CDSME Clear Compelling Message: It's always the right time to take control of your health! CDSME Customers Individual w/Chronic Condition(s) Health Care Providers (HCP) Other Organizations (CCRCs, AAAs) Health Insurance Providers Problems faced by Pain and fatigue Activity limitations Physical limitations Loss of independence Little time with HCP Not receiving adequate information Trouble finding & assessing services Out of pocket expenses Multiple Chronic Conditions Feeling of being un-empowered/no control Financial limitations Ability to work Difficulty communicating Health Literacy Medication administration Lack of choice/assertiveness Passive or active patient Unplanned healthcare visits Readmission Treatment challenges for patients with Multiple Chronic Conditions(MCC) Drug Interactions Preventable admissions Frequent admissions Problems coordinating care Low satisfaction with care for people with chronic conditions Poor outcome Lack of knowledge about local resources Frustration with time constraints Issues with quality of life for members/clients Community perception of quality of services offered by organization Problems coordinating care or assisting members/clients with coordinating care Decrease staff time Decreased readmissions (30 day window to bring individuals leaving skilled back into independent living) Unplanned or unnecessary acute healthcare visits High % of resources used by consumers with chronic conditions (84%) Duplicated tests Increased utilization costs Decreased cost per insured A more empowered patient who is actively managing health Increase patient accountability Existing Alternatives Hospital Based Diabetes Education YMCA/Wellness Centers Internet Counseling services Support groups VAIL Smoking Cessation Diabetes Educators Nurse Educators Care Managers Referrals to other programs Nurse Practitioners who can educate Location specific programs Other Evidence Based programs Group support Nurse Phone consultation Website educational resources
CDSME Customers Individual w/Chronic Condition(s) Health Care Providers (HCP) Other Organizations (CCRCs, AAAs) Health Insurance Providers CDSME Unique Value (evidence based, researched over time with consistent results, low cost to implement, based on self-efficacy model) Expand options Informed Health Care Consumers Active & Positive Self-Management Opportunity for more control Advocate Symptom/ Disease Management Emotional wellbeing Appropriate for most abilities Does not require previous knowledge but builds on the participants' current status Provides personal accountability Increase quality of life Increased functionality Activated informed patients Better use of resources Engage patients more effectively in care Behavior change Improved communication Low cost or no cost intervention Expand treatment options Patient Satisfaction Meet quality standards Increased psychological health status, self-efficacy, and health behaviors Net savings of $390-520 per person over 2 years Less time spent with each patient Activated informed members/clients Behavior change Member/client increased psychological health status, and health behaviors Low or no cost intervention Low or no cost intervention Net savings of $390-520 per person over 2 years Better use of resources Customer satisfaction Channels (How will we reach customers) Referral from past Participants HCPs and Organizations - Referrals Media Emergency Departments Workshop sites/sponsors Social Media Family members/target caregivers Group chat/blog for past participants Participants telling HCPs VICAP Folders Personal visits Mailing schedule/information Newsletters Participants telling HCP Program adopted by hospital or provider Flow chart for HCPs Facebook Personal visits Mailing schedule/information Newsletters Program champions Personal visits Contact within organization
CDSME Customers Individual w/Chronic Condition(s) Health Care Providers (HCP) Other Organizations (CCRCs, AAAs) Health Insurance Providers Problems/Solutions Transportation/vouchers, partnerships, offer where there is public transportation Motivation (burden vs benefit)/ focus on benefits Commitment - believe it will work/ use past participants to promote Accessibility/ variety in schedule Time (length of workshop)/stress that there is a break and it is interactive Not feeling well/this might help… Overwhelmed/CDSME can help you take control! Time/easy referral system Knowledge/keep going back - try to educate multiple people in the practice Lack of integration into practice/find the right person to advocate for CDSME Siloed Care/Medical Home Closed mindedness/collect outcomes One more thing/easy referral process Top of mind awareness/prompt on screen Awareness/newsletters, CCRC representative on Steering Committees to create a larger network of awareness Difficulty getting people to participate/incentives Non reimbursement/ Complicated reimbursement/ Key Stakeholders (Whose buy in do we need, key influencers, who else?) Individual Caregiver Family Food Banks Community Foundations How will success be measured? Improved lifestyle Lower Health Care Cost More informed patients Fewer readmissions, unplanned visits Community image of supporting healthy aging Lower health care costs Fewer unplanned visits Care managed more appropriately by consumer