The Impact of Community-based Wellness Programs on The Triple Aim

People with disabilities experience a staggering incidence of secondary conditions that can
result in death or negatively impact their health, participation in the community, and
quality of life. Many of these chronic secondary conditions are preventable. The Institute
for Healthcare Improvement has advocated for optimizing care through programs that
simultaneously improve health and the patient experience of care, while reducing cost, called
the "Triple Aim." Studies have shown that the Triple Aim can be achieved through programs
that facilitate community integration; however the U.S. healthcare system lacks a paradigm of
care for individuals with disabilities that promotes community integration.

Living in the community affords many benefits for individuals with disabilities and chronic
conditions. Studies have shown that higher integration into the community is associated with
better health outcomes, longevity, higher quality of life, and lower cost of care. For
example, it is estimated that the social support networks of the elderly saves the U.S.
Government over 190 billion dollars annually through positive impacts on health.

The U.S. healthcare system, however, currently lacks a paradigm of care for individuals with
disabilities that facilitates their integration into the community. Impactful research
studies will be those that investigate delivery models that incorporate community-based
services and that are funded through non-traditional means. One example of an innovative
model of care is a wellness intervention wherein community-based interventions are delivered
by non-profit organizations. For example, a recent study showed that using community-based
peer health coaches to conduct telephone interventions for individuals with chronic spinal
cord injury (SCI) resulted in greater confidence toward health goals and a greater connection
to resources. Another recently published study on the "Living Well" program used health
facilitators to conduct weekly health workshops. This program was implemented by 279
community-based independent living centers funded under Title VII of the Rehabilitation Act
in 46 states, served approximately 9 million participants, and saved an estimated 30 million
dollars. Many other studies have also demonstrated a positive impact of wellness
interventions in a wide variety of chronic and disabling conditions.

Community Living and Support Services (CLASS) is a non-profit organization in Pittsburgh, PA,
that provides a host of programs that aim to achieve community integration for individuals
with disabilities. One such program is Community Partners which began in 1986. Community
Partners offer non-traditional case management services which involved physically meeting
with consumers in the community and telephonic support. The services provided included
assisting clients in managing their personal care needs (e.g. activating attendant care
services, or learning how to prepare meals), medical needs (e.g. taking medications on time
or ensuring follow up at medical appointments), wellness needs (e.g. eating a balanced diet
or engaging in adaptive exercise), and social needs (e.g. connecting with vocational
rehabilitation or support groups)

A second example of an innovative model of care is the Program for All Inclusive Care for the
Elderly (PACE). A PACE organization is a unique capitated managed care program provided by a
non-profit, public entity, and in some cases a for-profit entity. The PACE model is a dually
capitated, multidisciplinary approach to delivering both medical services and LTSS in
accordance with a participant's needs. The services are delivered in the community whenever
possible, usually integrate into a primary care medical home, and offer non-medical services
including an adult day health center and in-home support services where appropriate. These
organizations are typically responsible for all traditional Medicare-covered services
(hospitals, physicians, and post-acute care), as well as supportive care.

The services are delivered in the community whenever possible, usually integrate into a
primary care medical home, and offer non-medical services including an adult day health
center and in-home support services where appropriate. These organizations are typically
responsible for all traditional Medicare-covered services (hospitals, physicians, and
post-acute care), as well as supportive care. The services include, but are not limited to,
all Medicare and Medicaid services. At a minimum, a PACE organization must provide 16
different types of services including social work, medications, personal care, nutritional
counseling, recreational and other therapies, transportation, and meals. The care team is
comprised at a minimum of a primary care physician who works a substantial amount of time at
the PACE, a nurse, social worker, physical therapist, occupational therapist, recreational
therapist or activity coordinator, dietitian, PACE center supervisor, home care liaison, and
health workers/aides. These organizations also provide support and respite care for families
and other caregivers of participants. Today, 119 PACE programs in 31 states serve over 38,000
participants.

The overall goal of this project is to evaluate the impact of the Community LIFE program (a
PACE model) on the Triple Aim for individuals with disabilities (health improvement,
satisfaction of care, and cost).

The study findings will provide evidence as to whether these types of community-based
delivery system could be scaled to larger populations and adopted by an integrated delivery
system through an innovative funding mechanism.

Inclusion Criteria:

- Individuals who are eligible for the Community Partners program

- Individuals who are eligible for the Community LIFE program between the age of 55-64.

Exclusion Criteria:

- Individuals who are eligible for the Community LIFE program under the age of 55 or
older than 64 years old.