Partnering for Better Health

The CHOPT for Medicaid Initiative

Ashley Hernandez Gray, MPP

Health Research Associate

November 15, 2016

@Innov8Medicaid

What is the Institute?

The mission of the Institute for Medicaid Innovation, a 501(c)3 entity, is to improve the lives of Medicaid enrollees through the development, implementation, and diffusion of innovative and evidence-based models of care that promote quality, value, equity and the engagement of patients, families, and communities. The vision of the Institute for Medicaid Innovation is to provide independent, unbiased, nonpartisan information and analysis that informs Medicaid policy and improves the health of the nation.

Project Overview & Key Findings

CHOPT for Medicaid

Purpose of Project

• Identify the “state-of-science” within Medicaid Managed Care • Understand Medicaid initiatives that engage clinicians and

community stakeholders • Identify innovative and promising best practices • Capture the voice of families and children • Develop an implementation toolkit • Host a convening meeting with all stakeholders

Key Elements of Project

• National Advisory Committee • Environmental Scan • Identification of Innovative & Promising Best Practices • Interview with Families • Toolkit • Convening Meeting • Other Dissemination Efforts

Profile of Health Plan Respondents

Source: 2016 CHOPT for Medicaid National Childhood Obesity Questionnaire

Percentage of Single State and Multistate Plan Respondents Market Share of Medicaid MCO Respondents

State Markets Represented by Health Plan Respondents

Source: 2016 CHOPT for Medicaid National Childhood Obesity Questionnaire

Findings from National Questionnaire

• Common components of interventions include:

– A method of identifying members for weight management (commonly member and physician referrals)

– Health education materials for members (print, member newsletters, telephonic outreach, and website) in all languages upon request

– Use of local community resources to reach members, including through community health workers

– Dissemination of educational materials for clinicians about clinical guidelines and weight management program information

• Health plans evaluate outcomes associated with interventions using

patient satisfaction (94%), NCQA-endorsed children’s health measures (51%), and process measures (36%)

Findings from National Questionnaire

MMCOs identified the top challenges:

− Clinicians are not documenting body-mass-index (BMI) scores − Difficulty targeting or identifying Medicaid enrollees for

initiatives − Educating parents and/or members about risks associated with

childhood obesity − Cultivating parent and/or child participation or engagement − Cultural perspectives on obesity − Sustainability of interventions to prevent and treat childhood

obesity − Food deserts and lack of affordable healthy food options in

member communities

Tips for Designing and Implementing Childhood Obesity Initiatives

Key Take-Aways from Family Interviews

• The most important information comes from the voices of families and children

• 28 families who participated in one of the case study programs were interviewed

• Family interviews revealed interconnected factors that impact the efficacy of the initiative and influence a family’s ability to maximize participation, including four themes: – Time – Motivation – Access – Support

Family Interview Overview

Overview of Common Themes from Family Interviews

www.MedicaidInnovation.org

Building a Culture of Health in Childhood Obesity: Overview & Action Plan for Medicaid Health Plans

Featured Tools: – CHildhood Obesity Prevention & Treatment (CHOPT)-

Action Statement (CHOPT-AS) The CHOPT-AS template is a four-step process to guide your planning and implementation efforts. Most importantly, this template includes an Operational Worksheet to organize and collect your preliminary thoughts for your initiative.

– A Step-by-Step Worksheet of the Four-Step Process The step-by-step worksheet accompanies the CHOPT-AS template, providing guidance on completing the four-step process. Each step of the process is described at length, posing thought-provoking questions and providing tips to complete the CHOPT-AS tool.

Building a Culture of Health in Childhood Obesity: Overview & Action Plan for Medicaid Health Plans

Supplemental Tools to Facilitate the Completion of the CHOPT-AS: − Goal Setting Worksheet

This tool follows the SMART (Specific, Measurable, Attainable, Relevant, Time-Bound) method of identifying goals.

− Aims and Drivers for Improvement Template This template offers a visual aid of a driver diagram to assist your organization with Steps 2 and 3.

− Communications Plan Worksheet This worksheet provides your organization with questions to consider as you develop strategies to communicate with your key stakeholders and community resources.

Contact CHOPT Team

Ashley Hernandez Gray, MPP Health Research Associate

Agray@MedicaidInnovation.org

Jennifer Moore, PhD, RN Executive Director

Jmoore@MedicaidInnovation.org Moorejen@med.umich.edu

@Innov8Medicaid @JenniferEMoore_

Upstream Goes Mainstream UnitedHealthcare Collaborates with Community Partners to Address Obesity and Food Insecurity

Hunger and poor nutrition prevent people from living healthier lives.

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Hunger Obesity Paradox

21% Children in

poverty

1 in 7 Americans are food insecure

1.6X Obesity among poor

children

1. America’s Health Rankings, UnitedHealth Group. http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015AHR_Annual-v1.pdf 2.Hunger & Poverty Facts and Statistics. Feeding America. http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 3.Obesity and the Economics of Prevention: Fit not Fat - United States Key Facts. OECD. http://www.oecd.org/unitedstates/obesityandtheeconomicsofpreventionfitnotfat-unitedstateskeyfacts.htm

The challenge is complex and requires multiple approaches to overcome.

22 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Upstream Approach: 4-H Food Smart Families

Food Smart Families is active in 8 states, 40 counties, and with 163 partners.

23 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

2015-2016 School Year Impact

37K People

educated

92% Youth know what makes a balanced

diet

18K Caregivers referred to SNAP, WIC

Strong Grantee Characteristics: •Experience working on the chosen topic •Relationships that will yield strong results, including demonstrated understanding of target population •Staff capacity to support a new program, or scale/expand an existing successful program •Expectations to make a positive consumer impact, beginning with Specific, Measurable, Actionable, Realistic and Time-bound (SMART) goals •A track record evaluating their performance •Cultural values that align to Our United Culture

24 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Collaboration with Community Partners to Address Obesity and Food Insecurity

Improving Whole-Person Health Through Integrated

Health and Social Services

Presented by Denise Clemente November 15, 2016

Services based on social determinants integrated deliver the most impact. But separately, each also provides expert, customized assistance.

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© 2016 United HealthCare Services, Inc. All rights reserved.

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myCommunity Connect Food Pantry Pilot

Condition Specific: Diabetes

Arizona

Condition specific food pantry pilot, focused on Diabetes

Cross Sector Collaboration UnitedHealthcare myConnections Chicanos Por La Causa St. Mary’s Food Bank Maya’s Farms Crooked Sky Farms

In addition to food, provided education & health services onsite

Program Overview & Goals

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Goals: Collect proof points to show that providing the right kind of food will produce better health outcomes at a lower cost

• Targeted 50 UHC Medicaid/Dual Coverage Members • Weekly Distribution of Fresh, Locally Grown Produce and Dry

Goods • Measured AC1 at Beginning, Middle, and End of Pilot • Analyze Claims Data

Scope

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• The program is free of cost to the member • Members received one bag of dry foods and one bag of fresh fruits and veggies a

week • Members were eligible to receive special prizes each week

• Members picked up food every week at Chicanos Por La Causa • Pilot Duration was 7 months • A special dietician and chef created the meal plans to share every week based on

food in the bags • Members had access to videos and special education classes instructing them on

how to prepare food

Program Specifics

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• Arizona State University analyzing outcomes and findings, creating white paper (ETA March 2017)

• Average 50% participation rate throughout pilot duration

• Estimated 80% of participant families, caretakers attended food distribution

• Exit survey shows participants would like continuation of pilot, felt food pantry

helped them with their Diabetes management

• Pilot yielded opportunities to identify other social needs such as housing, employment, education for the participants

• Based on experience, pilot is being replicated in MI and NC.

Findings and Outcomes

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THANK YOU