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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 [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]
