1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Guiding Principles

11. # 1 Do No Harm to Categorical Program Integrity
Address a specific need
Accountable to funders  *
Burden Definition Principles Integration Points Examples Take Away

12. # 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

13. # 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

14. # 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

15. # 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

16. # 6 Engage Stakeholders Evolution, not revolution Need, not just want
Shared decision making, not directive
Burden Definition Principles Integration Points Examples Take Away

17. 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

18. Points of Integration

19. 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

20. 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

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

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

23. 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

24. Program Integration: What’s Happening in States?

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

26. 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

27. PROGRAM INTEGRATION ACTIVITIES
NACDD
PROGRAM INTEGRATION ACTIVITIES

28. 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

29. 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

30. 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

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

32. For Additional Information
 Woodcock Blvd. Suite Atlanta, Georgia 30341
NACDD (770) 
Lorrie Graaf (515) 
Burden Definition Principles Integration Points Examples Take Away