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Patients becoming more involved with care of chronic conditions
Forty-six states are actively building delivery and distribution systems to ensure that programs in chronic disease self-management are readily available to individuals with chronic conditions, especially older adults, says Sue Lachenmayr, MPH, program associate at the Center for Healthy Aging in Washington, DC.
In the past few years, most states have received federal grants so that state public health and Medicaid agencies can implement the Palo Alto, CA-based Stanford Patient Education Research Center's Chronic Disease Self-Management Program, notes Ms. Lachenmayr.
"It is vital for Medicaid directors and providers of services to the chronically ill to know more about this valuable resource," she says.
The program can improve quality of life, maintain good health, and delay or minimize the debilitating effects of chronic diseases, says Ms. Lachenmayr, as well as providing potential cost savings.
Ms. Lachenmayr says that participation in chronic disease self-management programs has grown, and the expectation is that it will continue to grow even more in the coming years. "Some states are already piloting medical homes and including community-based chronic disease self-management programs as a patient activation strategy," she says.
In this program, says Ms. Lachenmayr, individuals learn and practice strategies that help them to be better self-managers and improve their ability to communicate with health care providers.
Fewer admissions, ER visits
Alaska Medicaid contracts with a Quality Improvement Organization (QIO) that helps patients get appropriate care and teaches self-management, according to Jon Sherwood, medical assistance administrator at Alaska's Department of Health and Social Services.
"The contract is limited and targets patients where their assistance is expected to have the greatest outcomes," says Mr. Sherwood. "It helps these patients avoid emergency room and inpatient hospital admissions."
The state's public health agency currently offers a limited diabetes self-management program, adds Mr. Sherwood. "The state of Alaska is currently evaluating the medical and health home options included in the ACA [Affordable Care Act]," he says. "Self-management would be a component of those options."
The Maryland Department of Aging is the main provider of chronic disease self-management programs across the state, according to nutrition and health promotion programs manager Judy R. Simon, MS, RD, LDN.
The program "Living Well: Take Charge of Your Health," targets seniors and began in 2006, says Ms. Simon. Since then, it has expanded to 16 of the 19 statewide area agencies on aging across Maryland, she notes, and a "Living Well with Diabetes" program was added.
"Living Well has grown over the years," says Ms. Simon. "Our programs have reached a total of over 1,500 seniors across the state."
In 2010, the Living Well program received additional funding from the American Recovery and Reinvestment Act to target low-income, Medicaid-eligible seniors and other vulnerable groups, Ms. Simon reports.
"We are in the planning stages of coordinating our outreach efforts to this population," she says. "To date, we've begun a cross-referral process with the Delmarva Foundation's Every Diabetic Counts (EBC) program."
Delmarva Foundation is a federally designated QIO for Maryland, currently under contract to the Centers for Medicare & Medicaid Services to improve the quality of health care for Medicare beneficiaries, says Ms. Simon.
"The Living Well Program is a great compliment to the medical model of the EBC program," says Ms. Simon. Living Well focuses on self-management strategies to allow participants to integrate the information they receive in their EBC classes into their day-to-day lives, she explains.
"We've also begun a partnership with Federally Qualified Health Centers (FQHCs), which provide services to the Medicaid population," reports Ms. Simon. "As a result, the number of medically underserved population, which our program serves, will begin to grow exponentially."
While The Living Well program targets seniors, the FQHC will be devoting resources in order to reach all age groups, she explains. The agency is also partnering with statewide and local organizations, health clinics, local health departments, and hospitals that serve Medicaid-eligible seniors, notes Ms. Simon.
"In addition, we are launching a statewide outreach campaign about all of our services, entitled '3Ps: Planning, Prevention, and Preparedness,'" which will have significant media involvement," says Ms. Simon.