1. Referring to Health Self Management Programs: the five whys for providers

2. - Possible Agenda- 10 min- introductions 5 min-warmup *https://youtu.be/uRQ853sRt0ohttps://youtu.be/uRQ853sRt0o 5 min- take pre-questions 10 min- tell us more about patients & your site’s history with programming 30 min- The five whys for providers Questions? *CCMI would like to acknowledge funding support from the Ministry of Health Patients as Partners Program for making this video possible

3. #1: Chronic Disease is the #1 health problem in the US

4. Chronic Disease in the United States The #1 cause of death and disability Accounts for 75% of the nation’s health care spending Two thirds of the increase in health care spending is due to the increased prevalence of treated chronic disease Research proves majority of cases of chronic diseases could be prevented

5. Source: CDC Report on Multiple Chronic Conditions Among Adults; Chart: Lauren Giordano / The Atlantic

6. Chronic Disease in the United States In 2010, chronic diseases represented 7 of the top 10 causes of death in the U.S. Source: Indicators for Chronic Disease Surveillance - United States 2013 Deaths: Final Data for 2010, National Vital Statistics Report 2013 Heart Disease Cancer Chronic Lower Respiratory Diseases Stroke Alzheimer’s Disease Diabetes Kidney Disease

7. #2: California is special -Los Angeles county is even more so....

8. Chronic Disease in California Half of the cost of chronic disease care in California result from heart disease, diabetes, high blood pressure and chronic obstructive pulmonary disease (COPD) Individuals with multiple chronic conditions (20% of population) account for 60% of the state’s health care expenditures California Health Care Almanac, http://www.chcf.org/publications/2015/04/chronic- conditions-californians

9. Economic Burden of Chronic Conditions in California

10. Chronic Diseases in Los Angeles County http://www.nap.edu/read/12830/chapter/5

11. #3: By referring to Health Self- Management programs providers have a vehicle to address social determinants of health

12. Chronic Disease Indicators INCOME Education Employment http://infobase.phac-aspc.gc.ca/cdiif/

13. Adults living under 138% of the federal poverty level are more likely to have two or more chronic conditions compared to those in the highest income group (400% FPL)

14. Population Health Chronic diseases continue to be a public health problem in the United States Studies have shown that race and socioeconomic status are two of the main determining factors to an individual developing a chronic disease Closing the gaps related to availability of resources and decreasing the prevalence of chronic diseases should continue to be a public health goal

16. The Triple Aim

17. Chronic Diseases and the correlation between hospital admissions

18. Heart Disease Overall, adults with heart disease had nearly twice the rate of emergency department visits as the overall California adult population which is an estimated 38%

19. Diabetes Among adults with diabetes, more than one in four reported visiting the emergency department in the past year, and nearly one- fourth of those visits were diabetes-related

20. Chronic Obstructive Pulmonary Disease (COPD)

21. Hospital Admissions and Chronic Diseases

22. Health Services Utilization Compared to those with only one chronic condition, people with multiple chronic conditions used substantially more services and products, especially hospital care and prescription drugs

23. Cost Savings…

24. Healthcare Cost Savings Self-Management programs can improve healthcare delivery through: – Increased patient-physician communication – Better Education on medication utilization – Patient activation and self efficacy Healthcare Cost Savings Estimator Tool http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410329/

25. Healthcare Cost Savings Self-Management Program participants demonstrate: – Improved self-reported general health – Fewer social activity limitations – Increased physical activity – Decrease in depression, fatigue, and pain Healthcare Cost Savings Estimator Tool http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410329/

26. Healthcare Cost Savings Cost savings are achieved through these programs by: – Healthcare utilization decreasing – Reduced hospitalizations, ER visits, LOS (Length of stays) **Average saving per CDSMP participant= $364 which amounts to $3.3 billion of national savings

27. 4: Referring to Health Self- Management programs helps to build sustainable relationships

28. Why Self-Management Programs? Benefits for the patients – Reduces disease symptoms – Improves quality of life – Allows patients to be active partners in their health – Improves communication with doctor – Allows individuals to be more active and independent

29. Why Self-Management Programs? Benefits for the health care system – Fewer hospital readmissions – Increase in availability of beds for inpatient treatment – Decreased cost

30. Return on Investment Large healthcare system – 2014 invested $1.4 million Provided CDMSE to 7,000 patients 3 month follow-up showed only 7% of participants utilized Emergency Department or were hospitalized for chronic condition

31. Self-Management Interventions Effective, affordable and EVIDENCE-BASED Convenience of class offerings Taught by trained and certified instructors Evidence evaluated by reputable universities and organizations

32. Types of Interventions Self-Management Education workshops – Provides opportunity for developing skills and the confidence to manage health conditions Physical activity classes Exercise classes – Provides techniques to exercise safely without worsening conditions

33. GROUP HEALTH Hear how patients with chronic conditions live healthier lives - by working together. https://youtu.be/3x0GCipm_ZE Group Health: Published on Jan 2, 2014

34. Self-Management Education Workshops 2- 2 ½ hour workshops 6-8 week programs Addresses a variety of chronic conditions Teaches participants techniques to deal with pain, fatigue, physical limitations, etc Incorporates behavioral skills such as goal-setting, problem-solving, overcoming barriers, etc

35. Physical Activity Classes 1-3 classes per week Practice balancing, stretching, endurance, strength training Modified for different skill and ability levels Increases confidence in managing health

36. Exercise classes 1-3 classes per week, 6 weeks for 1 hour per week Improved range of motion Increased physical activity Increased joint flexibility Improved self-rated health Maintenance of muscle strength

37. Caregivers Caring for a disabled family member can be: – challenging – impacting to the caregivers mental health – threaten the quality of life of the caregiver – altering to social relationships

38. Program effects on Caregivers Decreases depressive symptoms in caregivers Reduces burden Increases coping skills

39. #5: YOU have the ability to influence what your patient decides to do!

40. Provider Recommendations Provider referrals make patients more likely to attend self-management classes Provider influence is of more importance to the patient than one would think – Patients VALUE their providers opinions

41. What can Providers do? Order brochures to be provided to patient from electronic medical record (EMR) Encourage class referrals in team huddles and emails Insert messages pertaining to classes into After Visit Summary notes to be given to the patients Recommend local classes through utilization of the Healthier Living website Encourage patients to start classes before symptoms become severe

42. Self-Management Programs Include… Arthritis Foundation Exercise Program Chronic Disease Self- Management Programs (CDSMP) Tomando Control de su Salud Walk with Ease Chronic Pain Self- Management Diabetes Self-Management Manejo Personal de la Diabetes (Spanish Diabetes Self-Management) Camine con gusto (Spanish Walk with Ease) Un Asunto de Equilibrio: Controlando el Temor a Caerse (Matter of Balance)

43. References California Health Care Foundation http://www.chcf.org/publications/2015/04/chronic-conditions-californians Economic Burden of Chronic Disease in CA, 2015 http://www.cdph.ca.gov/programs/cdcb/Documents/CDPHEconomicBurdenCD2015California.pdf http://www.cdph.ca.gov/programs/cdcb/Documents/CDPHEconomicBurdenCD2015California.pdf Implementing CDSMP in an integrated health care system http://www.nhpf.org/library/handouts/Wicklund.slides_10-02-09.pdf Healthcare Cost Savings Estimator Tool for Chronic Disease Self-Management Program http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410329/ Effect of a Self-management Program on Patients with Chronic Disease, 2001 http://ecp.acponline.org/novdec01/lorig.htm California Health Care Almanac California Health Care Almanac http://www.chcf.org/publications/2015/04/chronic-conditions-californians Ory MG, Ahn SN, Jiang L, Lorig K, Ritter P, Laurent DL, Whitelaw N, Smith ML: National Study of Chronic Disease Self-Management; Six Month Outcome Findings. J Aging Health: 2013, 25:1258 Qin, J., Theis, K.A., Barbour, K.E., et.al. Impact of arthritis and multiple chronic conditions on selected life domains – United States, 2013. MMWR 2015; 64:578-582. Indicators for Chronic Disease Surveillance - United States 2013 Deaths: Final Data for 2010, National Vital Statistics Report 2013 Caregiver Support interventions http://cssr-pw01.berkeley.edu/pdfs/famcare_04.pdf