Ohio Public Employees Retirement System CDSME Experience

Transcription

1 Ohio Public Employees Retirement System CDSME Experience Sarah Durfee, RN, Clinical Programs Officer, OPERS Marc Molea, AICP, Chief Strategic Partnerships, ODA May 27,

2 Ohio Healthy U (CDSME) Infrastructure Dedicated State Staff 12 AAAs/Site Coordinators Statewide License, centralized data Variety of Workshops: CDSMP, DSMP, Chronic Pain, Arthritis (aka, Healthy U in Ohio) Base of Master Trainers and Leaders On-line Workshops - Better Choices, Better Health 2

3 Quick Stats on Healthy U # of AAA regions with dedicated Site Coordinators to plan, coordinate, promote and report etc. 12 # of Master Trainers 65 # of Lay Leaders 425 # of Implementation Sites 414 # of counties with active sites (up from 53 last year) # of Workshops since # of Workshop Participants 7,000+ % of Workshop Completion Rate 78% 61 3

4 ODA Established Partnerships Ohio Department of Health Ohio Commission on Minority Health Ohio Mental Health & Addiction Health Home OPERS Department of Rehabilitation and Corrections Opportunities for Ohioans with Disabilities Veteran s Administration Medical Centers Ohio Patient-Centered Primary Care Collaborative 4

5 OPERS Background Pension fund for Ohio s retired public service employees Retiree health care is offered, but, not guaranteed Focus of recent years has been preservation of retiree health care into the future Major changes to health care eligibility being phased in Retirees trust information from OPERS Retirees prefer printed communications, although, internet usage among retirees is growing 5

6 OPERS CDSME Experience to Date Available to Non-Medicare adult enrollees (~ 80K) First workshops offered July 2013 Expanded to include DSMP (December 2013) Participation in 25 workshops offered to date (thru April 2014) Around 200 OPERS CDSME/DSMP participants to date 6

7 OPERS CDSME Promotional Strategies Initial Strategies OPERS retiree newsletter articles (with testimonials) Personalized mailings From OPERS One per household plus reminder follow-up letters (~30K total) Zip codes within AAA service area Robocalls week prior to workshop Yield - < 1% 7

8 OPERS CDSME Promotional Strategies Current Strategies (began April 2014) Replaced USPS with households within AAA s service area by zip code OPERS-specific Include more graphics than the prior printed letter Reminders via blasts OPERS retiree newsletter articles OPERS Web pages Including videos, testimonials, etc. Information also shared by OPERS self-insured plan administrator s DM vendor 8

9 OPERS CDSME Promotional Strategies Future Strategies (TBD) In addition to current strategies Include on OPERS blog and Facebook pages Display CDSME video for viewing during OPERS retiree open enrollment and other educational sessions ODA/AAAs to man a table at OPERS open enrollment meetings Utilize teletown hall format (interactive phone session) Work with self-insured plan administrator to disseminate to high volume providers Extend messaging into contributing employer groups OPERS future retirees Consider expanding to online version, Better Choices, Better Health 9

10 OPERS Evolution of Reimbursement Covered costs of participant books paid under administrative budget Believe in the value of CDSME Shifting to paying agreed upon fees for CDSME costs, prorated based upon number of sessions attended Claims payment under OPERS 401h trust requires electronic claims submission to OPERS claims administrator 10

11 Evolution of CDSME Reimbursement Claims Payment under Commercial Plans Electronic Claims Submission EIN by billing entity for AAAs CPT/HCPCs procedure codes Use of a Clearinghouse Claims Administrator Contracting Recognition as an approved provider May require custom provider contract Other processes AAAs (e.g. verify participant eligibility) O4A 11

12 Lessons Learned Don t Underestimate the Need to Champion the Cause Belief in Non-Traditional Delivery Model is Key Quote Stanford results Be Prepared to Customize to Meet Your Needs Promotional messaging Participant satisfaction/workshop feedback Commit to Collaboration OPERS and ODA collaborated on promotional strategies and operational details Engage AAA site coordinators Be Flexible/Prepared to Change Processes Charting new territory (open vs. closed workshops) Solicit input and keep everyone informed 12

13 Contact Information Sarah Durfee Ohio Public Employees Retirement Systems Marc Molea Ohio Department of Aging Diane Beaty-Cargile Ohio Department of Aging 13

14 Self-Management Programs for Oregon Public Employees: Progress and Lessons Learned May 27, 2014 Laura Chisholm, MPH, MCHES Chronic Disease Self-Management Lead Oregon Public Health Division / Oregon Health Authority

15 Overview Some background: SM programs in Oregon Milestones in policy development Enabling factors Barriers to policy implementation Next steps

16 Stanford Program participants by county of residence, 2012

17 Participants by program and year,

18 National Diabetes Prevention Program Two organizations with master trainers Oregon Health & Science University Schnitzer Diabetes Health Center YMCA of Marion/Polk County (Salem) A dozen other organizations with trained leaders Moda Health (Eastern OR Coordinated Care Org) grant

19 Policy Implementation Milestones Oregon Health Authority formed (1/10) Consolidated health-related functions: public health, public employee benefits boards, Medicaid Medicaid program becomes a champion (7/10) Disease Management Coordinator attends national CDSMP ARRA grantee conference Employee benefits boards offer free Weight Watchers benefit (2010)

20 Policy Implementation Milestones Medicaid Health Evidence Review Commission review (2/11) Initially approved as a Medicaid benefit Decision rescinded due to budget concerns re: FQHC encounter billing rates Attracted decision makers attention, enhanced political will for policy change

21 Policy Implementation Milestones State employee benefits boards (PEBB & OEBB) invite presentations on CDSMP (2/11) PEBB & OEBB promote CDSMP and BCBH to early retirees (winter/spring 2011) Limited participation Enthusiastic response & feedback to boards

22 Policy Implementation Milestones Health Engagement Model implementation (2011) Wellness program: HRA and 2 qualified activities per year 2011/2012 State employee BRFSS improvements Reduced obesity rate Increased fruit/veg consumption Trend toward decreased dx of cholesterol, hypertension, diabetes

23 Policy Implementation Milestones PEBB/OEBB promote CDSMP & BCBH as Health Engagement Model approved activities (2012) Count toward two required annual health actions PEBB/OEBB approve CDSMP and NDPP as benefits (2013) Available at no cost to all members Implementation delayed due to contracting issues BCBH will be offered as a 2015 benefit

24 Enabling Factors Sufficient/growing delivery infrastructure Champions Evidence base Documented burden & cost savings potential Anticipated system for contracting & billing (Self-Management Hub/Alliance)

25 Implementation Challenges Program delivery contracting issues Many licensed organizations have no billing capacity Lack of statewide contracting network creates administrative barrier for health plans Time constraints HEM implementation politics Inability to measure policy impact HEM qualifying activities are self-tracked

26 Oregon s Current Self-Management Delivery & Financing Structure Oregon Living Well Network Program Delivery Organizations Public Health & State Unit on Aging Coordinate training & TA Collect/reports data Advocate for policy change (insurance coverage) Coordinate network????? Purchasers

27 Additional Lessons Learned It takes time work for incremental change Contracting & billing infrastructure is crucial Local data (participation, outcomes) useful/preferable

28 Next Steps Address the need for program delivery contracting networks Establish billing infrastructure Continue evaluation

29 For more information Laura Chisholm, MPH, MCHES Self-Management Technical Lead Oregon Health Authority Public Health Division (971)