MassachusettsPartnershipforHealthPromotionand
ChronicDiseases
MassachusettsPreventionandWellness
TrustFund
Manager, JessicaAguilera-Steinert,MSW,LICSW
•BackgroundofPWTF:OriginsinHealthCareReform
–Legislation
–GoalsoftheFund
•DesignandImplementationofGranteeProgram
–Selectionof Conditions
–Granteeselection
–FocusingonROI:TieringofInterventions
•EvaluationOverview
–Measures/Outcomes
Backgroundof the Prevention and
Wellness Trust
•Cost containment
•Chapter224of the Acts of 2012
–Accessto PrimaryCare
–Strategies to addresshealthdisparities
–Establishedthe PWTF: A multimillion dollar focus on prevention as a meansto reducinghealthcarespending
• TheMassachusettsPublicHealthAssociation
• TheMassachusettsHealthCouncil
• AmericanHeartAssociation
• TobaccoFreeMassachusetts
• HealthCareforAll
• MassachusettsAssociationof HealthBoards
• BostonPublicHealthCommission
• $57millionintrustfor4years
• Upto10%onworksitewellnessprograms
• Nomorethan15%onadministrationthrough
MDPH
• Atleast75%mustbespentonagranteeprogram
• Norequirementforspendingequalamounts
annually
MGLChapter224,Section60
All expendituresshouldservethefollowingpurposes:
• to reduceratesof themostprevalentand
preventablehealthconditions,andsubstanceabuse;
• toincreasehealthybehaviors;
• to increasethe adoptionof workplace-based
wellness;
• toaddresshealthdisparities;
• to develop astrongerevidence-baseof effective
preventionprogramming.
• 17memberboard(14gubernatorialappointments)
• The Board makesrecommendationsto the
Commissioneron:
– Administrationand allocation ofPWTF
– Establishmentofcriteriaforthe granteeprogram
– Performanceevaluation
– Annualprogressreportto thelegislature
•TheAdvisoryBoardmet 3timesto guidevisionofthe PWTFgrantee program andreview thedevelopment oftheRFR
• Boardcontinuesto meetquarterlyto guideactivities
WorkingBackward from theOutcomeMeasures
• Examinedcosttrendsbyhealthcondition
• Examinedprevalenceofpreventablehealthconditions
• Examinedco-morbiditiesbyconditionandcost
•Lookedatoptimumpopulationsizebasedoncostof interventionsandrelativeeffectiveness
•Selected13healthconditionswith strongevidencefor deliveringROI– basedonknowninterventions - and developedcomprehensive2-pagefactsheets
Incorporated advice from PWAB,experts,public listeningsessions
•Importanceofpartnershipsacrosscommunityand clinicalsetting
•Balancebetweenevidence-basedinnovative interventions
•Healthdisparitiesandunder-servedregionalfocuswhen possible
ExternalExpertTeams
Designof Grantee Program
• Selectedpriorityconditionsbasedonassociated
interventionswith 3to 5yearROI
•Populationandserviceareasizemustbematchedto availableresourcesandestimatedcostof interventions
• EmphasizeCommunity-ClinicalPartnerships
• All granteesrequiredto usebi-directionale-Referral
• DatadrivenQualityImprovementapproach
• Modelmustbesustainable
PriorityConditions
(2 of4 arerequired,at
minimum)
Tobaccouse Asthma(pediatric) Hypertension
Falls amongolderadults
OptionalConditions
(NotRequired)
Obesity Diabetes Oralhealth
Substanceabuse
OtherConditions
(notspecified)
Proposedbyapplicant
VulnerablePopulationsand Co-MorbidMentalHealthConditions
Plansto address the conditionslistedabove shouldalso includespecificstrategiesto
reducedisparitiesinthe burdenofthese conditions(e.g.,racialand ethnic
disparities).Mentalhealth conditions,such as depression,may beviewedasco-
morbidto anyof theabove. Interventions may beproposedandtailoredfor
populationsaffectedby mentalhealthconditions.
Applicantswererequiredtohavethreetypesof
PartneringOrganizations:
•Clinical(healthcareproviders,clinics,hospitals)
•Atleastoneclinicalpartner mustuse and be ableto shareElectronicMedicalRecords
•Community(schools,fitnesscenters,non-profits, andmulti-serviceorganizations)
•Other(municipalities,regional planningagencies,
worksites,andinsurers)
Foranyconditionproposed,applicantswererequiredto
includeinterventionsineachof 3domains:
• Community– Supportsbehavioralchangeto improvehealththroughindividual,socialand physicalenvironmentswherepeopleliveandwork
• Clinical– Improves clinicalenvironment– delivery
andaccess
• Community-ClinicalLinkages– Strengthens connectionbetweencommunity-basedservicesand healthcareproviders
•Including a requirement toparticipatein bi-directional e-referral
Grantee Program:
Selection, populations,interventions,
and support
• BarnstableCountyDepartmentof HumanServices(Barnstable,
Mashpee, Falmouth,Bourne)
• BerkshireMedicalCenter(BerkshireCounty)
• Boston PublicHealthCommission(NorthDorchesterand
Roxbury)
• HolyokeHealth Center,Inc.
•Townof Hudson(Framingham,Hudson, Marlborough, Northborough)
• Cityof Lynn
• ManetCommunityHealthCenter,Inc.(Quincyand Weymouth)
• New Bedford HealthDepartment
• Cityof Worcester
Partnerships are Across the State
•CapacityBuildingPhase:each awardup
to $250,000
•ImplementationPhase: Between $1.3M
and$1.7M on anannualbasis
•Total populationwithinfundedcommunities
is 987,422(approximately15% of the state
population)
•Some of the most racially/ethnicallydiverse
communitiesin the state
•Many communitieswith large percentagesof people livingbelow poverty as well
Prevalenceof PriorityHealth Conditions
Health Conditionsto be Addressed
Tiered Approachto Interventions
Tier1
–Straightforwardaccesstodata
–Strongevidence base for clinicalimpact
–High likelihoodofproducingReturn onInvestment(ROI)
Tier2
–Availabledata sources
–Inconsistentor emergingevidence base
–Lowto moderate likelihoodofproducingReturn on
Investment
Tier3
–No PWTF evaluation and littletechnicalassistance
–Minimalbudget
Tier 1 Interventions
Condition Clinicaland CommunityInterventions• Implement USPSTFRecommendationsfor TobaccoUseScreeningand
Tobacco Treatment
Pediatric • CareManagementfor High-RiskAsthma Patients
Asthma • Home-Based Multi-Trigger,Multi-ComponentIntervention
• Comprehensive ClinicalMulti-FactorialFall Risk Assessment
Falls • HomeSafety AssessmentandModificationforFalls Prevention
• Evidence-based guidelinesfordiagnosis and managementof
Hypertension hypertension*
• ChronicDisease Self-ManagementPrograms
• All partnerships
• Statewideinnovation
– Variedmodels
– Consistenttraining
– ConsistentSupervision
• Certification
E-ReferralLinkagesareaHallmarkofthePWTF
• Bi-directional,electronicreferrals betweenclinicaland
communityorganizations
– Within eachgranteepartnership
– IntegratedintoEMRforatleastoneclinicalpartner
– Use web-based e-ReferralGatewayfor otherpartners
• StateInnovationModel funding for 3sites
– Firstsuccessful e-Referralsent June30th!
– Basisfor PWTF e-Referralapproach
Create
• e-Referralrequiresbi-directionalelectroniclinkageaswellas
organizationalconversationtoinitiatecommunity-clinicallinkages
Evaluate
• e-Referralsystemcanprovidebaselinereportson# ofreferrals,#
ofservicesreceived,andotherinformatione.g.# ofpoundslost
• Whenintegratedwiththe EHR,healthsystemscanevaluatethe
impactof thesecommunityprogramsonpopulationhealth
Sustain
•Onceinstalled,thee-Referralsystemcanbemodifiedto add additionaltypesof communityresources
•Usingthee-ReferralsoftwareandEHRs, community-based organizationscanmakethecaseforclinically meaningfulandcost- effectiveprogramming
OutboundTransaction
Transmissionfrom EHR
ClinicalSetting
Identifiespatient appropriatefor communityintervention
e-ReferralsfromClinicalProvider toCommunityOrganization
PatientContactInformation
Referral-specificinformation:
(1)Parent/GuardianInformation
(2)Condition status
(3)Reasonforreferral
CommunityResource
Patientcontactedby CommunityOrganization toenrollinintervention
ClinicalSetting
Feedbackreportsadded toEHR.
Atnextappt,providerseesupdateintheEHRand reassessstatus
InboundTransaction
TransmissiontoEHR
ProgressreportfromCommunity
OrganizationtoClinicalProvider
Sessionsattended Conditionstatus Next steps
CommunityResource
CommunityOrganization providesfeedbacktoclinical provider
Grantees
•Partnershipsworking on governance,work plans, budgetplanning,communicationplans,condition workgroups,e-referralpreparation
PWTFTeam
• Technicalassistanceframework
• QualityImprovementmodel
• Learningsessions
• SharePointdevelopedforcommunication
• TrainingPlan
Evaluation Overview
OutcomemeasuresdefinedbyChapter224
• Reductionin prevalenceof preventable health conditions
•Reductionin healthcarecostsand/or growth inhealth carecost trends
• Beneficiariesfrom the healthcarecostreduction
•Employee health, productivityand recidivismthrough workplace-basedwellnessorhealthmanagement programs
TwoPrimary Goals
• Using evaluation topromotechange(QualityImprovement)
• Using evaluation todemonstratechange
Problem:PWTFhas9ServiceAreas,across3
Domains,formorethanadozeninterventiontypes
Issue:TheQIprocessshouldberelevantto
allparticipantsat alltimes
Solution:ConceptualUniformity
– Highlevelmeasures
– Similaracrosshealthconditions
•Explicitgoals
•QualityImprovement framework
•Implementednew local policies
•Implementednew clinicalpractices
•Seeking new fundingsources(ACOs,payers)
•e-Referralchanges conversation between
partners
THANK YOU
Questions?