Care Worker Training: Evidence from the CMS Health Care Innovation - PowerPoint PPT Presentation

Innovations in Direct Care Worker Training: Evidence from the CMS Health Care Innovation Awards Portfolio Presenters: Co-authors: Britta Anderson, Jennifer Satorius, Lynne Snyder, Alana Knudson Health Workforce Research Innovations Session 2017 Health Interest Group Meeting June 24, 2017

Disclosure The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. Research reported in this presentation was supported by the Center for Medicare & Medicaid Innovation under No. HSSM-500-2011-00002I, Order No. HHSM-500-T00010. No author (Britta Anderson, Alana Knudson, Lynne Snyder, Jennifer Satorius) has a relevant commercial relationship to disclose. 2

Overview  Health Care Innovation Award (HCIA) evaluation  Framework  Methodology  HCIA programs training Direct Care Workforce  Direct Care Workforce Training Models – California Long-Term Care Education Center (CLTCEC) – University of Arkansas for Medical Sciences (UAMS)  Models that Include Direct Care Workers – South Carolina Research Foundation (SCRF) HOMECARE+  Summary and Thinking Ahead 3

NORC Evaluation of Health Care Innovation Awards

Health Care Innovation Awards  Center for Medicare & Medicaid Innovation (CMMI) testing payment and service delivery models meeting three-part aim for Medicare, Medicaid & Children’s Health Insurance program (CHIP) beneficiaries  Better Care, Better Health, Smarter Spending  Rapid-cycle evaluation to provide feedback to CMMI and awardees to support continuous quality improvement  NORC evaluates 23 of the 107 first round Health Care Innovation Awards (2012-2016)  Complex/High-Risk Patient Targeting  Diverse group serving patients with multiple chronic conditions living in the community (e.g., frail older adults, children with complex health conditions), at high risk for hospitalization, re-hospitalization, emergency department (ED) visits, or nursing home stays. 5

HCIA Evaluation: Conceptual Framework Do innovations deliver better care, better health, smarter spending? What innovations are effective for which populations, how and why? Context (Exogenous) Intervention Implementation Experience Program Effectiveness Outcomes for   Regulatory & Policy Components Scope Program (Outcomes for   Environment Reach Assistive Technology &  Beneficiaries) Sustainability   Program Marketplace Dynamics Durable Medical   Utilization Replicability &  Stakeholders & Models Equipment  Scalability Cost   Partnerships Launch Patient Targeting &  Quality of Care  Community Resources Timeliness Recruitment (including Patient  & Supports Communication & Health Experience) IT  Health &  Patient/Caregiver Functioning Engagement  Dosage  Fidelity, Adaptability, & Context (Endogenous) Self-Monitoring  Organizational Capacity  Leadership  Organizational Culture & Workforce Development  Implications for Inter-Professional Staffing  Workforce Teamwork Training Implementation Domains Outcome Domains 6

California Long Term Care Education Center (CLTCEC)

California Long Term Care Education Center (CLTCEC) Care Team Integration of the Home-Based Workforce Location: California (Contra Costa, Los Angeles, and San Bernardino Counties) Client Population: Disability, Dually Eligible, Limited English Proficiency, Racial/Ethnic Minority, Urban Reach: 6,598 pairs of beneficiaries and IHSS providers Intervention: Trains pairs of Personal Care Attendants (PCAs) and clients who receive services through California’s In -Home Support Services (IHSS) program • Enhance communication and care coordination across home and clinical settings • Improve management of chronic disease, to reduce ED visits, hospitalizations, length of stay in skilled nursing • Provide better quality, patient-centered care to IHSS consumers • Integrate PCAs into health care team Image: California Long-Term Care Education Center 8

CLTCEC: Survey Design  Consumer & Workforce versions (designed by University of California San Francisco/administered by CLTCEC)  Goals:  Consumer survey: Measure impact of care team integration training on IHSS provider’s integration and involvement in consumer’s care team, as well as the care delivered to consumers  Provider survey: Assess experiences of IHSS providers with care team integration training, measuring trainee satisfaction and perceived effectiveness of training in improving home care skills and facilitating integration into consumer’s healthcare team  Mode: Self-administered via Nook (or paper-and-pencil as needed)  Timing: Beginning and end of training (pre/post similar design); administered 2014-2015  Sample:  IHSS Consumers – 2,618 consumers completed pre-training survey, and 3,063 completed post-training survey – 1,300 consumer respondents with pre-post matched data included in analysis  IHSS Workforce – 6,090 providers completed pre-training survey, and 6,393 completed post-training survey – 4,561 workforce respondents with pre-post matched data included in analysis 9

CLTCEC: Workforce Survey Analysis Healthcare Team Integration Pre-training Post-training How often are you now communicating with your consumer’s healthcare team (n=4,213) 1 More than before training ___ 59.3% How many times in the past month did you communicate with your consumer’s healthcare team? (n=3,699) 1 Mean number of times 2 5.3 4.1 (n=1,949) (n=2,166) Did not communicate with healthcare team this 22.2% 18.7% past month 1 Smaller item sample size associated with both questions due to missing or invalid data excluded from analysis. 2 Mean based on number of valid, within-range responses 10

CLTCEC: Consumer Survey Analysis Healthcare Team Integration  Healthcare Team Integration Pre-training Post-training IHSS providers should be part of healthcare teams (n=1,135) 1 Strongly Agree/Agree 94.3% 95.0% Times in the past month main IHSS provider communicated with anyone from healthcare team (n=894) 1,2 Mean number of times 3 3.4 (n=38) 3.5 (n=466) Don’t know how many times 13.8% 19.2% IHSS provider did not communicate with 67.5%* 1.8%* healthcare team this past month * Differences between pre/post training surveys significant at p<0.01 1 Smaller item sample size due to missing or invalid data excluded from analysis. 2 T-test performed on collapsed responses of “IHSS provider did not communicate with healthcare team” versus “Did Communicate/Don’t know how many times.” 3 Mean based on number of valid, within-range responses 11

CLTCEC: Consumer Survey Analysis Self-Reported Health Outcomes Pre-training Post-training General health (n=1,048) 1,2 Excellent/Very Good/Good 22.4%* 42.7%* Fair/Poor 77.6% 56.8% How often did you feel sad or depressed (n=941) 1,2 All of the time 13.8%* 10.5%* Some of the time 38.3% 32.7% A little of the time 22.3% 24.4% None of the time 25.6% 32.3% Number of ER visits in the past 4 months (n=942) 1 : 67.2% 69.6% None Hospitalizations in the past 4 months (n=937) 1 : 79.3% 84.3% None *Differences between pre/post training are statistically significant at p<0.01. 1 Smaller item sample statistics due to missing or invalid data excluded from analysis. 2 T-test performed on collapsed responses of “Excellent/Very Good/Good” versus “Fair/Poor” and “All of the time” versus “Some/ alittle/none of the 12 time.

CLTCEC: Claims Analysis  Difference-in-difference (DID) analysis  Matched group of comparators  Medicare claims (1/2013 to 3/2016)  1,020 Medicare Fee-For-Service (FFS) beneficiaries, comprising 16% of all CLTCEC enrollees  Cost  Significant increase in total cost of care ($1,175 per beneficiary per quarter) – Significant decrease in total cost of care (-$1,522 per beneficiary per quarter) in second year only  Significant increase in total cost of care overall ( $4,301,627)  Utilization  Significant decrease in emergency department visits (-44 per 1,000 beneficiaries per quarter) in second year only *Quarterly outcomes are statistically significant at p<0.10. **Overall outcome is statistically significant at p<0.01. 13

University of Arkansas for Medical Sciences (UAMS)

University of Arkansas for Medical Sciences (UAMS) Cost-Effective Delivery of Enhanced Home Caregiver Training Location: Arkansas, California, Hawaii, Texas Sponsored by the Schmieding Center for Senior Health and Education in Northwest Arkansas Reach: 3,447 trainees Client Population: Older adults, Rural Intervention: Provides enhanced training for family caregivers and paid direct care workers to better manage the care of elderly adults in the home Image: University of Arkansas for Medical Sciences • Improves caregivers’ mastery of: o clinical skills o knowledge of specific health conditions o provision of care o ability to encourage client participation in management of their own health • Provides advanced skills training through Family Care Advocate (FCA) course. Skills include strategies to: o improve health literacy o enhance role of caregivers as part of the health care team 15