1. COMMUNITY SELF-MANAGEMENT PROGRAMS FOR PEOPLE WITH EPILEPSY
Jody R. Kakacek, MNPM, PhD
Epilepsy Foundation
BACKGROUND
MATERIALS AND METHODS
RESULTS
Self-management is a critical component of achieving seizure control in people with epilepsy. However, patients need support to develop these skills, and evidence shows that the use of specific programs under the guidance of community healthcare workers (CHWs) and other nontraditional health providers (NTHP), such as navigators, health educators and coaches, or advisors improves these skills, as well as overall delivery of coordinated care, and reduces disparities.1
Working with CHWs and NTHP is an evidence-based public health practice,1 and services are now reimbursed by the Centers for Medicare and Medicaid Services under the Affordable Care Act.2 However, only 7 of 40 states working to integrate CHWs into healthcare systems currently have conducted studies to determine evidence of cost savings.3
Because of the limited research available about the integration of CHWs and NTHPs in systems, the Epilepsy Foundation worked with two of its local affiliate offices to develop a case study of their work in different states.
Epilepsy Foundation of Michigan
During this pilot, the affiliate determined that there were:
significant reductions in ER visits
reductions in stress and smoking
notable improvements in exercise, activity limitation, drowsiness and depression
Epilepsy Foundation of New Jersey
In an initial pilot of the 12 week program conducted at Rowan University, 70% of participants experienced improvements in quality of life scores
Over 770 students were trained to work with people with epilepsy and other developmental disabilities. These students have also been given research-related funding opportunities and invitations to national and international conferences.
Epilepsy Foundation of Michigan
The Epilepsy Foundation Michigan worked with PROGRESS to Wellness, a 3- to 6-month phone-based epilepsy self-management program for adults.
The program uses a step-by-step problem solving process and motivational interviewing with individual wellness planning calls with health coaches every two weeks.
Participants work toward goals in four Wellness Domains:
seizures and physical symptoms
emotional and social well-being
memory and thinking
self-sufficiency
The Michigan affiliate also reached out to Blue Cross Blue Shield of Michigan and the Bureau of Medicaid Care Management and Quality Assurance, Medical Services Administration through the Michigan Dept. of Health and Human Services to explore reimbursement options.
Epilepsy Foundation of New Jersey
The Epilepsy Foundation New Jersey took a different approach to wellness for people with epilepsy by using their pilot of Get FIT (Fitness-Integration-Training), which is dedicated to promoting an inclusive culture of health and wellness for people with disabilities, chronic health conditions, and their caregivers. The Foundation used the Epilepsy Self-Management Scale (ESMS) for pre and post assessment.
The affiliate built coalition partnerships by joining the Regional Chronic Conditions Coalition and the Managed Long Term Services and Support Community Advisory Committee, and started the Get FIT statewide coalition to reach out to ACOs and FQHCs to be a part of the coalition and promote the Get FIT program in their centers as reimbursable service for patients with epilepsy. Clinicians were encouraged to obtain referrals for patients for Get FIT through care management organizations for youth, and through support coordinators and Medicaid support programs waivers for adults.
University partnerships were also offered during the grant period, which increased the capacity of students training to become community health workers. There were Get FIT internship opportunities that trained future health promotion and allied health professionals on the program and included job opportunities upon graduation.
A Get FIT Youth group is being funded as a pilot project at a local YMCA by WellCare, a Medicare and Medicaid Managed Care Plan.
PURPOSE
PURPOSE
The purpose of this case study was to examine how different epilepsy self-management programs were practiced and promoted in two states, as well as looking at methods of reimbursement, to determine necessary steps for replication in other areas.
Two affiliates of the national office of the Epilepsy Foundation, the Epilepsy Foundations of Michigan and New Jersey, received grants to develop relationships with state agencies and third party payers to initiate reimbursement policies for community health educators working with people with epilepsy in self-management activities.
CONCLUSIONS
There is a need to develop a system to request per patient/per program reimbursement, as well as to determine the price of the program and appropriate case load.
2. Documentation of cost savings can encourage private party payers, such as WellCare in New Jersey to fund these types of programs.
REFERENCES
1. Centers for Disease Control. (2015). Addressing chronic disease through community health workers: a policy and systems-level approach. Accessed October 12, 2016 from
2. Centers for Medicare and Medicaid Services . (November 27, 2013). CMCS Informational Bulletin: Update on Preventive Services Initiatives. Accessed October 12, 2016, from
3. Tomaschek, E., Kobau, R., Begley, C., Elam, K., & Guerrero-Luera, R. (2015). Nontraditional Health Providers: Untapped Opportunities in Epilepsy Care. Poster presented at the annual Epilepsy Foundation Skills Building Institute in Denver, CO
This program is made possible with funding from the Centers for Disease Control and Prevention (CDC) under cooperative grant agreement number 1U58DP Its contents are solely the responsibility of the authors and do not necessarily represent the views of the CDC. The views and information provided in this poster are solely those of the Epilepsy Foundation and should in no way be deemed as substitution for medical advice.