Critical_Issues_Aging-Chronic_Care_Chall

Critical Issues in Aging Addressing the Chronic Care Challenge Through Collaborative CareMarch 27, 2008 : 

Critical Issues in Aging Addressing the Chronic Care Challenge Through Collaborative CareMarch 27, 2008

Addressing the Chronic Care Challenge Through Collaborative Care : 

Addressing the Chronic Care Challenge Through Collaborative Care 2008 NCOA-ASA Annual Meeting Robin Mockenhaupt, RWJF March 27, 2008

Agenda : 

Agenda Chronic Care in the US What will it take to improve care for chronic illness? Role of the Aging Network

The “Take Home” Messages : 

The “Take Home” Messages The Aging Network has a significant opportunity NOW to improve chronic care outcomes The Aging Network should be leaders in integrating chronic care services and systems between health care and the community Effective and timely action will improve outcomes and reduce costs for those we serve

The “Take Home” Messages : 

The “Take Home” Messages The Aging Network has a significant opportunity NOW to improve chronic care outcomes

Chronic Care in the US : 

Chronic Care in the US More than 125 million Americans suffer from one or more chronic illnesses and 40 million limited by them. Despite annual spending of nearly $1 trillion and significant advances in care, one-half or more of patients still don’t receive appropriate care. Gaps in quality care lead to thousands of avoidable deaths each year. Best practices could avoid an estimated 41 million sick days and more than $11 billion annually in lost productivity. Patients and families increasingly recognize the defects in their care.

Slide 7: 

Prevalence of Select Chronic Conditions, 2003 US Adults Ages 65 and Over Prevalence estimates from the NHIS

Number of Chronic Conditions per Medicare Beneficiary : 

Number of Chronic Conditions per Medicare Beneficiary 63% 95%

Changing Outcomes = Fundamental Change : 

Changing Outcomes = Fundamental Change Effective practice changes are similar across conditions influencing physician behavior, better use of non-physician team members, enhancements to information systems, planned encounters modern self-management support care management for high risk patients prepared and engaged community resources

Slide 10: 

Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team DeliverySystem Design Decision Support ClinicalInformationSystems Self-Management Support Health System Resources and Policies Community Health Care Organization Chronic Care Model Improved Outcomes

Self-Management Support : 

Self-Management Support Emphasize the patient's central role. Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving, and follow-up. Organize resources to provide support.

Community Resources and Policies : 

Community Resources and Policies Encourage patients to participate in effective programs. Form partnerships with community organizations to support or develop programs. Advocate for policies to improve care.

What will it take to improve care for chronic illness? : 

What will it take to improve care for chronic illness? End the complacency* US 30th in life expectancy (Cuba is 29th) Rank among the lowest of Western countries in other health indicators 40–50% more expensive than other countries Nearly 1 in 6 have no health insurance; 25% higher mortality rate Significant racial, ethnic and income disparities *Ed Wagner, MD, AGS, 2007

What will it take to improve Care for Chronic Illness? : 

What will it take to improve Care for Chronic Illness? We know that the current care systems cannot do the job Need to change care systems Major stakeholders need to be involved and committed to improvement Payers, plans, providers, patients Regional Quality Improvement Shared data and performance management

What will it take to improve care for chronic illness? : 

What will it take to improve care for chronic illness? Engaging consumers Report cards and public info Consumer education Improving health care delivery and systems IT tools QI strategies Consensus guidelines Care management Aligning benefits/financing Incentives, measures and rewards

What will it take to improve care for Chronic Illness? : 

What will it take to improve care for Chronic Illness? Someone needs to take and thenassure leadership… Political leaders? Providers? Plans? Payers? Patients? Why not the Aging Network?

The “Take Home” Messages : 

The “Take Home” Messages The Aging Network should be leaders in integrating chronic care services and systems between health care and the community

Slide 18: 

Aging Network Aging Network Aging Network Aging Network

The “Take Home” Messages : 

The “Take Home” Messages Effective and timely action will improve outcomes and reduce costs for those we serve… …What can you do?

The Role of the Aging Network in Addressing the Chronic Care Challenge : 

The Role of the Aging Network in Addressing the Chronic Care Challenge John Wren Deputy Assistant Secretary for Policy & Management U.S. Administration on Aging March 27, 2008

Aging Services Network : 

Aging Services Network U.S. Administration on Aging Central Office and Regional Offices Area Agencies on Aging (655) Local Service Providers (29,000) State Units on Aging (56) CONSUMERS Older People & Family Caregivers (10,000,000)

Strategies for Modernizing the Aging Network’s Role in Health & LTC : 

Strategies for Modernizing the Aging Network’s Role in Health & LTC Help seniors take more control of their health --- Evidence-Based Prevention Program Make it easier for consumers to learn about & access care options --- Aging & Disability “one stop shop” Resource Centers Provide more choices for high-risk individuals --- Nursing Home Diversion Programs

Key Elements of AoA’s Prevention Strategy : 

Key Elements of AoA’s Prevention Strategy Evidence-Based Models Partnerships Funding and Technical Assistance

AoA Evidence-Based Prevention Initiative : 

AoA Evidence-Based Prevention Initiative 2003 -- Community Projects in 12 Sites -- National Technical Assistance Center 2004 on-going -- Workshops & National Learning Networks for States 2006 -- 24 State Projects 2007 -- Hispanic Health Disparity Initiative - 8 cities

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Metropolitan Area Projects of HHS Hispanic Elders Health Initiative Evidence Based Disease Prevention Projects MA State Projects Funded by Atlantic Philanthropies

Private Foundation Partners : 

Private Foundation Partners Archstone Atlantic Philanthropies Baptist Health Foundation of San Antonio Barbara Henley Foundation Brown Foundation California Community Foundation California Endowment California Healthcare Foundation Colorado Health Foundation Comprehensive Health Education Foundation Davis Family Foundation Donaghue Medical Research Foundation Elwood Foundation Frees Foundation Grand Rapids Community Foundation Health Foundation of South Florida Healthcare & Nursing Education Foundation Horizon Foundation Houston Endowment, Inc. Isla Carroll Turner Friendship Trust John A. Hartford Kaiser Foundation Health Plan Kronkosky Foundation Merck Institute for Aging & Health Northwest Health Foundation PacificSource Charitable Foundation Piper Trust Robert Wood Johnson Rockwell Fund St. Luke’s Health Foundation TXU Energy Unihealth Foundation United Way Weinberg Foundation Wellness Foundation William Bingham 2nd Betterment Fund

AoA Evidence-Based Prevention Initiative : 

AoA Evidence-Based Prevention Initiative 2008 Activities - -- Cost studies on 3 programs -- Partnerships with QIOs -- Linking Participants to Medicare Claims Data -- Assessing Feasibility of Medicare Reimbursement for Stanford Diabetes Self-Management Program

Contact Information : 

Contact Information John Wren Deputy Assistant Secretary for Policy & Management U.S. Administration on Aging (202) 357-3460 John.Wren@aoa.hhs.gov

Addressing the Chronic Care Challenge Through Collaborative Care The Medical Perspective : 

Addressing the Chronic Care Challenge Through Collaborative Care The Medical Perspective Rob Schreiber, M.D. Physician-in-Chief Hebrew SeniorLife Harvard Medical School Boston, MA

The Wake Up Call:Medicare Expenditures David Walker General Comptroller of the US : 

The Wake Up Call:Medicare Expenditures David Walker General Comptroller of the US In 2040, “if nothing changes, the federal government's not gonna be able to do much more than pay interest on the mounting debt and some entitlement benefits. It won't have money left for anything else – national defense, homeland security, education, you name it,"

The New Environment for Community Based Organizations : 

The New Environment for Community Based Organizations Is your organization going to be relevant? Do you provide value to the social and health system? How do you demonstrate and measure it? Leadership and vision is needed Is their organizational readiness to implement change?

Slide 32: 

The Expanded Chronic Care Model, (Barr, Robinson, Marin-Link, Underhill, Dotts, Ravensdale, & Salivaras, 2003).

The Challenge : 

The Challenge CBOS have significant difficulty working with the medical care system Silo mentality still is the norm Leveraging your reputation and connections not effective here How do CBOS and the Health Care system build consensus to serve a population as envisioned by the Expanded Chronic Care Model?

Seek to Understand the Health Care Provider : 

Seek to Understand the Health Care Provider Measurement and scientific method is the rule Evidence-based decision making is the “standard of care” for health care providers Outcomes are critically important to demonstrate value and effectiveness Evidenced-based approaches and initiatives have been lacking in the vast majority of CBO

Barriers Connecting with Health Care Providers : 

Barriers Connecting with Health Care Providers Clinicians are very busy and are hard to engage Clinician behavior is regarded as relatively hard to influence and practice styles vary Changing clinician behavior requires understanding how physicians prescribe, refer and communicate Take Home Point: Start “EB” programs before there is support from providers

How Do Senior Care Agencies Integrate into the System? : 

How Do Senior Care Agencies Integrate into the System? Develop coalitions focusing on healthy aging initiatives-invite medical care providers Build programs and they will come AoA Evidence-based disease prevention programs Use of existing funds for community education, outreach, marketing funneled into funding these programs Do not depend on up-front support of medical community Advocate for the role of the Aging Network with legislators

Best Practices in Physical Activity : 

Best Practices in Physical Activity http://www.healthyagingprograms.org/content.asp?sectionid=73&ElementID=98 Cress, M.E., Buchner, D.M., Prohaska, T., Rimmer, J., Brown, M., Macera, C., DiPietro, L., Chodzko-Zajko, W. (2004). ACSM Best Practices Statement—Physical activity programs and behavior counseling in older adult population. Medicine and Science in Sports and Exercise, 36,11, 19917-2003.

Essential Features of Self-Management Programs : 

Essential Features of Self-Management Programs Self-management is defined as the tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions. Adams et al., 2004 http://www.nap.edu/catalog/11085.html

Need to Engage Physicians and the Medical Care System : 

Need to Engage Physicians and the Medical Care System Need to clarify your vision and strategy Develop an understanding of what is needed by medical care community to help them succeed Need to find physician champion(s)-opinion leader Develop programs that are well-established, accessible and on going Feedback to the providers of medical care the outcomes that occur

CBOS Engaging Physicians with Evidenced-Based Programs : 

CBOS Engaging Physicians with Evidenced-Based Programs Marketing programs smartly Keep it simple Available and accessible Be Prepared to Answer “What is the evidence”? “Will it really work for my patients”?? “What is in it for me” (WIIIFM)?

Talking Points to the Medical Community and Physicians : 

Talking Points to the Medical Community and Physicians National initiative AoA, CDC, AHRQ, CMS State governments agencies are leading this change Improve quality of care and satisfaction Increase demand for provider’s services P4P $ now attached to medical care practice Posting of outcomes of providers by payers

The Role of the Engaged Aging Network : 

The Role of the Engaged Aging Network Mentor other provider organizations Work collaboratively to promote Health Aging Initiatives and Disease Prevention Leveraging your connections with other medical providers, hospitals Work with your State Legislators Continue to innovate

Slide 43: 

“Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world." -- Joel Barker

How the Aging Network Can Help Meet the Chronic Care Challenge : 

How the Aging Network Can Help Meet the Chronic Care Challenge James Firman NCOA President & CEO March 27, 2008

US Federal Spending in Billions, 2006 : 

US Federal Spending in Billions, 2006

Developing and Strengthening the Community Portion of the Chronic Care Model : 

Developing and Strengthening the Community Portion of the Chronic Care Model COMMUNITY ORGANIZATIONS Advocate for policies that improve health HEALTHCARE ORGANIZATIONS Self Management Support Decision Support Delivery System Design Clinical Information Systems Prepared Proactive Practice Team Prepared Proactive Community Partners Productive Interactions & Relationships Improved Health and Functional Outcomes Provide gap-filling and linkage services = Where Aging Network can help Increase access to benefits and services AGING NETWORK

Barriers to greater participation of the aging network in chronic care : 

Barriers to greater participation of the aging network in chronic care Lack of business case about the value of community-based EBP and other community-based services A disorganized, “non-network” of aging services The need for greater business acumen “Utilities”problem Lack of incentives for fee-for-service health care providers to reduce overall utilization/expenditures

What the Aging Network Needs to do to Make Markets Work” for Community-based Chronic Care : 

What the Aging Network Needs to do to Make Markets Work” for Community-based Chronic Care Get out of the “services” business and into the “outcomes” business Prove that programs achieve improvements in health status and pay for themselves (at least on marginal cost basis) Make it easier and “safer” for regional and national payers to contract with local aging service providers. Centralize more of the contracting and other business functions Organize itself to achieve scale across payers and across markets

What Would Long-term Success Look Like? : 

What Would Long-term Success Look Like? Significant improvements in health outcomes for millions of older adults Demonstrated increase in number/degree of “informed, activated patients/consumers” Demonstrable net savings to Medicare, Medicaid and Managed Care Organizations At least $1 billion of Medicare funds flow annually to community-based organizations in the aging network for chronic care services Contracted network(s) are robust, growing social enterprise(s) Public policy changes support a greater role for the aging network.