C alifornia Evidence-based Initiative – Partnership Opportunities June Simmons, CEO Partners in Care Foundation September 29, 2008

Partners in Care Foundation Non-profit in Los Angeles, CA Focuses on aging issues Changes the way healthcare services are delivered Develops, evaluates and disseminates innovative programs to improve care

California Evidence-Based Initiative 2006 California Departments of Aging and Public Health awarded 3- year grant from Administration on Aging to spread EB self-care Brings evidence- based programming to age-based organizations Partners in Care is the state program office, California Health Innovation Center

The Scope of the Problem lifeChronic diseases affect the quality of life of 90 million And represent 80% of the health care dollar 1.7 million Americans die of a chronic disease each year- 70% of deaths in U.S. 87% of persons aged 65 and over have at least one chronic condition; 67% have 2 or more – 1.3 million in CA Solution requires vital provider system development AND patient activation – education models have failed. Lifestyle change and self-care stem from internal commitment by the patient

Opportunity for Impact 99% of Medicare spending is on behalf of beneficiaries with at least one chronic condition 80% of health care costs go to 20% of patients: those with chronic diseases

Target Population Have at least 1 chronic condition Family members, friends or caregiver of someone with a chronic condition Must have stamina to attend a 2 ½ hour class, plus travel time for 6 weeks Must have cognitive function to participate Diverse seniors in underserved communities

C alifornia Evidence-Based Programs **Healthier Living: Managing Ongoing Health Conditions Matter of Balance: Managing Concerns about Falls Healthy Moves for Aging Well Medication Management Improvement System

Evidence-Based Programs Are supported by extensive research and have been proven to work Clear, structured, detailed description of the program Have measurable outcomes Easier to market the program and engage partners Increases effective use of resources to enhance programming Best Practice Promising Practice Evidence Based Model

Healthier Living: Managing Ongoing Health Conditions Developed by Stanford University Patient Education Research Center as a collaborative research project between Stanford and Kaiser Permanente aka Chronic Disease Self-Management Program (CDSMP) Designed to help people better manage chronic health conditions and live a happier, healthier life. Adopted as a benefit for Kaiser patients

Chronic Conditions Arthritis Chronic lung disease Diabetes Heart condition Cardiovascular disease Chronic pain Depression Cancer Stroke HIV/AIDS Any ongoing health condition

Patient Activation vs. Education Brief physician visit can’t do it all Lifestyle change is challenging – behavior change comes from internal, not external Research has developed new approaches to help people gain insights and new behaviors to promote health and delay the progression of chronic conditions

Goals of a Self-Management Program –Participant learns how to identify problems –Participant learns how to act on problems –Participant learns problem-solving skills related to chronic conditions –Participant learns how to generate short-term action plans

Parts of an Action Plan 1. Something YOU want to do 2. Achievable 3. Action-specific 4. Answer the questions: What? How much? When? How often? 5. Confidence level of 7 or more

Workshop Overview  Managing symptoms  Dealing with difficult emotions (frustration, anger, pain)  Personalizing a fitness and exercise program  Relaxation techniques  Tips for eating well  Medication "how to's"  Improving communications (family, friends, doctors)  Effective problem-solving  Setting weekly goals

Fewer outpatient visits Fewer emergency room (ER) visits Fewer hospitalizations Fewer days in hospital Health Care Utilization Effects

Healthcare Utilization Effects Saves enough money through reductions in healthcare expenditures to pay for itself within the first year Results in more appropriate utilization of healthcare resources –Healthcare needs addressed in outpatient settings vs. ER visits and hospitalizations

Health Effects Greater energy/reduced fatigue Increase in exercise Fewer social role limitations Better psychological well-being Enhanced partnerships with physicians Improved health status Reductions in pain symptoms Decrease in depression Decrease in shortness of breath Improved quality of life Greater self-efficacy and empowerment!!

Other Benefits Effective across chronic diseases Wide variety of chronic illnesses addressed = Efficiencies of scale Effective across socioeconomic and educational levels –Used by various ethnic groups in the US and internationally in England, Denmark, Australia, Japan, China, Norway & Canada –Attests to program’s broad reach and appeal Enables participants to manage progressive, debilitating illness –Even with worsening disability, no increase in use of healthcare resources

Other Benefits (cont’d) Important health benefits persist over time –improvements in exercise and social/role limitations can be seen over a 2-year period Supported by decades of federal research –Developed through 20 years of grants from NIH, US Agency for Healthcare Research & Quality, and Centers for Disease Control & Prevention

Materials- Multiple Languages Participant Workbook English Spanish Chinese Japanese Korean Relaxation CD English Spanish Chinese Leader’s Manual English Spanish Chinese Japanese Korean Bengali Dutch German Hindi Italian Norwegian Somali Turkish Vietnamese Welsh Arabic

Getting Started Certified Master Trainers Certified Lay Leaders

Partnership with CAPG - Tools Work with CAPG leadership to identify physician groups to participate Physician group readiness assessment Patient screening and referral criteria Education tools for office/clinical staff Referral forms Fax back form for CBO

Pilot Models of Delivery Partnership with Community –Referral –Accesses community based network –create min-networks Examples –Santa Cruz –LA Medi-Cal groups Hosted on Site –Incorporate into health education or case management –Larger groups, some with hospital systems Examples –Healthcare Partners –Sharp Healthcare

Taking New Model to Scale Already proven method, the question is how to go to scale Contracted network with economies of scale and capacity for responding to volume, maintaining quality and fidelity and cost-effective Partners in Care Foundation is working to prepare a rollout at this level. Will begin with several pilots

California Health Innovation Center Public Health Sector Senior Housing Sites Hospitals Health Plans Parks and Recreation Community Colleges Faith-Based Orgs Mental Health Sector Senior Centers Physician Groups Target Sectors For ADOPTION/ENGAGEMENT

California’s Community College Older Adult Programs

Resources Partners in Care Foundation Stanford CDSMP website Center for Healthy Aging of NCOA

Questions?? W.June Simmons,CEO Partners in Care ext 117