1. Building Community Partnerships for Health June Simmons Partners in Care Foundation

2.  The shift to health – from health care  The new demographics of health  The Chronic Care Model

3.  50% of Americans have a chronic condition ◦ 25% have multiple chronic conditions.  7 of 10 deaths in US each year due to chronic disease  7% of Medicaid population but 54% of costs  80% of health care costs go to 20% of patients -- those with chronic diseases

4.  Largest and most diverse state: ◦ 38 million residents ◦ 3.9 million residents ages 65+ (10%) 1  62% of all older people report having 2+ chronic conditions 2,3  58% of older Californians have some type of arthritis 4  14.8% of CA seniors suffer from diabetes 5  30% of the state’s elderly minorities are diabetic 5  Heart disease accounts for 29% of the state’s deaths 6 1 CDC. Population Estimate 2006. 2Yen I, Trupin L, Yelin E. The relationship between health and employment. San Francisco, CA: Institute for Health Policy Studies; 2001. 3 Partnership for Solutions. Chronic conditions: Making the case for ongoing care. Baltimore, MD: Johns Hopkins University; 2002. 4 Lund LE. Prevalence of Arthritis in California Counties, 2001: Center for Health Statistics; December 2003. 5 Lund LE. Prevalence of Diabetes in California Counties: 2003 Update: Center for Health Statistics; February 2005. 6 CDC. Chronic diseases: The leading causes of death California. CDC. Available at: http://www.cdc.gov/nccd php/publications/factsheet/chronicDisease/California.ntml. Accessed 8/1, 2006.

5. Age % 65 years old and over10.7% Ethnic Background % White persons, not Hispanic44.5% % Persons Hispanic or Latino34.7% % Asian persons12.1% % Black persons6.8% % Other1.9% Socio-economic Characteristics % Of Medi-Cal beneficiaries20.5% % Below Poverty8.1% % Near Poor (0-199% of Poverty)28.6% % Limited English Proficient16.9% Health/Functional Status Fair or Poor Health29.6% Have any disability42.2% Sedentary Lifestyle37.2% Arthritis/Moderately or highly limited in daily activities57.7% Diabetes — Ever Diagnosed14.8% Hypertension — Ever Diagnosed53.5% Heart Disease — Ever Diagnosed23.7% Impaired Activities Due to Emotional Problems Last Month11.5%

7.  Development of New Evidence-Based Health Promotion Models  Transformation of the Aging Network  What is Evidence-Based

9.  A New Vision is Being Crafted ◦ Health Care Providers do not have to solve the problem of chronic disease alone ◦ There are powerful, proven programs available  New strategies are being developed and tested to take these new programs to scale

10.  Peer-led, 2-hour sessions for 6 weeks  Any chronic disease  Focus on goals and action plans  Techniques to deal with problems such as frustration, fatigue, pain and isolation  Appropriate exercise for maintaining and improving strength, flexibility, and endurance  Appropriate use of medications  Communicating effectively with family, friends, and health professionals  Nutrition  How to evaluate new treatments.

11.  After 12 months, significant improvement in: ◦ Amount of exercise (ROM & aerobic), ◦ Cognitive symptom management ◦ Communication with physicians ◦ Self-efficacy – Confidence in coping ◦ Health status (fatigue, shortness of breath, pain, role function, depression, health distress) ◦ Utilization:  Emergency department (ED) visits  Physician visits  Hospital days  Spanish version available; Effective among minorities

12.  Arkansas  Arizona  California  Colorado  Connecticut  Florida  Hawaii  Idaho  Illinois  Indiana  Iowa  Maine  Maryland  Massachusetts  Michigan  Minnesota  New Jersey  New York  North Carolina  Ohio  Oklahoma  Oregon  Rhode Island  South Carolina  Texas  Washington  Wisconsin

13.  Health care cost savings in programs that improve quality of life  CMS working with AoA at national level – Move senior centers from recreation to wellness  Aging Departments working with Public Health at state level – Fall prevention, flu, etc.  Locally, health care and aging/disability service providers pursuing goal of individual responsibility and empowerment in self-care

14.  How can we reach real scale  Tobacco is a good example of the model of change  How do we engage people in this change?  Physicians are proven most powerful referral source

15.  3.9 million older adults  Chronic disease summary  Strategies to reach evolving  Want to build a “distribution system” that is scalable and sustainable

16. Evidence- Based Project Office Public Health Sector Senior Housing Sites Hospitals Health Plans Physician Groups Community Colleges Faith- Based Orgs Mental Health Sector Senior Centers Parks and Rec. Target Sectors For ADOPTION/ENGAGEMENT

17.  New Partnerships to identify and engage older adults  Physician practices a location where many elders are seen  Physicians can identify those with chronic conditions  Physician referral is the most powerful tool

18.  Emphasize patient responsibility  Empower the patient – You CAN do it!  Know the resources  Write the prescription – for all chronic conditions  Follow-up encouragement  What changes did you make? Physician is the most powerful influence in patients signing up for and completing the 6-week program

19.  Community Colleges and K-12 offer free non-credit education to older adults  Paid for attendance  Can add new curricula  Have marketing in place  Teach in community settings

20.  Quality of life is at stake  The health dollar is at stake  With new knowledge and methods, we must transform community understanding  Mobilize the population to rise to the challenge  Take on the leadership