MARYLAND LIVING WELL CENTER OF EXCELLENCE

Chronic Disease Self-Management Education Program Grantee

Prevention and Public Health Fund 2021, effective May 1, 2021

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Goals

The overall purposes of this 3-year grant are to:

• Goal 1: Through robust partnerships,

develop a result-based, comprehensive

strategy for addressing behavioral health

and/or chronic pain among older adults

and adults with disabilities living in your

community.

• Goal 2: Significantly increase the number

of older adults and adults with disabilities

who participate in evidence-based selfmanagement education and/or selfmanagement support programs to

empower them to better manage these

chronic condition(s), while concurrently

pursuing the sustainability of these

programs beyond the end of the grant

period.

Strategies and Activities

The Maryland Living Well Center of Excellence

(LWCE), a Division of Mac, Incorporated Area 

Agency on Aging (AAA) and its partners will: 

• Implement system-wide changes to

ensure access and sustainability for

virtual and in-person self-management

and self-management support programs,

providing a continuum of care model for

Maryland’s highest risk and most costly 

individuals. 

• Reduce barriers to access by providing

‘loaner tablets’ to participants lacking

internet connectivity.

• Launch a social marketing campaign

program and provide trainings to

strengthen delivery capacity.

• Assist AAAs and nonprofit community

organizations to implement and test

billing/reimbursement opportunities.

Proposed Interventions

• Chronic Pain Self-Management Program

(CPSMP)

• EnhanceFitness (EF)

• PEARLS

Partnerships

To achieve the goals of the grant, LWCE will 

collaborate with the following key partners:

• Asian American Inter Community Service

• Anne Arundel County AAA

• Bay Area Center

• Carroll County AAA

• Charles County Department of Health

• Chesapeake Regional Information System

for Patients (CRISP)

• Frederick Health
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Prevention and Public Health Fund 2021, effective May 1, 2021

• Howard County AAA

• Johns Hopkins Geriatric Workforce

Enhancement Program

• Maryland Department of Disabilities

• Maryland Department of Health

• Maryland Department of Aging

• Prince George’s AAA

• TidalHealth

Anticipated Results

The LWCE and its partners propose to achieve the 

following results: 

• Reach 495 participants in CPSMP, EF

and/or PEARLS;

• Ensure AAAs/community-based

organizations are able to access a health

technology platform through CRISP,

Maryland’s designated health

information exchange;

• Hold at least 2 virtual trainings for

CPSMP, PEARLS and EnhanceFitness

leaders and counselors;

• Achieve a 70% completion rate in

program completion ;

• Work with state and local clinical and

community partners to assess older

adults and people with disabilities for

pain and/or depression and link them to

programs;

• Establish multiple referral resources

including the Maryland Access Point,

Aging & Disability Resource Centers,

Maryland 2-1-1, other social service

provider agencies, the Maryland Primary

Care Program, hospitals systems, and

managed care organizations;

• Assess the impact of bundling CPSMP,

PEARLS, and EF to reduce pain and

depression;

• Document quality of life and reduced

health care costs via CRISP;

• Connect clinical and community partners

to begin billing for sustainability; and,

• Increase AAA business acumen and

provide assistance to ensure a continuum

of care of Maryland’s highest risk and

most costly individuals.

Contact:

Leigh Ann Eagle

Maryland Living Well Center of Excellence

laeagle@macinc.org

For more information: 

Administration for Community Living 

U.S. Department of Health and Human Services

Washington, DC 20201

http://www.acl.gov