CDC’s CDSME Agenda - NCOA · o SME: peer instructors who have trained to lead these specific...

Federal Vision and Progress

CDC’s CDSME Agenda

Teresa J. Brady, PhD

Senior Behavioral Scientist

CDC Arthritis Program

Agenda

Building demand for CDSME

Expanding the CDSME science

base

Exploring financing opportunities

Building Demand for CDSME

Raising Awareness of SME

Marketing to Physical Therapists (PTs)

as referral partners

Marketing Toolkits

Raising Awareness of SME as a CD Management Strategy

Goal:

If feasible, develop and implement a self

management education awareness campaign

that:

appeals to people with a variety of chronic

conditions

is not marketing a specific intervention

program

Project Overview Phase 1: Exploring the feasibility

Phase 2: Developing campaign strategy and

materials

Upcoming

Phase 3: Pilot-testing campaign

Phase 4: Campaign Implementation

Simplified Path to Becoming a Chronic Disease Self Manager

•Symptoms

•Chronic Condition

Recognition

“I have a role (or

better figure out how) to

manage this”

A-Ha Moment

•Self Study

•Asking Questions

•Trial and Error

The Learning Process

•Monitoring

•Adapting

•Problem-solving

Active Self Managing

(The World According to Terry)

Accelerating the Learning Process

A-Ha

#2

Seeking

Resources

“gotta

learn

how”

“maybe

a class”

• Physician

• Word of mouth

• Direct to consumer

•Symptoms

•Chronic Condition

Recognition

“I have a role ( or

better figure out how) to

manage this”

A-Ha Moment

•Self Study

•Asking Questions

•Trial and Error

The Learning Process

•Monitoring

•Adapting

•Problem-solving

Active Self Managing

Self Management

Education/Training

How to learn ?

Accelerating the Learning Process

A-Ha

#2

Seeking Resour

ces

“gotta

learn

how”

“maybe

a class”

• Physician

• Word of mouth

• Direct to consumer

•Symptoms

•Chronic Condition

Recognition

“I have a role ( or

better figure out how) to

manage this”

A-Ha Moment

•Self Study

•Asking Questions

•Trial and Error

The Learning Process

•Monitoring

•Adapting

•Problem-solving

Active Self Managing

Self Management

Education/Training

Intervention

- specific

Marketing

How to learn ?

Project Development Phase 1—Exploring Feasibility

Environmental Scan

Literature review

Review of selected intervention-specific

marketing materials

13 key informant interviews

Focus groups Round 1: Exploratory

Focus groups Round 2: New Concepts

Phase 2: Refining concepts/materials

Phase 1—Exploring Feasibility Conclusions Awareness of SME is low

Term unfamiliar, but understood in context

of concepts

General chronic disease message can

appeal to broad range of consumers

Commonalities in message characteristics

and language

Website is preferred response mechanism

(.gov or .org)

CDC is trusted source

Phase 2: Refining Concepts/Materials Most popular executions

Raising Awareness of SME as a CD Management Strategy

Next Steps

Refining executions

Building/testing website

Pilot testing in several mid-size markets

Paid media

Earned media

Partnership placement

Campaign Specifics

Long-term Goal: increase enrollment in SME

programs

Objectives:

Increase awareness of SME as a chronic

disease management strategy

Drive consumers to website for more information

Increase receptivity to intervention specific

marketing

Timeline: pilot test in 2016

Other Learnings (that may inform your marketing)

Preferred language

“ongoing health problem/issue/condition”

“Chronic”, “illness”, “disease” all perceived

negatively (and inconsistently)

But identify themselves as having chronic

disease or illness

Education/workshop/program over class

“Helps you learn” over “teaches you”

“Strategies” over “skills”

“Techniques over” “tools”

Other Learnings (that may inform your marketing)

Common Preferences

Positive tone

Personal message

Empowering language

Clear concise message

Related to health

Show benefits

Don’t overpromise

Building Demand for CDSME

Raising awareness of SME

Marketing to Physical Therapists

(PTs) as referral partners

Marketing Toolkits

Background Research

On-line survey (N=841) to explore PTs:

awareness of and attitudes towards

evidence-based PA and SME programs

in the community,

factors that would influence their

decision to recommend these programs

to their patients , and

preferences for learning about these

community resources.

Awareness and Willingness to Recommend Programs

0%

10%

20%

30%

40%

50%

60%

70%

80%

PA Programs CDSMEPrograms

Program Awareness

Before Description After Description

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PA Programs CDSME Programs

Willingness to Recommend

Very Likely Somewhat Likely

Results Preferred Channels to Learn about Community Programs

2

1

14

18

19

19

21

21

25

31

33

42

51

82

0 10 20 30 40 50 60 70 80 90

Not interested in receiving information about these…

Other

Exhibit halls in at professional conferences

Newsletters

Webinars

Online video or DVD of a typical session

In-person presentations at my practice

Continuing Education courses

Presentations at professional conferences

Opportunity to visit the program facility/view a session

Articles in professional journals

Direct mail

Website information

E-mail

What would be the best way to get information about evidence-based group programs like these to you? [CHECK ALL THAT

APPLY]

Results Tools to Facilitate Recommendations

84

28 27

17 11 10

1 0

10

20

30

40

50

60

70

80

90

100

Materials togive topeople

(brochures,videos,flyers)

Programposters foryour office

Reminder inthe EMR

Periodicreminders

from programstaff

No reminderneeded

Stickers forpatient charts

Other

Which of the following tools would be helpful to you in making recommendations about evidence-based group programs to your

patients with [arthritis/joint pain and limited mobility]? [CHECK ALL THAT APPLY]

Results Program Characteristics Influencing PT Recommendation

PA Programs SME Programs

Percent Would Greatly Influence

(“5” on a

5-point scale)†

Percent Would Greatly Influence

(“5” on a

5-point scale)†

The programs are evidence-based (i.e., have been

shown to be effective for people with arthritis).

71% 69%

The programs would encourage post-therapy ongoing

physical activity for your patients with arthritis.

74% 75%

The programs are low cost,

o PA: approximately $2-$3 per session, or free.

o SME: $25-40 for 6 week session, or free.

64%

63%

The programs are led by

o PA: certified instructors

o SME: peer instructors

who have trained to lead these specific programs.

77%

47%

The programs are offered by credible and trustworthy

organizations in the community.

76% 69%

The programs are convenient for your patients with

arthritis (i.e., at convenient places and times).

o SME: or can be done online or through self study.

68%

62%

The programs are designed to lend camaraderie and

social support for your patients with arthritis.

49% 45%

The programs are not for profit and do not sell or market

anything to participants.

43% 49%

PA only: The programs cover techniques to exercise

safely.

80%

SME only: The programs help people learn to take an

active role in managing their conditions.

74%

SME only: The programs cover appropriate pain

management and other strategies to increase function

and improve quality of life.

62%

†Please rate how much each of the following pieces of information would influence your decision to recommend evidence-based PA

/SME Programs to your patients with arthritis.

Conclusions Re: PA Programs

PTs have strong awareness of programs in their community

are less familiar with CDC-identified programs

are very likely to recommend these programs

Re: SME Programs

PTs are less familiar with these programs in their community

most are unfamiliar with the CDC-identified programs

Are moderately willing to recommend to their patients

Next Steps

Developing national

strategy to promote PA

programs to PTs

Adding fact sheets (for

PT and for pts) to APTA

website

Will explore promotion

of CDSME in future

Other Learnings (that may inform your marketing)

Factors to emphasize in marketing SME:

(endorsed by 2/3 or more)

Encourage post-therapy PA

Help patients learn to take active role

Offered by credible community

organizations

Evidence-based

Building Demand for CDSME

Raising awareness of SME

Marketing to Physical Therapists (PTs)

as referral partners

Marketing toolkits

Outreach to PCPs

Direct-to-consumers outreach

Marketing Toolkits

Outreach to PCPs

Direct to Consumers--

Ambassador Outreach

Mark your Calendars…

NCOA Webinar

Marketing CDSME: Using the Personal

Touch to Put "Butts in Seats"

Tuesday May 19, 2015

Both guides downloadable from

www.cdc.gov/arthritis

Agenda

Building demand for CDSME

Expanding the CDSME science

base

Exploring financing opportunities

Expanding the Science Base

CDSMP impact on work outcomes

Impact of Implementation factors on

CDSME outcomes

Impact of CDSMP on Work

Conducted at University of North

Carolina-Chapel Hill (2014-2018)

Examining community-delivered

CDSMP, not work-site tailored CDSMP

Outcomes evaluated include

Usual health outcomes

Work-related outcomes:

Absentee-ism, Presentee-ism

Work self-efficacy, Work stressors

Impact of Implementation factors on CDSME Outcomes

Secondary meta-analysis

34 CDSMP/ ASMP studies (N=10,792)

Research Question:

Do implementation factors or fidelity moderate

CDSME outcomes

Impact of Implementation factors on CDSME Outcomes

Factors Analyzed

Setting (urban/rural)

Participant paid

Leader paid

Leader pair with chronic

disease (at least 1 leader)

Leaders received at least

minimum hours of training

Met 6 Lorig-defined

fidelity requirements*

Unable to Analyze

Setting

(community/health care)

How learned about

intervention (media/HCP)

Directed to intervention

(Self/Other)

Leader type (lay/HCP)

Leader status

(volunteer/job)

% of completers (80%)

Impact of Implementation Factors on CDSME Outcomes Findings

CDSMP/ASMP robust

59 analyses conducted; 80% found no

significant differences

Small counter-intuitive findings-- better

outcomes if:

Participant was not paid

Leaders were not paid

Leaders not meet minimum training

Fidelity requirements not met

Impact of Implementation Factors on CDSME Outcomes

What does it all mean?

CDSMP/ASMP can tolerate implementation

variability

Internal motivation may be important

From outcome standpoint, don’t worry about

not being able to pay participants or leaders

Further work needed to identify the

“essential elements” where fidelity is

essential to effectiveness

Agenda

Building demand for CDSME

Expanding the CDSME science

base

Exploring financing opportunities Understanding perceptions of:

State legislators

Employers and their vendors

Understanding State Legislators

2 focus groups to explore state

legislators’ attitudes towards:

Arthritis

Factors influencing their attention to

health issues

Potential actions to increase availability

of arthritis-appropriate evidence-based

community physical activity (PA) and

self management education (SME)

interventions

Focus Group Participants

• 16 legislators, 2 staff

• 56% Democratic

• 55% Female

What we learned…

Factors influencing decision to take action on a health issue:

Perceived seriousness

Life threatening takes priority

Cost and potential cost savings

Beliefs about the role of the state

Hearing from advocates

Reactions to Evidence-based Community Interventions

Reactions to Interventions:

Appealing to address multiple chronic diseases

Personal responsibility plays a role

Some skepticism about effectiveness (and

confusion with clinical treatments)

Limited support for incorporating interventions as a

covered benefit

Medicaid—little support

Medicaid Health Homes—some support

State Employee Benefit Plans—better chance of inclusion

Incorporating interventions as a covered benefit Medicaid—little support

“Would I try to get [these interventions]

included as a Medicaid benefit? Sure,

because it makes sense.

Would I be successful? No.”

“..it may work for like two minutes

and then next year they are going to

cut it because they are not going to

understand the dollars saved.”

Incorporating interventions…

Medicaid Health Homes—some support

“Medicaid health homes have a

chronic disease management

program…it is important to get

providers engaged…so they are

paying attention to whether or not

arthritis is part of the picture.”

Incorporating interventions… State Employee Benefit Plans—more interest

“Productivity is a big

issue. If you can

show impact on that

then maybe you can

get a little traction.”

“We are self

insured, so we set

our own benefits.”

Conclusions Health issue decisions influenced by perceived

seriousness and potential to save state funds.

Life threatening conditions perceived as more

serious than those that threaten quality of life.

Driven by immediate state budget concerns

Eliminate if not see cost savings

Some interest in state employee productivity

angle

Exploring Employer Perceptions

Key Informant Interviews with

Employers

Large, midsize

government, non-government

Health Insurers

Health and Wellness Vendors

Care Management Suppliers

A few learnings so far…

Most mid-size and large employers are

self insured

Health (medical) insurance and “health

and Wellness” benefits are contracted for

separately

Idea of offering “choice” to employees is

appealing

Need standard pricing, financing, referral

A few learning so far…

Employers think about costs in multiple

ways

Health care claims

Workers compensation

Occupational health and safety

Absentee-ism

Disability

A work in progress…stay tuned!

CDC CDSME Agenda

Using market research to build

demand for CDSME

Expanding the science base for

CDSME

Exploring financing opportunities

Contact Info

Teresa J. Brady, PhD

Senior Behavioral Scientist

CDC Arthritis Program

770-488-5856

Tob9 @cdc.gov

770-488-5856