NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS (NACDD) Program Integration: A Process Not an Outcome Healthy States Forum for State Legislators February 16, 2008 Lorrie Graaf Program Integration Coordinator

Chronic Disease Program Integration Today’s Focus Burden of Chronic Disease Program Integration Definition Guiding Principles Points of Integration State examples NACDD Examples/Activities

Chronic Diseases #1 cause of death and disability 75% of health care spending #1 cause for rising health care costs Most - prevented or better managed Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

Chronic Disease Program Integration About Chronic Disease Program Integration Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

Program Integration NACDD Definition What: Strategic alignment of chronic disease categorical program resources Why: Increase effectiveness and efficiency of each program in a partnership (without compromising the integrity of categorical program objectives) Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

Program Integration: The “What/Why” in Detail Create awareness of shared aims Facilitate effective problem solving Learn from each other Coordinate efforts Recruit more advocates Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

It’s about doing work differently! Not about adding work; It’s about doing work differently! Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

NACDD Program Integration: Where We Started March 2006: Chronic Disease Program Integration Workshop Conveners: NACDD & CDC Purpose: To discuss Challenges and benefits “How” of developing Tools and resources Attributes and skills for organizational change Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

Chronic Disease Program Integration: Workshop Outcomes Chronic Disease Program Integration: Guiding Principles 2) Recommendations State health agencies CDC NACDD Burden Definition Principles Integration Points Examples Take Away Burden Definition Principles Integration Points Examples Take Away

Guiding Principles

# 1 Do No Harm to Categorical Program Integrity Address a specific need Accountable to funders  * Burden Definition Principles Integration Points Examples Take Away

# 2 Identify Mutual Benefits and Opportunities Commitment to program; not a concept What’s in it for me? Burden Definition Principles Integration Points Examples Take Away

# 3 Be Guided by Efficiency Oriented Processes Stretch limited resources Avoid duplication of efforts Identify points of integration Burden Definition Principles Integration Points Examples Take Away

# 4 Be Focused on Health Outcomes Improved population health The most important guiding principle for program integration! Burden Definition Principles Integration Points Examples Take Away

# 5 Evaluate Integration Outputs and Health Outcomes Identify outcomes Create an evaluation plan Initial focus - process evaluation Burden Definition Principles Integration Points Examples Take Away

# 6 Engage Stakeholders Evolution, not revolution Need, not just want Shared decision making, not directive Burden Definition Principles Integration Points Examples Take Away

Make Program Integration the Norm # 7 Mobilize Leaders Objective: Make Program Integration the Norm Strategy: “Sell” the benefits Burden Definition Principles Integration Points Examples Take Away

Points of Integration

When Does Program Integration Make Sense? Compatibility Targets for change Delivery channels Strategies Data and analysis needs Burden Definition Principles Integration Points Examples Take Away

Targets for Change Health insurance companies Demographic group School systems Policy makers Demographic group Health care professionals Local communities Burden Definition Principles Integration Points Examples Take Away

Delivery Channels Health care settings Community Organizations Worksites Community Organizations Schools Burden Definition Principles Integration Points Examples Take Away

Strategies Skill building Professional development Policy change Media messages Environmental policies Coalition building Burden Definition Principles Integration Points Examples Take Away

Data and Analysis Needs Incidence and prevalence Vital statistics Morbidity (hospitalization, ER) Health behavior (BRFSS, YFBS) Public health laws and regulations Geographic community data Burden Definition Principles Integration Points Examples Take Away

Program Integration: What’s Happening in States?

Chronic Disease Programs Working together by: Building on common interests Finding points of linkage Leveraging resources Burden Definition Principles Integration Points Examples Take Away

State Examples Training Across Programs Joint Evaluation Activities Shared/Combined/Matching Funds Chronic Disease Coalitions Joint Project Implementation Joint Planning/Priority  Setting Joint Media Messages Burden Definition Principles Integration Points Examples Take Away

PROGRAM INTEGRATION ACTIVITIES NACDD PROGRAM INTEGRATION ACTIVITIES

Workshop Recommendations: NACDD Develop/disseminate integration tools Provide educational opportunities Provide outreach and recruit national partners Reach beyond chronic disease programs Advocate leadership support Assure continuity of integration activities Burden Definition Principles Integration Points Examples Take Away

NACDD Program Integration: Are We on Track? Tools – Web site and Materials Education – Chronic Disease Academy Outreach – State Integration Examples Reach Beyond Chronic Disease – Partners Advocate Leadership Support – State Assessment and TA Program Assure continuity of initiatives – Evaluation Burden Definition Principles Integration Points Examples Take Away

Program Integration: Take Away Points Process, not an outcome Enhances capacity to achieve common goals Helps stretch resources to create a greater impact Integrated policies and programs DO improve health Burden Definition Principles Integration Points Examples Take Away

The benefits of an integration initiative should be greater than the sum of individual program contributions. Burden Definition Principles Integration Points Examples Take Away

For Additional Information  2872 Woodcock Blvd. Suite 220 Atlanta, Georgia 30341 NACDD (770) 458-7400  www.chronicdisease.org Lorrie Graaf (515) 270-1045  lgraaf@chronicdisease.org Burden Definition Principles Integration Points Examples Take Away