« The Dual Agenda: August 20, 2014 Issue

Eldercare Voices

Taking Charge!  Evidence-Based Self-Management Programs Key to Better Care and Lower Costs

A perspective from Rob Schreiber, MD

Bob, a 65-year-old man recently diagnosed with type 2 diabetes, participated in a six-week Diabetes Self-Management workshop. The workshop focused on healthy nutrition, the importance of daily exercise, and the creation of realistic goals and action plans. The course also allowed him to connect with caring and resourceful classmates who readily shared their knowledge and experiences. Bob now has the confidence and tools to better manage his condition.

Rob Schreiber MDThe United States is facing unprecedented growth of its over-65 population as more than 10,000 baby boomers are now reaching this age daily. In addition, adults with disabilities are growing in numbers and make up a significant part of this population. With this demographic expansion comes continuing explosive growth in Medicare and Medicaid expenditures needed to provide health care services for this population. In The State of Aging and Health in America 2013, the Centers for Disease Control and Prevention (CDC) reported that two out of three older Americans have multiple chronic conditions such as diabetes, hypertension and heart disease, and over 95 percent of health care spending for older adults is attributed to chronic disease. Among the main precipitating causes of chronic disease are individual behavior patterns, such as poor nutrition habits, lack of physical activity and smoking. Social determinants of health, including environmental and financial issues also come into play. All told, 70 percent of health spending has a nonmedical cause.

Engaging the older adult to reach her best quality of life has continued to be a challenge for health care providers. The vital importance of the individual in taking responsibility for her own health is strongly recognized by the US Prevention Services Task Force as key to improving health outcomes. Indeed, according to a 2013 study, people actively involved in their health care tend to have both better outcomes and lower costs.  However, in the US health care system, there often exists no formal training or education aimed at activating individuals struggling with chronic illness to take a strong role in managing their own health.

The Massachusetts Healthy Living Center of Excellence (HLCE) seeks to address the gap in self-management education by providing community-based health and wellness programs for older adults. Unlike traditional programs, HLCE initiatives emphasize the patient’s role in managing his medical illnesses, resulting in better quality of care and better health outcomes. These programs teach self-confidence skills through an evidence-based approach that has been proven effective at improving one’s quality of life and health.

Through collaborative grants from the John A. Hartford Foundation, the Tufts Health Plan Foundation and the Administration on Community Living, the HLCE works with a team of community-based organizations to offer programs in every county in Massachusetts. The programs are typically offered in community-based settings such as senior centers, area agencies on aging, community health centers, hospitals, faith-based organizations and medical offices. Among the programs available in Massachusetts are:

CDSMP, the HLCE’s principle program offering, based on the Stanford Chronic Disease Self- Management Program, is a 6-week workshop offered to adults living with the challenges of one or more persistent health conditions. Participants meet for 2½ hours, once a week. Workshops, which are led by two certified lay leaders, use a mutually supportive model that encourages individual problem-solving, goal-setting and behavior change. The topics include: dealing with difficult emotions; physical activity and exercise; power of the mind; pain and fatigue management; healthy eating; communication skills; medication usage and making informed treatment decisions.

Studies of CDSMP have shown significant improvements in participants’ health and well-being, improved communication with health care providers, decreased pain and fatigue, increased confidence in participating in their health care, and, in some cases, reduced hospitalizations and associated cost savings. Because these evidence-based programs are even more effective when the results are shared with the participant’s health care team, the HLCE is working to build stronger linkages between older adults, their community-based organizations and providers. This type of integration is among the goals of the dual eligible demonstration projects and is viewed by many as a key means to improve care and lower costs. Indeed, many of the Massachusetts health care plans serving dually eligible individuals are already successfully implementing these programs.

To learn more about these programs in Massachusetts, visit the Healthy Living Center of Excellence website. For information on these programs in other states, visit the Administration on Aging website.

Rob Schreiber, MD is Medical Director of the Healthy Living Center of Excellence, Medical Director of Evidence-based Programs at Hebrew SeniorLife Department of Medicine in Boston, and a Clinical Instructor of Medicine at Harvard Medical School.

 

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