NCOA presentation, May Improving the lives of 10 million older adults by National Council on Aging 1

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1 NCOA presentation, May 2018 Improving the lives of 10 million older adults by National Council on Aging 1

2 NCOA s Center for Benefits Access Funded through cooperative agreement with ACL Help low-income Medicare beneficiaries access benefits through community & online solutions Resource Center for state Medicare Improvements for Patients & Providers Act (MIPPA) grantees (SHIPs - Pennsylvania s APPRISE, AAAs, ADRCs,). Support network of community organizations and state agencies serving as Benefits Enrollment Centers (BECs) BenefitsCheckUp online screening tool Improving the lives of 10 million older adults by National Council on Aging 2

3 State Health Insurance Assistance Program help with: Understanding Medicare Eligibility and Benefits Enrolling in Medicare, Extra Help and Medicare Savings Programs Navigating the Medicare Program Improving the lives of 10 million older adults by National Council on Aging 3 3

4 Improving the lives of 10 million older adults by National Council on Aging 4

5 Find Your Local SHIP MEDICARE Locate a SHIP at Improving the lives of 10 million older adults by National Council on Aging 5

6 Role of APPRISE in 10 Keys to Healthy Living Partnered with University of Pittsburgh s Graduate School of Public Health Promoted the 10 Keys to Healthy Aging to individuals attending outreach/enrollment events and Medicare health and wellness events Attended all 10 Keys to Healthy Living workshops to provide: o o Counseling on Medicare preventative benefits that coincided with the Healthy Key for that day, and Information on the programs that reduce Medicare health and drug costs and assist with eligibility and enrollment Improving the lives of 10 million older adults by National Council on Aging 6

7 Key Lower Systolic Blood Pressure Obesity = body mass index (BMI) 30 kg/m2 Intensive behavioral therapy consists of o o o o Screening for obesity using BMI measurement Dietary (nutritional) assessment Intensive behavioral counseling and therapy In primary care setting Improving the lives of 10 million older adults by National Council on Aging 7

8 Key Lower Systolic Blood Pressure (cont.) Coverage includes o One face-to-face visit every week for the first month o Then every other week for months 2 6 o Then every month for months 7 12 Must lose 6.6 lbs. in first 6 months to continue No cost if primary care doctor/practitioner accepts assignment Improving the lives of 10 million older adults by National Council on Aging 8

9 Key - Participate in Cancer Screenings Breast Cancer Screenings (Mammograms) Covered for all women with Medicare o One baseline mammogram Between 35 and 39 o Once a year starting at 40 No cost if provider accepts assignment Improving the lives of 10 million older adults by National Council on Aging 9

10 Medicare Savings Programs (MSPs) Financed by Medicaid; help pay Medicare premiums and costsharing for those with low income/assets Three programs: QMB, SLMB, QI Apply through Medicaid office Qualify with income up to 135% Federal poverty level and resources below established asset test Several states have more generous income and asset thresholds Eliminate Medicare late enrollment penalties Annual value of the benefit estimated at $1,608 Improving the lives of 10 million older adults by National Council on Aging 10

11 Extra Help/Part D Low Income Subsidy (LIS) Administered by Social Security Administration and Medicare Helps pay Medicare Part D (drug plan) costs for people with limited income/resources (income below 150% FPL and resources below established asset test) People pay between $1.25 and $8.35 for drugs at pharmacy Eliminates the drug coverage gap ( donut hole ) No late enrollment penalties Annual value of the benefit estimated at $4,000 Improving the lives of 10 million older adults by National Council on Aging 11

12 Closing the Enrollment Gap Improving the lives of 10 million older adults by National Council on Aging 12

13 APPRISE Contribution to the 10 Keys to Health Living Explained and confirmed Medicare s coverage for preventive benefits Provided strategies to limit Medicare s outof-pocket costs Introduced a trusted partner to help overcome obstacles Eased access to Medicare Savings Programs Recognized Medicare beneficiaries as multifaceted consumers Improving the lives of 10 million older adults by National Council on Aging 13 13

14 The mission of the CAPH-PRC is to promote healthy aging by addressing preventable disability and mortality in older adults in our region via interdisciplinary research, teaching, and practice. Director and Core Research Project PI: Anne B. Newman, MD, MPH Co-Director: Steven M. Albert, PhD Core Research Project Co-Investigators: Elizabeth M. Venditti, PhD; Steven M. Albert, PhD; Robert M. Boudreau, PhD; Michelle E. Danielson, PhD Deputy/Program Director: Michelle E. Danielson, PhD

15 University of Pittsburgh CAPH-PRC Major Initiatives Mobility & Vitality Lifestyle Program (core research project) o Aimed at reducing obesity & improving mobility in adults ages o 32-session behavioral activation program lead by trained CHWs at 26 community-based sites o Outcomes include weight loss and physical function 10 Keys TM to Healthy Aging (center core project) o Online training modules o Collaborators: State & local health depts.; PA Dept. of Aging (APPRISE); UPMC for Life; Arthritis Foundation Exercise Program Healthy Steps in Motion o Falls prevention PA Dept. of Aging Other Partnerships UPMC Aging Institute, Jewish Healthcare Foundation, Alzheimer s Disease Research Center

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17 NCOA presentation, May 2018

18 Assumptions Inputs Activities Outputs Short Term Outcomes Many older adults are unaware of disease prevention targets Long Term Outcomes Difficult for older adults to receive preventive care and counseling in risk reduction in primary care Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation

19 Assumptions Inputs Activities Outputs Short Term Outcomes Many older adults are unaware of disease prevention targets Difficult for older adults to receive preventive care and counseling in risk reduction in primary care Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA) 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders PA PrimeTime Health (PA Department of Aging) APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services) Long Term Outcomes Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation County Area Agencies on Aging (PA Department of Aging)

20 Assumptions Inputs Activities Outputs Short Term Outcomes Many older adults are unaware of disease prevention targets Difficult for older adults to receive preventive care and counseling in risk reduction in primary care Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA) 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders PA PrimeTime Health (PA Department of Aging) APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services) County Area Agencies on Aging (PA Department of Aging) PA PrimeTime Health coordinates delivery of APPRISE/10 Keys programs in senior centers 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components Completion of demographic form and pre- and posttest prevention knowledge; 6-month telephone follow-up to track behavior change Long Term Outcomes

21 Assumptions Inputs Activities Outputs Short Term Outcomes Many older adults are unaware of disease prevention targets Difficult for older adults to receive preventive care and counseling in risk reduction in primary care Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA) 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders PA PrimeTime Health (PA Department of Aging) APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services) County Area Agencies on Aging (PA Department of Aging) PA PrimeTime Health coordinates delivery of APPRISE/10 Keys programs in senior centers 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components Completion of demographic form and pre- and posttest prevention knowledge; 6-month telephone follow-up to track behavior change Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites APPRISE/10 Keys programs offered in counties annually, with older adults enrolled each year >70% participants completing >80% of APPRISE/10 Keys sessions Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition Long Term Outcomes

22 Assumptions Inputs Activities Outputs Short Term Outcomes Many older adults are unaware of disease prevention targets Difficult for older adults to receive preventive care and counseling in risk reduction in primary care Activating older adults to change behavior and seek clinical preventive services may reduce chronic disease risk Annual Medicare Wellness visit covers preventive care; states offer counseling in Medicare benefits Linking Medicare counseling to 10 Keys provides venue for dissemination and evaluation Funding (University of Pittsburgh CDC PRC; CMS Medicare Improvements for Patients and Providers Act, MIPPA, awarded to PA) 10 Keys to Healthy Aging, manualized program of behavior change, with website training for leaders PA PrimeTime Health (PA Department of Aging) APPRISE, PA State Health Insurance Assistance Program (PA Department of Human Services) County Area Agencies on Aging (PA Department of Aging) PA PrimeTime Health coordinates delivery of APPRISE/10 Keys programs in senior centers 10 Keys instructors (senior center staff and volunteers) certified by completing online training at PRC 10 Keys website 2-hour workshops 1x/week for 10 weeks (or 2x/week for 5 weeks) covering 10 Keys linked to Medicare Wellness Visit components Completion of demographic form and pre- and posttest prevention knowledge; 6-month telephone follow-up to track behavior change Monthly conference calls, annual meeting; web performance dashboard; $500 stipend to participating sites APPRISE/10 Keys programs offered in counties annually, with older adults enrolled each year >70% participants completing >80% of APPRISE/10 Keys sessions Monthly automated interview calls every 30 days for 6 months to monitor behavior, enrolling 250 participants, <10% attrition Increase in prevention knowledge: 20% increase in correct answers between pre- and post-test (13-item quiz) Long Term Outcomes Increase in prevention behaviors and health outcomes: (i) Reduce hypertension through diet, regular assessment, and antihypertensive use; (ii) reduce sedentary behavior through increased exercise; (iii) empower older people to discuss prevention with physicians to receive clinical prevention services Lower risk of hospitalization and disability in older PA residents Disseminate 10 Keys to Healthy Aging to other PRCs

23 PA APPRISE Regions

24 Partnership with University of Pittsburgh CDC Prevention Research Center 24

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26 Dissemination Statewide Five-week '10 Keys to Healthy Aging' series offered THE YORK DISPATCH POSTED: 04/13/ :45:33 AM EDT UPDATED: A DAY AGO The Red Lion Area Senior Center, 20-C Gotham Place, will host the five-week program, "10 Keys to Healthy Aging," 9:30 a.m. Tuesdays beginning this week. Developed by researchers at the University of Pittsburgh Graduate School of Public Health, the classes are designed to help people take ownership of their health. Participants will learn two healthy-aging keys each week. Admission is free. To register, call Kasie Ream, Program Coordinator, at /

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32 If you have had Part B for longer than 12 months, you can get a yearly Wellness visit to develop or update your personalized prevention plan based on your health and risk factors. This includes: Health risk assessment Review of medical and family history Develop or update a list of current providers and prescriptions Height, weight, blood pressure, and other routine measurements Detection of any cognitive impairment Personalize health advice List of risk factors and treatment options for you A screening schedule for appropriate preventative services

33 Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index of 30 or more. Who s covered? All people with Medicare may be screened for obesity. Counseling is covered for anyone found to have a body mass index of 30 or more. How often is it covered? Medicare covers 15 minute face-to-face individual behavioral therapy sessions and 30 minute face-to-face group behavioral counseling sessions Your cost if you have Original Medicare? You pay nothing!

34 Who s covered? Adults with Medicare (including pregnant women) who use alcohol, but do not meet the medical criteria for alcohol dependency. How often is it covered? Medicare covers one alcohol misuse screening per year. If your primary care doctor determines you are misusing alcohol you can get 4 brief face-to-face counseling sessions per year in a primary care setting (i.e., doctors office) Your cost if you have Original Medicare? You pay nothing!

35 Initial Research: Successful roll out in counties? - Increase in reach (sites, counties) Acceptable to participants? - Increase in numbers and completers (80%+ sessions) Increase in prevention knowledge? - Increase in knowledge between pre- and post-tests - Adoption of behaviors? 3/

36 Program Uptake: PA 10 Keys-APPRISE, : Tracking Partnership Total Sites, n Counties/AAA regions, n Participants, n Participants completing 8+ Keys, n (%) 60 (64.5) 129 (59.5) 391 (73.7) 464 (66.9) 1044 (68.1)

37 Participants 10 Keys-APPRISE Participants, Participants 300 Completers, 80%+ sessions

38 PA 10 Keys-APPRISE, : Tracking Outcomes Completed pretest prevention quiz, n=1085 Participating in 10 Keys-APPRISE workshops, , n=1534 Followed in Monthly Telephone Contact, n=147 Matched pretest and posttest prevention quiz, n=736 Provided prevention behavior at baseline, n=339

39 Baseline Prevention Behavior Prevention Behavior Reporting, % Not smoking 95.6 Flu immunization, prior 12 months 80.2 Pneumonia immunization, ever 76.1 Able to give systolic blood pressure value 74.9 Colon cancer screening, ever 73.3 Bone density screening, ever 68.7 Able to give blood glucose value 47.8 Exercise 2.5+ hr each week 38.7 Able to give LDL cholesterol value 29.8 Prevention behaviors, mean (SD) 5.8 (1.8)

40 Appendix 10 Keys to Healthy Aging Exam, with Key What is the minimum number of hours of regular physical activity an older adult should get per week? Circle One 6 hours 1 hours 5 hours 2½ hours What is a normal blood pressure level? Circle One 160/90 mmhg 120/80 mmhg 150/85 mmhg 142/72 mmhg

41 Boosting Prevention Knowledge Pre-Test, % Correct Post-Test, % Correct Physical activity Blood pressure level LDL cholesterol level Colonoscopy screening Mammography Smoking Blood glucose Pneumonia immunization

42 Results Mean (SD) age, 75.4 (8.5); 84.1% female; 89.8% white. Baseline mean 5.8 of 9 prevention behaviors reported Correlation of baseline prevention knowledge and reported prevention behaviors, r = 0.30, p <.001 In 13-item prevention quiz, increase from 61.5% to 78.5% correct, p <.001, across all behaviors In monthly follow-up, people completing more than half the Keys were more likely to report weekly muscle strengthening exercises (76.0% vs. 63.0%, p =.02) and blood pressure monitoring (84.1% vs. 72.6%, p =.06)

43 Conclusions Translation partner: PA Department of Aging. Infrastructure to field and track dissemination of 10 Keys: Host webinar training, conduit for MIPPA funding, quality assurance 10 Keys: Workshops can be fielded remotely through website training and regional AAA and APPRISE network PA Department of Aging seeks prevention programming: scalability Implementation products: Spanish translation (external funds), website training (PRC), linked Medicare counseling/10 Keys instructional materials (PRC/PA APPRISE) Lessons learned in planning for translation: Simplicity, consistency!

44 University of Pittsburgh, Graduate School of Public Health Department of Behavioral and Community Health Sciences (BCHS) Research on the dynamics of behavior change to improve the health of communities Contact: Steven M. Albert, PhD

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