Evidence-Based Interventions for Chronic Conditions ...€¦ · New York State Department of Health...
Transcript of Evidence-Based Interventions for Chronic Conditions ...€¦ · New York State Department of Health...
![Page 1: Evidence-Based Interventions for Chronic Conditions ...€¦ · New York State Department of Health Celeste Roeller Harp, MRP Intervention Coordinator, NYS Arthritis Program 518-408-5142](https://reader033.fdocuments.in/reader033/viewer/2022050400/5f7e06814da37c25a3060746/html5/thumbnails/1.jpg)
Evidence-Based Interventions for Chronic Conditions:
Chronic Disease Self-Management Financial Sustainability
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October 23, 2017 2
Introductions
• Jan Kaelin-Kee: NYSDOH Mohawk Valley CDSME
• Nancy Katagiri: NYSDOH Arthritis Program
• Dr. John May: Mohawk Valley PHIP
• Aletha Sprague: Mohawk Valley PHIP
Part of the team and spoke last month:
Celeste Harp: NYSDOH Arthritis Program
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October 23, 2017 3
Agenda
• Return on Investment
• Current Picture of Reimbursement
• Other Mechanisms for Sustainability
• Questions and Discussion
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October 23, 2017 4
Return on Investment• Value Propositions:• explains how your product solves customers' problems
or improves their situation (relevancy),
• delivers specific benefits (quantified value),
• tells the ideal customer why they should buy from you
and not from the competition (unique differentiation).
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October 23, 2017 5
Return on Investment• Value Propositions:• explains how your product solves customers' problems or improves their situation (relevancy),
• Increase communication and quality of life– Improved communications with clinicians
– Increased self-efficacy for management
– Increased activity and energy level
– Improved symptom management
– Decreased health distress
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October 23, 2017 6
Return on Investment• Value Propositions:• explains how your product solves customers' problems or improves their situation (relevancy),
• Increase communication and quality of life• delivers specific benefits (quantified value),
• Decrease hospital / ER use
• 5% decline in ER visits at 6 mos. and 12 mos.
• 5% decline in re-hospitalizations at 6 mos.
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October 23, 2017 7
Return on Investment• Value Propositions:• explains how your product solves customers' problems or improves their situation (relevancy),
• Increase communication and quality of life• delivers specific benefits (quantified value),
• Decrease hospital / ER use• tells the ideal customer why they should buy from you and not from the competition (unique
differentiation).
• No Pharma• Cost
• Side-effects
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October 23, 2017 8
Return on Investment
• Self-management Programs:
• Increase communication and quality of life
• Decrease hospital / ER use
• Without pharmaceuticals
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October 23, 2017 9
Return on InvestmentCosts
• Certification of trainers – variable – currently low
• Individual materials - $25
• Shared expenses for class of ten– Trainers – 2 @ $500 - $100
– Class materials - $5
– Site costs x 6 sessions - $60
$165
• Total $190
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October 23, 2017 10
Return on Investment
– Costs $190 to individual patient
– Savings (at 12 mos.)
• $900 (Lorig, Medical Care 2001)
• $714 (Ahn, BMC Public Health 2013)
• $3.3B annually with 5% participation
(Ahn, BMC Public Health 2013)
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October 23, 2017 11
Current Reimbursement Picture
• National Efforts
• CDSME in New York State
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October 23, 2017 12
National Efforts: Unified Contracting
• One stop shopping for insurance companies
• Benefits
– One point of contact for payers
– CBO’s can share resources
• Challenges
– Logistics
– Time consuming
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October 23, 2017 13
National Efforts:
Diabetes Insurance Reimbursement• Two diabetes self-management
interventions covered
– Diabetes Self-Management Education (DSME)
• This is not the Diabetes Self-Management Program (DSMP)
– National Diabetes Prevention Program
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October 23, 2017 14
Considerations of Chronic Disease
Self-Management
• Self-efficacy
• Peer-led services
• Local data
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October 23, 2017 15
Opportunities of Chronic Disease-
Self Management• Insurers care about consumer
satisfaction
– Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
• Chronic disease programs offer an answer to the needs of hospitals
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October 23, 2017 16
CDSMP in New York State
• Western NY Integrated Care Collaborative
– Funding from the Health Foundation
– Medicare certification for reimbursement for
DSMP as initial step
– Collaborating with insurers to become peer
leaders
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October 23, 2017 17
CDSMP in New York State
• Bassett Healthcare Network (Self-Insured)
– Excellus Accountable Cost & Quality
Arrangements (ACQA)
– Similar to an Accountable Care Organization
• Emphasis on physician-patient engagement
• Preventive care, patient safety and chronic illness
management
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October 23, 2017 18
OTHER SUSTAINABILITY
MECHANISMS
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October 23, 2017 19
Area Agencies on Aging
• Title IIID of the Older Americans Act
• Required support for evidence-based
interventions
– AAA
– Partner support
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October 23, 2017 20
Local Health Departments
• Article 6 reimbursement
– Promotion activities
– Some delivery
• Additional resources
– CDSMP materials
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October 23, 2017 21
Delivery System Reform Incentive
Payment (DSRIP) Program• Reduce avoidable hospital use by 25% over
5 years
• Domain 3 Project 3.b.ii– Evidence-based strategies to address chronic
disease
• Domain 4 Project 4.b.ii– Access to chronic disease preventive care and
management
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October 23, 2017 22
Other Opportunities
• Peer leader trainings
• Worksite CDSMP
– Organization support for employee
participation
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October 23, 2017 23
QUESTIONS AND DISCUSSION
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October 23, 2017 24
THANK YOU
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October 23, 2017 25
Contact InformationNew York State Department of Health
Celeste Roeller Harp, MRP Intervention Coordinator, NYS Arthritis Program518-408-5142 [email protected]
Nancy Katagiri, MPH, CPH NYS Arthritis Program Coordinator518-408-5142 [email protected]
Jan Kaelin-Kee, MSW, MS Ed Senior Health Program CoordinatorCDSME in the Mohawk Valley Initiative518-408-5142 [email protected]
Mohawk Valley Population Health Improvement Program
Aletha Sprague Mohawk Valley PHIP Supervisor 607-547-7639 [email protected]
John May, MD Mohawk Valley PHIP Program Lead and Primary [email protected]