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2001 Awards Programs 2001 Healthcare and Aging Awards:
Recognizing Innovation and Quality
And the winners are...
Seniors at Home and Health Net Seniority Plus
One aspect of the healthcare continuum that has been ignored by most healthcare delivery systems, including Medicare-Plus-Choice HMOs, is social services. Social services are crucial in providing the necessary support for elders to remain in their own homes. In order to fill this void, Health Net Seniority Plus, a Medicare-Plus-Choice HMO in California, entered into a unique partnership with "Seniors at Home" in January 2000. Seniors at Home is a division of Jewish Family and Children's Services, one of the largest nonsectarian providers of social services in the San Francisco Bay Area. This innovative program of social services and case management is designed to keep frail elders out of the hospital and in their own homes. Health Net and Seniors at Home believe that by working in partnership they can enhance the quality of life of their members while still reducing medical costs, thus producing a sustainable model to benefit older adults participating in Medicare-Plus-Choice. Health Net care managers or medical groups identify potential candidates for the program--frail older adults who have been discharged from hospitals or skilled nursing facilities, or who have had repeated emergency room visits. Comprehensive assessments of the elder's social, cognitive, physical and functional capabilities are conducted. Plans of care including appropriate interventions are then recommended. Seniors at Home social work case managers visit elder participants in their homes to implement the care plans. Most services provided are nonmedical and are funded either through nonprofit community agencies or by the elders. All parties involved in the care management of the patient, including Health Net and the medical group, are kept informed of the care plan, the progress on the plan, and the outcome at the close of the intervention. The program is clearly demonstrating the value and cost effectiveness of funding social services benefits to frail older adults. Initial results of the intervention program show considerable savings on medical costs, an increase in patient quality of life, and enhanced client satisfaction with Health Net and the elders' medical groups. Ultimately, this collaboration is a win for all involved--the health plan, the physicians, social services agencies, the community and most importantly, frail elders. APPLICANT ORGANIZATIONS Health Net Seniority Plus. Health Net is one of the largest for-profit network model health plans in California, serving more than 2 million members statewide. Established in June 1977 in California as a nonprofit public benefit corporation, the company converted to a for-profit corporation in 1992. Health Net is a subsidiary of Foundation Health Systems Inc., one of the nation's largest publicly traded managed care companies. Health Net has received a variety of prestigious awards, including the coveted C. Everett Koop National Health Award for excellence in health education programs. Health Net Seniority Plus is the company's network model Medicare HMO. Its 125,000 Medicare-Plus-Choice members are located mostly in urban and suburban areas. Seniority Plus offers Medicare beneficiaries an enriched benefit program beyond what is available under standard Medicare. Health Net contracts in two ways with medical groups to provide care for Seniority Plus members. Dual-risk groups in partnership with hospitals assume full risk for medical costs of their members. Shared risk groups assume full risk for professional services only; the other healthcare costs are paid by Health Net from a shared risk pool. Health Net is assuming full financial responsibility for the cost of the Seniors at Home program, so at this time the Seniors at Home program is only being offered to shared risk groups. Seniors at Home. Launched in the early 1990s, Seniors at Home is an innovative program of social services and case management orchestrated with the goal of keeping frail elders out of hospitals and nursing facility environments and in their own homes. Seniors at Home is a division of Jewish Family and Children's Services (JFCS), which was formed through the 1977 merger of the Eureka Benevolent Society, founded in 1850, and the Pacific Hebrew Orphan Asylum and Home Society, established in 1872. JFCS is governed by a 30-member board of directors including a cross-section of business and community leaders. Funding is diversified and is derived from private and governmental revenue streams. JFCS is the largest nonsectarian provider of social services to the five Bay Area counties of San Francisco, Marin, Sonoma, Santa Clara and San Mateo. Additional service areas are Alameda and Contra Costa Counties. Last year the agency's 500 staff members and more than 2,100 volunteers, operating out of 16 different offices, served more than 40,000 individuals. JFCS operates more than 40 programs that provide such services as emergency food and shelter; counseling for children, adults, families and elders; refugee resettlement and citizenship training; outreach to those with disabilities and individuals and their families dealing with HIV and AIDS; and friendly visits for the ill or isolated. DESCRIPTION OF PROGRAM Recognizing that utilization management alone does not address the social problems of frail elders nor the growing concern that early hospital discharges have an adverse effect on the overall health status of elders, Seniors at Home developed a home-based case management model. The model allows the program to provide services through a fiscally responsible agent under Medicare risk contracting. The goal of the Seniors at Home program has been to work with a health plan that recognizes that proactive, early intervention in the care of frail elders increases the quality of life of elders, reduces unnecessary medical expenditures, prevents hospitalizations and enables these elders to remain in their own homes. This partnership was found with Health Net in January 2000. Appropriate candidates for the Seniors at Home program--frail elders who have been discharged from hospitals or skilled nursing facilities--are identified by Health Net care managers. In addition, medical groups refer candidates who have had repeated emergency room visits or hospital readmissions within the time span of a few months. Once candidates are identified, complete assessments of the elders' social, cognitive, physical and functional capabilities are conducted. Plans of care are then recommended. Seniors at Home social work case managers visit participants in their homes, offering insight into the elders' lives that cannot be obtained any other way. Home visits enhance the care managers' ability to assess and recommend an appropriate level of services to target identified needs. Services provided may include arranging for behavioral health counseling, food and transportation services, socialization in the home or in day centers, durable medical equipment or medication management; ensuring home safety; providing home repair resources; establishing in-home assistance to help with daily living needs; examining appropriate housing options; assisting individuals with moving; and providing insurance counseling. Services may also include helping elders plan for the future by establishing surrogate decision-makers, durable powers of attorney and other appropriate legal documents. Health Net is funding the entire cost of the Seniors at Home intervention. Most services provided are nonmedical and are funded either through nonprofit community agencies or by the participants. Seniors at Home tracks demographic information, risk factors, medical diagnoses, intervention levels, helpfulness of services provided, and unmet needs pre- and post-intervention. During the intervention program, Seniors at Home monitors progress monthly. Outcomes are noted following the conclusion of the intervention program. In addition, patient satisfaction is assessed at four weeks, six weeks and after the case closes. Seniors at Home keeps Health Net and the elders' physicians apprised of progress and outcomes. The social services interventions help elders have more control over their own lives at a time when their potential for remaining in control is diminishing. Not all patients may be able to remain in their homes. However, the Seniors at Home program helps ensure the appropriate level of care to meet the patients' health needs and enhance their quality of life. COLLABORATIVE RELATIONSHIPS Health Net is funding the full cost of the Seniors at Home collaboration outside of its elder benefits programs. Health Net and Seniors at Home have standardized their interaction process, simplifying the referral and intake system to a one-page form that is faxed between the two entities in the initial authorization stage. The process is as follows:
By simplifying the request and authorization process to a one-page form, paperwork has been minimized and the actions from initial request to planned intervention are easily accessible. All parties involved in the care management of the patient, including Health Net and the medical group, are kept informed of the plan of care, the progress on the plan, and the outcome at the close of the intervention. EFFECTIVENESS OF PROGRAM It is estimated that approximately 6 percent of the elders aged 75 and older could benefit from the Seniors at Home intervention. This would mean a decrease in avoidable emergency room visits, ambulance calls, physician office visits, and inpatient and skilled nursing facility days. In addition, elders participating in the Seniors at Home program remain independent and safe in their own homes, thereby enjoying an improved quality of life. Initial results of the intervention program, both through formal research studies funded by the Robert Wood Johnson Foundation and through pilot program reviews of Health Net patients, show considerable savings on medical costs, an increase in patient quality of life, and increased satisfaction with elders' health plan and medical groups through the provision of the Seniors at Home intervention. Physicians will be surveyed at the end of this year. Results from four-week assessments indicate that at least 96 percent of participants understood why the Seniors at Home social worker visited; felt the social worker was easy to talk to and understood the major issues that impacted their ability to live independently; believed the social worker could offer assistance in important areas; and found it valuable that Health Net was helping them with these concerns. Patient satisfaction surveys completed following the close of the intervention programs show overwhelming satisfaction with the program, with all participants indicating they would recommend the Seniors at Home service to a friend. Additional findings:
In addition to satisfaction with the program, participants indicated the services provided were valuable in helping them maintain their quality of life:
Two case studies help illustrate the positive impact this program has on the lives of elders: An 87-year-old patient with two hospitalizations had a left-foot ulcer with gangrene and venous surgery. She was homebound and unable to navigate the stairs, and her husband--the primary caregiver--was undergoing chemotherapy. Both spoke only Spanish. The Seniors at Home case manager accompanied a Spanish-speaking social worker and applied for an array of services including transport, in-home support services, occupational therapy and senior housing. The case manager also ensured insurance coverage for the patients' numerous bills, provided long-term care counseling and worked with family members. Both patients are now going to a social services agency for daycare and case-worker monitoring. A 74-year-old patient living alone had a stroke and tuberculosis with a poor understanding of the proper medications. The patient also suffered from poor nutrition, complicated by difficulty swallowing. The Seniors at Home case manager arranged for speech therapy, medication management, and transit and food services. The patient's nutrition and swallowing improved, enabling a visit to family in Hawaii. PLANS FOR GROWTH Launched as a pilot program in January 2000, the Health Net-Seniors at Home collaboration began with three Health Net medical groups in the Bay area: Brown and Toland, Hill Physicians and San Mateo IPA. The pilot program was a success, and now Health Net and Seniors at Home will expand this collaborative effort to Sacramento and Southern California, with Orange and south Los Angeles Counties as the first target area. Seniors at Home will be identifying subcontractors whom they will train to implement the program. Health Net plans to work with Seniors at Home to ultimately expand this excellent program to all the major urban areas in California where there are sufficient Seniority Plus members to justify the effort. POTENTIAL FOR REPLICATION In order for this program to be replicated successfully in other geographic areas, the following criteria are essential:
Once the above criteria have been met, Health Net and Seniors at Home can assist in building a program with a focus on establishing a solid case management program. The program includes the following:
OBSTACLES OVERCOME AND LESSONS LEARNED Health Net and Seniors at Home have learned several lessons during the process of collaborating with each other and developing this project. Clear communication within the collaboration and with physicians and medical groups regarding referral sources and treatment plans and outcomes is important for success. Care selection and referral criteria must be developed to avoid over- or under-referring clients and/or services. However, the two organizations found that they did not encounter anticipated resistance from medical groups potentially reticent to work with a program imposed by the health plan. As the program cases continue to be monitored and reviewed, Health Net, Seniors at Home and participating physicians and medical groups will continue to learn and adjust the program accordingly. Health Net found that its infrastructure and internal computer systems were not set up to accommodate paying nontraditional, nonstandard Medicare providers. This required some short-term fixes as well as a more thorough examination of systems to identify needed adjustments. Another challenge lies in the availability and timeliness of needed community and civic resources, particularly adult protective services (APS). If Seniors at Home assessors find that elder clients are a danger to themselves or others, APS must be notified and assistance obtained. Since APS organizations are often underfunded and understaffed, it has been beneficial to nurture relationships with APS; the resulting familiarity with the Seniors at Home program and its legitimacy has helped facilitate timely response by APS when needed. The elders themselves often pose challenges. In many cases, they feel that they don't need any help and are unwilling to accept assistance. In other cases, they are fearful and need reassurance as to why the help is there, or they are forgetful and reluctant to cooperate with people they view as "chronic strangers." If Seniors at Home finds the client to be a danger to themselves or others, not only must APS be brought in but the family and physician must also cooperate to find the best solutions. And ultimately, if the elders are competent and aware, they have the right to refuse services outright even if they truly need assistance. Finally, the Health Net-Seniors at Home program has demonstrated the value of standardizing and simplifying the interaction between the two organizations. As the program is expanded, it will continue to evolve as continual review of the program and processes yield additional lessons and best practices that can be replicated. POTENTIAL FOR CONTINUATION The Seniors at Home program has proven to be financially effective. Because Health Net has primary responsibility for hospital and nursing home costs for members in shared risk groups, the plan's funding of the Seniors at Home program to help keep elders out of hospitals and nursing homes makes financial sense. Health Net is financing the Seniors at Home intervention in its entirety outside of the benefit structure. Recognizing that the cost savings will accrue to their health plan and participating medical groups, this unique funding has been successful in saving overall costs. There have been multiple outcome studies on the cost effectiveness of the Seniors at Home program. The previously mentioned controlled study funded by the Robert Wood Johnson showed sufficient cost savings for the intervention group to pay for the intervention. The recent results of Health Net's patient pilot program showed a cost savings of $114,000 as measured against potential costs if the pilot patients had not participated in the Seniors at Home intervention. This cost savings has an impact on the risk sharing between Health Net and its medical partners, and has the potential to affect senior premium rates in areas where the intervention is available. Seniors at Home services are purchased on a case-rate basis, and expenditures are made based on authorized levels of care. Case rates are kept modest to allow for the greatest participation of Health Net's enrollees. Health Net benefits though reduced medical costs and through increased satisfaction and potential retention of Medicare risk members. Additionally, the program enhances Health Net's relationship with contracted medical groups, benefiting the groups and their physicians without any direct cost to them. With this program, physicians can treat medical conditions with the confidence that the underlying structure to allow their instructions to be carried out is in place. The program also decreases office visits for clinical reasons. Seniors at Home also offers community agencies, which are often funded but underutilized, a valuable opportunity to carry out their mission and service obligations. Not only do the elders themselves and the participating organizations benefit from this program, but the community as whole gains, too. Because a social worker is available to family members of participating elders to answer questions and develop care plans for the elders, adult children are freed from care obligations that often result in lost work time and productivity. In short, the collaborative Health Net-Seniors at Home program is a win for all involved--the health plan, the physicians, social services agencies, the community and most importantly, the frail elders who are able to maintain an enhanced quality of life. CONTACT INFORMATION Health Net Seniors at Home Kaiser Permanente and the Alzheimer's Association of Los Angeles
Alzheimer's disease and related dementias affect more than 4 million Americans, and this number is expected to grow to 14 million by the year 2050. Alzheimer's disease affects 10 percent of the population age 65 or older, and as much as 47 percent of those 85 and over. Unfortunately, many people are mislabeled as having an irreversible dementia due to lack of knowledge on the part of physicians or unavailability of tools to distinguish irreversible conditions from those that are reversible. As a result, there can be unnecessary referrals to specialists, delayed diagnosis and consequent distress for patient, family and provider. In addition, the crushing social and emotional burdens carried by family caregivers of people with dementia strain the traditional healthcare system to which they turn for relief. Often what those caregivers require is respite, education or psychosocial support, which typically have not been provided by managed care. As a result, the physician becomes the contact to manage problems that can be more suitably addressed by other professionals. This compounds the attendant frustration of families and physicians. The Kaiser Permanente Metropolitan Los Angeles Member Service Area and the Alzheimer's Association of Los Angeles have collaboratively established a model program for people with dementia and their families. The program is designed to improve care from the time of diagnosis to the end of life by increasing accuracy in the diagnosis of dementia, improving provider and caregiver satisfaction, and enhancing the continuity of care. Although the program is being implemented at Kaiser Permanente, the model is designed so that it can be used in other managed care settings. It includes development of a guideline for the diagnosis of dementia, a provider training program, member education and support, and provision of care coordination. The project was jointly funded by the Alzheimer's Association and by Kaiser Permanente's Garfield Foundation in 1997 and implementation began in 1998. Kaiser Permanente's Metro Los Angeles Region oversaw the implementation of the project with intensive mentoring and consultation provided by the Alzheimer's Association of Los Angeles. The project's activities included:
As the original demonstration project enters its final year, plans are underway to transition this project into a new, permanent, expanded care management program for memory impaired and frail elders at Kaiser. This will institutionalize this service in the Kaiser Permanente Metro Los Angeles Region. In addition, five other Kaiser regions from Colorado to Hawaii have developed dementia programs drawing upon this model. DESCRIPTION OF APPLICANT ORGANIZATIONS Kaiser Permanente. Kaiser Permanente Medical Care Program is a nonprofit integrated health maintenance organization (HMO) committed to providing excellence in quality of care and quality of service. Founded more than 50 years ago, the HMO is recognizing the challenges of aging in the lives of many of its long-term members. Kaiser Permanente offers Senior Advantage, a product designed for the Medicare population. Kaiser Permanente is one of the largest healthcare delivery systems in the nation. Its Metropolitan Los Angeles Member Service Area provides service to a multicultural, socioeconomically diverse population that includes more than 40,000 individuals ages 65 and older. The member service area consists of two hospitals and numerous medical office buildings within the metropolitan Los Angeles area. Kaiser Permanente's Metro Los Angeles Region provides well-organized continuing care services, which include a geriatric program with an approved geriatric fellowship, extensive social work services, a geriatric assessment clinic, a home health agency, a hospice program, comprehensive health education services, utilization management and a long-term care program. Alzheimer's Association of Los Angeles. The Alzheimer's Association is the national volunteer health organization dedicated to researching the prevention, cure and treatment of Alzheimer's disease and related disorders and to providing support to afflicted patients and their families. The Los Angeles Chapter of the Alzheimer's Association of Los Angeles was founded in 1982 by concerned family caregivers to make the future brighter for victims of dementia and their families. The association was incorporated as a nonprofit in 1984. Since then, through the efforts of more than 500 dedicated volunteers and a small support staff, the Los Angeles Chapter has provided services to more than 55,000 patients and families. The chapter's mission includes the following:
DESCRIPTION OF PROGRAM Kaiser Permanente and the Alzheimer's Association have formed an alliance committed to enhancing the care of individuals and families affected by Alzheimer's disease and related disorders. This relationship provides a unique opportunity to design a system of care that will ensure that Kaiser Permanente members receive the highest quality of care possible when confronted with this catastrophic diagnosis. Planning for the project began in 1994 after Kaiser Permanente was approached by the Alzheimer's Association with concerns about patient care. Four areas of concern surrounding this population were noted: (1) identification of the cognitively impaired; (2) accuracy of diagnosis; (3) management after diagnosis; and (4) overall coordination of care. The goal of the collaboration is to develop a sustainable program that addresses these concerns across the continuum of care. The services developed consist of the following: Diagnostic Guideline for Primary Care Providers. A guideline was developed by Alzheimer's Association staff and volunteers working as consultants to Kaiser staff. According to the guideline, the primary care physician begins the diagnostic process with a history and the Folstein Mini-Mental Status Examination. If a dementing process is suggested, laboratory tests and neuroimaging are recommended. Neurologic, psychiatric or geriatric consultation also may be considered. Once a diagnosis is established, the patient is referred to a care manager who develops and implements a plan of care in concert with the family and the primary care physician. Provider Training. Kaiser Permanente and the Alzheimer's Association collaboratively designed a three-hour didactic, interactive training session for physicians, nurse practitioners, physician's assistants and social workers in Kaiser's primary care, neurology, psychiatry, home health, hospice and emergency departments. Each year during this three-year demonstration project, Kaiser personnel were provided with dementia care training. Learning objectives include the ability list the signs and symptoms of dementia; make a deferential diagnosis of dementia per the developed guideline; and appropriately manage a patient's course of illness to meet biopsychosocial needs. Providers are encouraged to address comorbidities; refer patients to internal Kaiser Permanente and external community resources; and manage behavioral problems, family issues, safety issues, quality-of-life issues and end-of-life issues. This training program, which was developed through funding from Pfizer Pharmaceuticals, included development of a videotape to train providers. Member Education. Kaiser and the Alzheimer's Association have jointly developed caregiver education classes to be offered to Kaiser members. In addition, the project team collaborated with a national publisher of health education materials to revise an existing brochure on dementia for Kaiser members to use. Care Coordination. The project's care-coordination model provides information, support and referral to caregivers through one-on-one and group interaction. Care coordinators are dementia-specialist social workers who also facilitate adherence of primary care physicians to the guideline and the established plan of care. The two current care coordinators are Kaiser staff who have been trained and mentored by Alzheimer's Association staff. DESCRIPTION OF COLLABORATIVE RELATIONSHIPS In 1994 staff from the Los Angeles chapter of the Alzheimer's Association and administrators and physicians from the Southern California Region of the Kaiser Permanente Medical Care Program began discussions regarding their mutual goals as related to patients and families confronting Alzheimer's disease and other related disorders. Their agreed-upon goal is to assure a well integrated, high-quality service to this patient population. The Alzheimer's Association has served in an intensive consultation capacity to assure the achievement of this goal. The two organizations established a work group consisting of staff and volunteers from the Alzheimer's Association and administrative and physician staff from the Kaiser Permanente Metro Los Angeles Region. Kaiser Permanente staff come from many different areas of the organization: primary care, gerontology, psychiatry, neurology, social work, health education, pharmacy, regional administration; and support staff. The Alzheimer's Association developed a document that outlined some of the problems that HMO members with dementia face and suggested possible solutions. Using this document as a base, several work groups evolved, each consisting of a multidisciplinary group of representatives from the two organizations: The Diagnostic Work Group assessed how Kaiser Permanente members with probable dementia are currently evaluated and facilitated the development of a diagnostic protocol. The System of Care Work Group was charged with developing a care model and pathway outlining how people with probable dementia and their families will receive care over the course of the disease, beginning at the time of evaluation and continuing through the final stages. The Education Work Group's mission is to develop training programs for physicians and other healthcare providers in the Kaiser Permanente system and to organize educational opportunities for patients and their families. The Evaluation Work Group's mission is to design a tool that assures continuous enhancement of service and measures the progress of the program. In 1996, each partner sought funds to develop the joint program. Kaiser Permanente's internal Garfield Foundation provided $350,000 for implementation of a new model of care that uses two dementia-specialist social workers as case managers, support group leaders and physician liaisons. The Alzheimer's Association provided $80,000 in funding for a full project evaluation. Through the participation of its staff and volunteers, the association also provided its expertise in dementia care. Staff from the two organizations have now worked collaboratively for more than six years. Together they have developed a diagnostic protocol; three years of training programs for providers; education programs and support groups for caregivers; and a more responsive system of care to support affected Kaiser members. Throughout the program, the Alzheimer's Association staff "mentored" Kaiser Permanente project staff to improve the quality of dementia care. EFFECTIVENESS OF PROGRAM A comprehensive project evaluation was funded by the national Alzheimer's Association. The Organizational Development Department at Kaiser Permanente has designed and implemented the evaluation with input from the Alzheimer's Association research consultants. Early managed care program outcome analyses focused heavily on service utilization and cost. As programs have evolved and matured, the emphasis has begun to shift to measuring provider and member satisfaction and quality of care. In keeping with this trend, the evaluation of this program is measuring (1) improved quality of care through physician compliance with the guideline; (2) enhanced provider knowledge; (3) increased member satisfaction; and (4) increased provider satisfaction. Provider and member satisfaction are evaluated via pre- and post-project questionnaires. Provider compliance with the guideline and other practice changes are being assessed through chart reviews. The program evaluation should be completed by June 2001. Preliminary data show significant improvement in consumer and provider satisfaction with service delivery and some changes in patterns of provider practice. PLAN FOR GROWTH As the original demonstration project draws to a close, Kaiser Permanente's Metro Los Angeles Region is transitioning this project into an expanded care management program for frail or memory-impaired older adults that is in scheduled to start spring 2001. The new project will more than triple the staffing of the original demonstration. It creates two nurse-social worker/dementia specialist teams to serve Kaiser members in the region. The Alzheimer's Association of Los Angeles will provide training for team members and ongoing physician training on request. In addition, the expanded project will offer a single point of entry for intake into the expanded system of care, as well as caregiver support groups and medical backup by geriatric specialists. All currently active project clients will transition into the new care system, which is expected to easily accommodate them while greatly increasing the overall number of individuals served. POTENTIAL FOR REPLICATION In 1998 a consortium of five Kaiser Permanente service areas--Hawaii, San Diego, Sacramento, Denver and Portland, Ore.--received funding from Kaiser Permanente's Garfield Foundation to develop improved systems of care for people with dementia. The consortium was directed by administration to model its activities after the Metro Los Angeles Project. The projects were developed with consultation from staff of the Alzheimer's Association of Los Angeles. Other Kaiser regions have expressed interest in this model of care. OBSTACLES OVERCOME AND LESSONS LEARNED There were four significant barriers to the success of this project: Differences in organizational culture. Community resource organizations and managed care organizations have different missions and assumptions about the provision of care. Each organization is unique, and therefore collaborative team members must operate much like anthropologists to understand each other's world views, patterns of communication and internal system of organization. Lack of understanding can create mistrust and lead to project failure. Patience is essential as system change is very slow. Mistrust. Many managed care organizations have been "burned" by the media and may be reluctant to expose system weaknesses to outsiders. Conversely, community resource organizations often assume that managed care personnel are primarily concerned about profit and are interested in quality of care only secondarily. These assumptions must be suspended if staff are to form effective program development partnerships. Funding. Adequate resources are necessary for program innovations and evaluations. Implementation planning must include resource development through such measures as grants and in-kind support, or plans will fail. Staff turnover. This is a time of great flux for most managed care organizations. Reorganization affected this project annually. The Alzheimer's Association is also a changing and growing agency. Throughout the project, staff turnover was a challenge that led to breakdowns in procedures and data collection. To enhance project continuity, supervisors of project personnel also were trained in dementia care and project procedures. As this demonstration project is transitioned into a permanent and expanded program of the Kaiser Permanente Metro Los Angeles Region, the Alzheimer's Association of Los Angeles has committed itself to ongoing training of new Kaiser Permanente project staff. POTENTIAL FOR CONTINUATION Both sponsoring organizations have benefited from the positive publicity this project has received. At least four articles referencing the project have appeared. In addition, for Kaiser Permanente, this project has served as a model leading to partial replication in other regions and local expansion. The project has stimulated an increase in quality initiatives targeting dementia care within the Kaiser system. For the Alzheimer's Association of Los Angeles, the project has led to several other quality-focused initiatives including the development of a postdiagnostic care guideline for primary care physicians and a new consumer health education campaign. It also has improved the association's understanding of the challenge of changing healthcare provider behaviors and has led to increased sophistication in program planning for partner agencies.
CONTACT INFORMATION Debra L. Cherry, Ph.D. Ralph Yep, M.D. Awards Review Committee ASA wishes to acknowledge the members of the review panel for their work in reviewing award submissions: Lynne Anker-Unnever, New Mexico State Agency on Aging, Santa Fe, NM; Jodi Cohn, SCAN Health Plan, Los Angeles, CA; Connie Evashwick, Center for Health Care Innovation, California State University, Long Beach, CA; Nancy Gorshe, Assisted Living Concepts, Portland, OR; Marcie Parker, Optum, Golden Valley, MN; Jean Polatsek, National Pharmaceutical Council, Reston, VA; Terrie Raphael, Visiting Nurse Service of New York, NY; Cheryll Schramm, Aging Services Division, Atlanta Regional Commission, Atlanta, GA; and Helene Weinraub, Highmark Blue Cross Blue Shield, Pittsburgh, PA.
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