1. Department of Social and Health Services Aging and Disability Services Administration Candace (Candy) Goehring MN RN Developing a $tart Up, $ustainability and Financial Plan for CDSMP

2. What is the Stanford University Chronic Disease Self-Management Program? – “The Chronic Disease Self-Management Program is a workshop given two and a half hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with a chronic diseases themselves.” http://patienteducation.stanford.edu/programs/cdsmp.html

3. What is Self-Management Support ? Patient Education 1. Information and skills are taught 2. Usually disease-specific 3. Assumes that knowledge creates behavior change 4. Goal is compliance 5. Health care professionals are the teachers Self Management Support 1. Skills to solve pt. identified problems are taught 2. Skills are applied across conditions/needs 3. Assumes that confidence yields better outcomes 4. Goal is increased self- efficacy 5. Teachers can be professionals or peers

4. What does CDSMP Look Like? Small group setting (10-15 people) Led by two trained leaders, at least one of whom is a peer with a chronic condition Standardized training for leaders Highly structured teaching protocol Standardized participant materials and companion book 2 ½ hours per week; 6 weeks Multiple chronic diseases and symptoms in the same group Focus on self-efficacy, action planning, problem solving, and communication

5. The Evidence Base Research indicates participants spend Fewer days in the hospital Fewer outpatient and ER visits Participants report Improvement in self-reported health and health distress Improvement in social life/activities Improved energy/less fatigue Demonstrated cost-savings http://patienteducation.stanford.edu/bibliog.html

6. Burden of Chronic Disease in WA Today Nearly 3 million case of seven common chronic conditions: – Cancers – Diabetes – Heart disease – Hypertension – Stroke – Mental disorders – Pulmonary conditions Milken Institute (2007)

7. Impact of Chronic Disease 60 % of deaths 84% at high risk 1 million live with chronic diseases 75% of health related spending ($4.9Billion) Lost productivity ($18.2 Billion) Total Cost $23.1 Billion – ( source: BRFSS. Milken, OFM)

8. Two Paths – Two Choices Two Paths, Two Choices — Chronic Disease in Washington TOMORROW On our current path, Washington will experience a dramatic increase in chronic disease in the next 20 years. But there is an alternative path. By making reasonable improvements in preventing and managing chronic disease, we can avoid 746,000 cases of chronic conditions in 2023. – Data Source: Milken Institute

9. Reasonable improvements in preventing and managing chronic disease could reduce future economic costs of disease in Washington sharply, by 28% ($22.6 billion) in 2023. $17.9 billion of this would come from gains in productivity, and $4.6 billion would come from reduced treatment spending. – Data Source: Milken Institute

10. Avoidable Costs in 2023 (Billions) Treatment Expenditures Lost ProductivityTotal Current Path$16.3$63.6$80.0 Alternative Path$11.7$45.7$57.4 Costs Avoided Data Source: Milken Institute $4.6 (28%) $17.9 (28%) $22.6 (28%)

11. HOW CAN WE IMPROVE HEALTH AND REDUCE COSTS WITH CDSMP? Financial Sustainability for Evidence Based Programs: Strategies and Potential Sources of Financing A summary of key ideas and tips for partners to consider (NCOA, CDC, Gordon and Galloway, ebhpprograms@ncoa.org)

12. Financial Sustainability Strategies 1.Need a diversified and reliable long-term funding base with multiple partners. 2.Recruit well connected community members to serve on a sustainability committee. 3.Engage in financial planning – early and active targets. 4.Pay attention to costs as well as revenue. Efficiency and productivity extend the reach of resources

13. Financial Sustainability Strategies 5. Recognize the link between marketing and financial sustainability. 6. Think broadly about the range of assets (referrals, reputation, in-kind resources, materials, facilities). 7. Set priorities and incorporate the program into the state budget (HCBS Waiver) 8. Work with other organizations to incorporate CDSMP into their budgets. 9. Tailor a plan that takes advantage of what is unique about your organization.

14. Potential Sources of Revenue Charities and Philanthropies Medicaid Health Care Organizations Senior Housing Employers Continuing Education Advocacy Strategies Bequest Marketing Charging Participants

15. State Level Work for Sustainability Looking for additional funding from Medicaid, Older Americans Act, private organizations. Living Well Website developed in 2009 to link partners and others in WA who are working on EBDP programs – (http://livingwell.doh.wa.gov)http://livingwell.doh.wa.gov Dissemination to other AAA’s. ADSA and DOH communications with other federal, state and local partners and potential partners. Sharing our stories and collaborating with Oregon, Idaho, and Alaska ARRA grantees. Developed CDSMP/Tomando and PEARLS as a Medicaid waiver service.

16. Home and Community Based Service Waivers Aged, Blind and Disabled (ABD) HCBS Waivers – The WA State ABD waiver is titled Community Options Program Entry System (COPES). – COPES allows clients to choose to receive home and community based services instead of nursing facility care. Once a client is determined functionally and financially eligible for the waiver program, the client chooses where to receive services; at home, in a residential setting, or a nursing facility. Waiver services include personal care services and the categorically needy medical program.

17. WA State COPES Waiver Services Criteria In addition to personal care services, clients can receive other waiver services if they meet the secondary eligibility criteria for these waiver services. Federal rule requires that waiver services not replace other services clients have access to under Medicaid, Medicare, health insurance, LTC insurance, other community or informal resources available to them. Waiver services may not be used when the vendor refuses the reimbursement or considers the payment inadequate from these other resources. Waiver services may not supplement the reimbursement rate from other resources.

18. What are the “other” waiver services? Personal Emergency Response System Home delivered meals Skilled Nursing Transportation Nurse delegation (in-home) Home health aide Environmental modifications Specialized medical equipment Adult Day Care Client training (includes RN, PT,OT,ST, behavior supports, pain management, exercise and self-management programs)

19. Client Training Service Definition Client training needs are identified in the long term care assessment or in a professional evaluation. This service is provided in accordance with a therapeutic goal in the plan of care and includes for example; – Adjustment to serious impairment – Maintenance or restoration of physical functioning – Self-management of chronic disease – Acquisition of skills to address minor depression – Management of personal care – Development of skills to work with care providers including behavior management.

20. Client Training and CDSMP Waiver Authorization CDMSP consists of 6 units, one unit per week, for 6 consecutive weeks. – The unit rate includes the cost of the 2.5 hour class, leader time and all workshop costs and materials. – Providers (individual or agency) must be contracted through the AAA as certified trainers for CDSMP. – The service is provided in accordance with a therapeutic goal in the plan of care. – The service is provided in a manner consistent with protecting and promoting the client’s health and welfare, and appropriate to the client’s physical and psychosocial needs. – The service is provided within the scope of practice of the contractors license and in compliance with professional rules

21. Making the Connection with Chronic Care Management

22. The CDSMP Cost Calculator The National Council on Aging and the Lewin Group developed the CDSMP cost calculator to help organizations better understand and manage the costs of CDSMP You can use the calculator to produce estimated “per participant” and “per workshop” costs. Works for all Stanford University CMSMP related programs (Tomando and Diabetes)

23. CDSMP Cost Centers FTE’sSalaryFringe BenefitsIndirect Costs Personnel and Program Administration Workshop CostsCDSMP LicenseWorkshops Leader Costs# of participants and completers CDSMP workshops held and cancelled Leader Training NCOA Cost Calculator Factors

24. Cost Calculator Access If you have access to the Healthy Aging Online Community http://www.healthyagingcommunity.org/library.htm?mo de=view&did=4328&lid=524&wf=1309 If you do not have access to the Healthy Aging Online Community please visit the following survey link and fill out the required information. https://www.surveymonkey.com/s.aspx?sm=vYNmb7f1jR 41Y_2flm2LSqDA_3d_3d

25. My Contact Information Candace (Candy) Goehring – Aging and Disability Services Administration – 360-725-2562 – goehrcs@dshs.wa.gov goehrcs@dshs.wa.gov