Establishing Return on Investment for Evidence-Based Programs and Services that Address Social Determinants of Health

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The Maryland Living Well Center of Excellence (LWCE), a Division of MAC Inc. AAA, receives patient referrals from physicians to a wide array of evidence-based programs (EBPs). As part of the process, an assessment of the patient’s social needs assists with enrollment in EBPs and identifies other non-clinical services such as transportation or home-delivered meals. During COVID, identifying and addressing older adults' needs, including social isolation and mental health issues became even more critical. Patient referrals are received via the state’s health information exchange secure system (HIE). Patient enrollment and attendance in an EBP, along with information about other services provided, is documented via the HIE and reported to the referring physician. Maryland hospitals are in a single- payer, capitated rate system for Medicare reimbursement. Hospitals are responsible for all individuals within their catchment area, which requires a public health approach that focuses on prevention, early detection and appropriate treatment.

Sue Lachenmayr

MPH, CHES, Statewide Program Manager

Maryland Living Well Center of Excellence - MAC, Inc.

Sue oversees statewide implementation of evidence-based programs; assists in grant-writing, partnership/capacity building; provides leader trainings for various evidence-based wellness programs and implements evidence-based community workshops. She collaborates with healthcare systems to embed and sustain evidence-based behavior change programs into care delivery. Sue was previously the Senior Director of the National Council on Aging Chronic Disease Self-Management Resource Center where she led a team of professionals in providing national technical assistance to 47 state agencies. Prior to that, Sue oversaw evidence-based program implementation across New Jersey for the Department of Health and Senior Services and was previously a lobbyist for the Alzheimer’s Association in New Jersey.

Leigh Ann Eagle BS

Chief Operations Officer, Maryland Living Well Center of Excellence

Maryland Living Well Center of Excellence - MAC, Inc.

Leigh Ann Eagle is the Chief Operating Officer of the Living Well Center of Excellence (LWCE) at MAC, Inc., an area agency on aging that oversees Maryland’s implementation of Healthy Aging Evidence Based Programs. Ms. Eagle is responsible for all aspects of program management for LWCE. She created the Mid Shore Coalition for Chronic Disease. Under Leigh Ann's leadership, Living Well is connecting healthcare organizations with aging and community resources to coordinate statewide program delivery. LWCE is a one of twelve National Network Lead Entities funded by the U.S. Administration for Community Living.

Jennifer Tripken, Ed.D., CHES (Moderator)

Associate Director, Center for Healthy Aging

National Council on Aging

Dr. Jennifer L. Tripken is an Associate Director, Center for Healthy Aging at the National Council on Aging. In this role, Jennifer supports the expansion and sustainability of evidence-based health promotion and disease prevention programs in the community and online through collaboration with national, state, and community partners. Prior to joining NCOA, Jennifer worked for eight years as a university professor in Health Education and Promotion. Before that, Jennifer spent six years as a middle and high school Health Education teacher in New York.

Jennifer earned her Ed.D. in Health Education at Teachers College, Columbia University, her M.Ed. in Health Education at Boston University, and her B.S. in Athletic Training at Pennsylvania State University.