Evidence-Based Interventions for Chronic Conditions ...€¦ · New York State Department of Health...

Evidence-Based Interventions for Chronic Conditions:

Chronic Disease Self-Management Financial Sustainability

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

October 23, 2017 3

Agenda

• Return on Investment

• Current Picture of Reimbursement

• Other Mechanisms for Sustainability

• Questions and Discussion

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).

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

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.

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

October 23, 2017 8

Return on Investment

• Self-management Programs:

• Increase communication and quality of life

• Decrease hospital / ER use

• Without pharmaceuticals

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

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)

October 23, 2017 11

Current Reimbursement Picture

• National Efforts

• CDSME in New York State

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

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

October 23, 2017 14

Considerations of Chronic Disease

Self-Management

• Self-efficacy

• Peer-led services

• Local data

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

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

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

October 23, 2017 18

OTHER SUSTAINABILITY

MECHANISMS

October 23, 2017 19

Area Agencies on Aging

• Title IIID of the Older Americans Act

• Required support for evidence-based

interventions

– AAA

– Partner support

October 23, 2017 20

Local Health Departments

• Article 6 reimbursement

– Promotion activities

– Some delivery

• Additional resources

– CDSMP materials

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

October 23, 2017 22

Other Opportunities

• Peer leader trainings

• Worksite CDSMP

– Organization support for employee

participation

October 23, 2017 23

QUESTIONS AND DISCUSSION

October 23, 2017 24

THANK YOU

October 23, 2017 25

Contact InformationNew York State Department of Health

Celeste Roeller Harp, MRP Intervention Coordinator, NYS Arthritis Program518-408-5142 celeste.harp@health.ny.gov

Nancy Katagiri, MPH, CPH NYS Arthritis Program Coordinator518-408-5142 nancy.katagiri@health.ny.gov

Jan Kaelin-Kee, MSW, MS Ed Senior Health Program CoordinatorCDSME in the Mohawk Valley Initiative518-408-5142 janice.kaelin-kee@health.ny.gov

Mohawk Valley Population Health Improvement Program

Aletha Sprague Mohawk Valley PHIP Supervisor 607-547-7639 aletha.sprague@bassett.org

John May, MD Mohawk Valley PHIP Program Lead and Primary Investigatorjohn.may@bassett.org