations to expand reach and share resources and expertise

Collaborate on leader recruitment, training, sharing

Share and standardize best practices and tools

Centralize and share workshop schedules

Develop feedback and reporting processes

Current challenges and next steps

Recruiting leaders in underserved areas

Integrating more closely with clinical care

Coordinating with community organizations to expand

reach into our contracted network

Creating opportunities for “SMS light”

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A nonprofit service and advocacy organization © 2012 National Council on Aging

Q&A

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