Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 1
NCOA presentation, May 2018
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 2
NCOA’s Center for Benefits Access
• Funded through cooperative agreement with ACL
• Help low-income Medicare beneficiaries access benefits
through community & online solutions
• Resource Center for state Medicare Improvements for
Patients & Providers Act (MIPPA) grantees (SHIPs -
Pennsylvania’s APPRISE, AAAs, ADRCs,).
• Support network of community organizations and state
agencies serving as Benefits Enrollment Centers (BECs)
• BenefitsCheckUp® online screening tool
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 3
State Health Insurance Assistance Program help with:
Understanding Medicare Eligibility
and Benefits
Enrolling in Medicare, Extra Help
and Medicare Savings Programs
Navigating the Medicare Program
3
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 4
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 5
Find Your Local SHIP
https://www.medicare.gov
1-800-MEDICARE
Locate a SHIP at
1-877-839-2675
www.shiptacenter.org
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 6
Role of APPRISE in 10 Keys to Healthy Living
• Partnered with University of Pittsburgh’s Graduate School of
Public Health
• Promoted the 10 Keys to Healthy Aging to individuals
attending outreach/enrollment events and Medicare health
and wellness events
• Attended all 10 Keys to Healthy Living workshops to provide:
o Counseling on Medicare preventative benefits that coincided with the
Healthy Key for that day, and
o Information on the programs that reduce Medicare health and drug
costs and assist with eligibility and enrollment
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 7
Key – Lower Systolic Blood Pressure
• Obesity = body mass index (BMI) ≥
30 kg/m2
• Intensive behavioral therapy
consists of
o Screening for obesity using BMI
measurement
o Dietary (nutritional) assessment
o Intensive behavioral counseling
and therapy
o In primary care setting
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 8
Key – Lower Systolic Blood Pressure (cont.)
• Coverage includes
o One face-to-face visit every week for the first month
o Then every other week for months 2–6
o Then every month for months 7–12
▪ Must lose 6.6 lbs. in first 6 months to continue
• No cost if primary care doctor/practitioner accepts
assignment
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 9
Key - Participate in Cancer Screenings
Breast Cancer Screenings (Mammograms)
• Covered for all women with Medicare
o One baseline mammogram ▪ Between 35 and 39
o Once a year starting at 40
• No cost if provider accepts assignment
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 10
▪ Financed by Medicaid; help pay Medicare premiums and cost-
sharing for those with low income/assets
• Three programs: QMB, SLMB, QI
• Apply through Medicaid office
▪ Qualify with income up to 135% Federal poverty level and
resources below established asset test
• Several states have more generous income and asset
thresholds
▪ Eliminate Medicare late enrollment penalties
▪ Annual value of the benefit estimated at $1,608
Medicare Savings Programs (MSPs)
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 11
Extra Help/Part D Low Income Subsidy (LIS)
▪ Administered by Social Security Administration and Medicare
▪ Helps pay Medicare Part D (drug plan) costs for people with limited income/resources (income below 150% FPL and resources below established asset test)
▪ People pay between $1.25 and $8.35 for drugs at pharmacy
▪ Eliminates the drug coverage gap (“donut hole”)
▪ No late enrollment penalties
▪ Annual value of the benefit estimated at $4,000
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 12
Closing the Enrollment Gap
Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 13
APPRISE Contribution to the 10 Keys to Health Living
✓ Explained and confirmed Medicare’s coverage for preventive benefits
✓ Provided strategies to limit Medicare’s out-of-pocket costs
✓ Introduced a trusted partner to help overcome obstacles
✓ Eased access to Medicare Savings Programs
✓ Recognized Medicare beneficiaries as multi-faceted consumers
13
Director and Core Research Project PI: Anne B. Newman, MD, MPH
Co-Director: Steven M. Albert, PhD
Core Research Project Co-Investigators: Elizabeth M. Venditti, PhD; Steven M. Albert, PhD; Robert M. Boudreau, PhD; Michelle E. Danielson, PhD
Deputy/Program Director: Michelle E. Danielson, PhD
The mission of the CAPH-PRC is to promote healthy aging by addressing preventable disability and mortality in older adults in our region via
interdisciplinary research, teaching, and practice.
University of Pittsburgh CAPH-PRC
Major Initiatives
• Mobility & Vitality Lifestyle Program (core research project)
o Aimed at reducing obesity & improving mobility in adults ages 60-75
o 32-session behavioral activation program lead by trained CHWs at 26 community-based sites
o Outcomes include weight loss and physical function
• “10 Keys”TM to Healthy Aging (center core project)
o Online training modules
o Collaborators: State & local health depts.; PA Dept. of Aging (APPRISE); UPMC for Life; Arthritis Foundation Exercise Program
• Healthy Steps in Motion
o Falls prevention – PA Dept. of Aging
• Other Partnerships
• UPMC Aging Institute, Jewish Healthcare Foundation, Alzheimer’s Disease Research Center
NCOA presentation, May 2018
Assumptions Inputs Activities Outputs Short Term Outcomes
Long Term Outcomes
• Many older adults are unaware of disease prevention targets
• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care
• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk
• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits
• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation
Assumptions Inputs Activities Outputs Short Term Outcomes
Long Term Outcomes
• Many older adults are unaware of disease prevention targets
• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care
• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk
• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits
• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation
• Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA)
• 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders
• PA PrimeTimeHealth (PA Department of Aging)
• APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services)
• County Area Agencies on Aging (PA Department of Aging)
Assumptions Inputs Activities Outputs Short Term Outcomes
Long Term Outcomes
• Many older adults are unaware of disease prevention targets
• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care
• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk
• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits
• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation
• Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA)
• 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders
• PA PrimeTimeHealth (PA Department of Aging)
• APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services)
• County Area Agencies on Aging (PA Department of Aging)
• PA PrimeTimeHealth coordinates delivery of APPRISE/10 Keys programs in senior centers
• 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website
• 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components
• Completion of demographic form and pre- and post-test prevention knowledge; 6-month telephone follow-up to track behavior change
Assumptions Inputs Activities Outputs Short Term Outcomes
Long Term Outcomes
• Many older adults are unaware of disease prevention targets
• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care
• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk
• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits
• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation
• Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA)
• 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders
• PA PrimeTimeHealth (PA Department of Aging)
• APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services)
• County Area Agencies on Aging (PA Department of Aging)
• PA PrimeTimeHealth coordinates delivery of APPRISE/10 Keys programs in senior centers
• 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website
• 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components
• Completion of demographic form and pre- and post-test prevention knowledge; 6-month telephone follow-up to track behavior change
• Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites
• APPRISE/10 Keys programs offered in 15-20 counties annually, with 500-600 older adults enrolled each year
• >70% participants completing >80% of APPRISE/10 Keys sessions
• Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition
Assumptions Inputs Activities Outputs Short Term Outcomes
Long Term Outcomes
• Many older adults are unaware of disease prevention targets
• Difficult for older adults to receive preventive care and counseling in risk reduction in primary care
• Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk
• Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits
• Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation
• Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA)
• 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders
• PA PrimeTimeHealth (PA Department of Aging)
• APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services)
• County Area Agencies on Aging (PA Department of Aging)
• PA PrimeTimeHealth coordinates delivery of APPRISE/10 Keys programs in senior centers
• 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website
• 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components
• Completion of demographic form and pre- and post-test prevention knowledge; 6-month telephone follow-up to track behavior change
• Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites
• APPRISE/10 Keys programs offered in 15-20 counties annually, with 500-600 older adults enrolled each year
• >70% participants completing >80% of APPRISE/10 Keys sessions
• Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition
• Increase in prevention knowledge: 20% increase in correct answers between pre- and post-test (13-item quiz)
• Increase in prevention behaviors and health outcomes:
(i) Reduce hypertension through diet, regular assessment, and antihypertensive use;
(ii) reduce sedentary behavior through increased exercise;
(iii) empower older people to discuss prevention with physicians to receive clinical prevention services
• Lower risk of hospitalization and disability in older PA residents
• Disseminate 10 Keys to Healthy Aging to other PRCs
PA APPRISE Regions
Partnership with University of Pittsburgh
CDC Prevention Research Center
24
Dissemination Statewide
3/2016 26
Five-week '10 Keys to Healthy Aging' series offered
THE YORK DISPATCH
POSTED: 04/13/2015 12:45:33 AM EDT | UPDATED: A DAY AGO
The Red Lion Area Senior Center, 20-C Gotham Place, will host the five-week program, "10 Keys to Healthy Aging," 9:30 a.m. Tuesdays beginning this week.
Developed by researchers at the University of Pittsburgh Graduate School of Public Health, the classes are designed to help people take ownership of their health. Participants will learn two healthy-aging keys each week.
Admission is free.To register, call Kasie Ream, Program Coordinator, at 244-7229.
If you have had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized prevention plan based on your health and risk factors. This includes:
• Health risk assessment• Review of medical and family history• Develop or update a list of current providers and prescriptions• Height, weight, blood pressure, and other routine measurements• Detection of any cognitive impairment• Personalize health advice• List of risk factors and treatment options for you• A screening schedule for appropriate preventative services
Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index of 30 or more.
Who’s covered?All people with Medicare may be screened for obesity. Counseling is covered for anyone found to have a body mass index of 30 or more.
How often is it covered?Medicare covers 15 minute face-to-face individual behavioral therapy sessions and 30 minute face-to-face group behavioral counseling sessions
Your cost if you have Original Medicare?You pay nothing!
Who’s covered?Adults with Medicare (including pregnant women) who use alcohol, but do not meet the medical criteria for alcohol dependency.
How often is it covered?Medicare covers one alcohol misuse screening per year. If your primary care doctor determines you are misusing alcohol you can get 4 brief face-to-face counseling sessions per year in a primary care setting (i.e., doctors office)
Your cost if you have Original Medicare?You pay nothing!
Initial Research: 2013-2016
3/2016 35
Successful roll out in counties?
- Increase in reach (sites, counties) Acceptable to participants?
- Increase in numbers and
completers (80%+ sessions) Increase in prevention knowledge?
- Increase in knowledge between
pre- and post-tests
- Adoption of behaviors?
Program Uptake: PA 10 Keys-APPRISE, 2013-16: Tracking Partnership
2013 2014 2015 2016 Total
Sites, n 7 15 23 38 83
Counties/AAA
regions, n 5 12 14 11 14
Participants, n 93 217 530 694 1534
Participants
completing 8+
Keys, n (%)
60 (64.5) 129 (59.5) 391 (73.7) 464 (66.9) 1044 (68.1)
10 Keys-APPRISE Participants, 2013-2016
93
217
530
694
60
129
391
464
0
100
200
300
400
500
600
700
800
2013 2014 2015 2016
Par
tici
pan
ts
Participants
Completers, 80%+ sessions
Participating in 10 Keys-APPRISE
workshops, 2013-2016, n=1534
Completed pretest
prevention quiz, n=1085
Matched pretest and posttest
prevention quiz, n=736
Provided prevention behavior at
baseline, n=339
Followed in Monthly Telephone
Contact, n=147
PA 10 Keys-APPRISE, 2013-16: Tracking Outcomes
Baseline Prevention BehaviorPrevention Behavior Reporting, %
Not smoking 95.6
Flu immunization, prior 12 months 80.2
Pneumonia immunization, ever 76.1
Able to give systolic blood pressure value 74.9
Colon cancer screening, ever 73.3
Bone density screening, ever 68.7
Able to give blood glucose value 47.8
Exercise 2.5+ hr each week 38.7
Able to give LDL cholesterol value 29.8
Prevention behaviors, mean (SD) 5.8 (1.8)
Appendix “10 Keys”™ to Healthy Aging Exam, with Key
What is the minimum number of hours of regular physical activity an older adult should get per week? Circle One
6 hours1 hours5 hours2½ hours
What is a normal blood pressure level? Circle One
160/90 mmHg120/80 mmHg150/85 mmHg142/72 mmHg
Boosting Prevention KnowledgePre-Test, % Correct Post-Test, % Correct
Physical activity 27.0 60.7
Blood pressure level 82.1 94.6
LDL cholesterol level 33.2 69.7
Colonoscopy screening 29.5 61.8
Mammography 77.8 87.4
Smoking 92.0 95.0
Blood glucose 44.9 71.1
Pneumonia immunization 37.6 59.6
Annual flu shot 72.4 81.0
Results• Mean (SD) age, 75.4 (8.5); 84.1% female; 89.8% white. Baseline
mean 5.8 of 9 prevention behaviors reported
• Correlation of baseline prevention knowledge and reported prevention behaviors, r = 0.30, p < .001
• In 13-item prevention quiz, increase from 61.5% to 78.5% correct, p < .001, across all behaviors
• In monthly follow-up, people completing more than half the Keys were more likely to report weekly muscle strengthening exercises (76.0% vs. 63.0%, p = .02) and blood pressure monitoring (84.1% vs. 72.6%, p = .06)
Conclusions Translation partner: PA Department of Aging. Infrastructure to field
and track dissemination of 10 Keys: Host webinar training, conduit for MIPPA funding, quality assurance
10 Keys: Workshops can be fielded remotely through website training and regional AAA and APPRISE network
PA Department of Aging seeks prevention programming: scalability
Implementation products: Spanish translation (external funds), website training (PRC), linked Medicare counseling/10 Keys instructional materials (PRC/PA APPRISE)
Lessons learned in planning for translation: Simplicity, consistency!
University of Pittsburgh, Graduate School of Public Health
Department of Behavioral and Community Health Sciences (BCHS)
Research on the dynamics of behavior change to improve the health of communities
Contact: Steven M. Albert, [email protected]
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