Healthcare and Substance Use Services … a national perspective Prevention and Recovery Conference 2014 November 6, 2014 0
w w w. T h e N a t i o n a l C o u n c i l. o r g Thank you! This morning… • Healthcare Environment • Implications for Specialty Addictions and Mental Health • Practice and Public policy agenda 1
www. The. National. Council. org 2250 Behavioral Health Organizations in 50 States 750, 000 staff serving 8 million adults, children, and families with mental illness and substance use disorders… 2
Members are community problem solvers…
w w w. T h e N a t i o n a l C o u n c i l. o r g Caring for complex, costly adults & children… Socially vulnerable patients (income, language, race/ethnicity, health disparities) Here Clinically vulnerable patients (complex, difficult healthcare needs) 4
Change: Not just your state or organization
w w w. T h e N a t i o n a l C o u n c i l. o r g And it’s not just our sector… Seminar on Surviving Insurance Exchange Challenges Aetna, Ameri. Care, Blue Cross, Lilly, Magellan… • Maintain profits in environment of health reform & budget uncertainty • Capture your share of the soon to expand Medicaid market 6
Best of times but complex times as healthcare change is profound and fast paced… Parity and the ACA 7
Best of times…recognizing impact of co-morbidities • ¼ of all hospital stays comorbid mental or substance use disorder • Untreated comorbid conditions generate higher overall costs
www. thenationalcouncil. org Best of Times: Opportunity to Improve Lives… Addiction ravages communities, families, and individuals. > Leading cause of preventable death in the U. S. > Since 1980, 3. 3 million people in U. S. died of addictions, while 600, 000 people died of AIDS Contact: communications@thenationalcouncil. org | 202. 684. 7457 9
www. The. National. Council. org Best of times: Increasing awareness and support… • Addiction as chronic medical disorder that responds to treatment (Mc. Lellan and Kleber, JAMA 2000 • Block Grant • Legislation • Media 10
w w w. T h e N a t i o n a l C o u n c i l. o r g Inconvenient Treatment Truths: • #1: We have failed to bend the curve for morbidity and mortality from addictions or mental illness. (Health Homes) • #2: More people getting more of today’s Rx but outcomes are not any better • #3: In spite of progress, we still don’t know enough to ensure prevention, recovery, or cure • #4: Science is Slow. But we need to use what we already know to correct course! 11
Operating struggles as we move from silo to equality… > Managed” care (carve outs/ in) – Commercial business > > > models Relationships with physical health – Build it or buy it Knowing costs/cost-cutting techniques – Standardize care Resources – Financing new service lines, facility improvements, HIT, workforce Collaboration – different language with new players Competition – for consumers and payers Increased compliance scrutiny 12
w w w. T h e N a t i o n a l C o u n c i l. o r g In these complex times… National Council and SAAS Merger… 13
w w w. T h e N a t i o n a l C o u n c i l. o r g Understand Environment… • Appetite for Experimentation • Competition driving Monopoly Economy • Demand for Impact enabled by technology revolution 14
www. thenationalcouncil. org Reform is all about Service Redesign… >Reduce institutional care >Deliver health services within an integrated and connected delivery system >Identify and manage “high need/cost” individuals
Payers focused on models that integrate medical care, behavioral health and social supports; and take responsibility for a population… > Integrated Care > Healthcare Homes > Accountable Care Organizations
w w w. T h e N a t i o n a l C o u n c i l. o r g States… Increasing Medicaid coverage/spending • Increase about 13. 2% across the country in FY 15 from 18% in 28 expansion states to 5% 18% in 23 states not expanding • Medicaid directors - delivery system reforms • Rapid shift to managed care — carve out and integrated Kaiser Family Foundation’s Commission on Medicaid and the • “Any willing provider” Uninsured and State Medicaid • Medicaid health homes; patient-centered medical Directors homes; integrating care; and financing for the dual eligible beneficiaries. 18
National Council and Bi-directional Integration… Sustainability*** >Learning Communities – FQHC/SUD >SAMHSA-HRSA Center for Integrated Health*** >NY State Geriatric Technical Assistance Center >Ohio Training & Technical Assistance Center >CDC 19
Service Redesign to Payment Redesign … Episodic Cost Accountability Total Cost Accountability RISK Traditional Fee-for-Service Minimal Shared Pay-for. Savings Performance Bundled Shared Payment Savings s Savings Potential for Health Plans and Customers Partial Full Risk Substantial 20
Competition and consolidation… Large legacy hospital healthcare systems in acquisition mode to gain market share Behavioral health embedded in primary care; or partnering with hospitals/medical homes to provide care to people with complex conditions New players economy of scale and standardization – mergers; private equity Monopoly Economy 21
Technology… in our Hands, Homes or Offices e. Health Revolution Big Data Cut costs by 197 billion over next 25 years
Demand for Impact… World Class Customer Service Branding - think Nordstrom, Starbucks, Apple, and Amazon Prime • Accessible • Provides a personal touch • Resolves problems well.
Outcomes… > Transparent > Standardized > Measured > Benchmarks
Experimentation, Competition, Demand for Impact … • Free standing and Embedded Practice Units — • • • Responsible for disease, related conditions, and circumstances Patient Specific Outcomes-based Care — Measure full set of outcomes and costs for each patient Bundled Payments — preferred provider for chronic conditions Geographical Expansion — Affiliations, mergers, and acquisitions = volume Standardize Across Sites — Determine scope of service and standardize care across sites Enabling Technology Platform — Enable measurement; new reimbursement approaches; tie delivery systems together 25
The best way to manage change is to lead it.
Our Quality Initiatives… Improving the operations and administrative backbone to support clinical practices Improving patient outcomes through implementation of evidence-based and promising practices Developing future healthcare leaders • 25 -30 initiatives • Varied funding sources • Range in size: 5 organizations – hundreds • Primarily only available to members, with some exceptions • 1100 organizations 27
Behavioral Health Center of Excellence • known by the entire community as a great place to get care and a great place to work World Class Customer Service: “Kind words can be short and easy to speak, but their echoes are truly endless. ” Excellent Outcomes: “Take responsibility for making sure I receive the best possible health care. ” Easy Access: “Be there when I need you. ” Comprehensive Care: “Provide or help me get the health care and services I need. ” Excellent Value: “We are accountable for both the cost and quality of care. ”
Our Policy Agenda… 2% of Bills become Laws Just over half of bills proposed saw some form of committee consideration; however, most of these actions consisted of proforma referrals to relevant subcommittees Only 7% of bills introduced made it to the floor of either the House or Senate, a marker that the bill enjoyed serious deliberation Analysis • The vast majority of bills introduced in the 112 th Congress failed to become law, and most never even came close • Only 2% of bills introduced in the 112 th Congress were ultimately enacted Sources: Library of Congress Legislative Information System; Congressional Research Service.
Mental Health First Aid: $15 million in FY 2014 MHFA Act (S. 153/H. R. 274)*
2014 Appropriations > SAMHSA: +$144 M > Substance Abuse Prevention & Treatment Block Grant: +$19 M > Mental Health Block Grant: +$24 million > Primary/Behavioral Health Integration: +$19 M
Addictions Legislation Breaking Addiction Act Reps. Marcia Fudge and Tim Ryan of Ohio, authors of H. R. 5136. Ø H. R. 5136 allows Medicaid for residential substance use treatment, including detox Ø 8 -10 states participate in $300 million demonstration program. Ø 15 million Medicaid beneficiaries could gain access to treatment Ø Demonstration is the first step toward broader evaluation of Medicaid payment policy.
Comprehensive Addiction and Recovery Act Ø Resources for states and local governments combat addiction. Ø Expands prevention and educational; disposal sites for unwanted prescriptions; naloxone to law enforcement Senators Sheldon Whitehouse (D Ø Launches evidence-based opioid -RI) and Rob Portman (R-OH), and heroin treatment program authors of S. 2839 Ø Strengthens prescription drug monitoring programs.
Social Justice Agenda > Ensure ADA, Rehabilitation Act, Fair Housing Act, and > > other laws protecting against discrimination are enforced. Eliminate or reduce barriers to SSI/SSDI Ensure people with drug and/or criminal histories receive food and other assistance they need. Provide voting rights to individuals no longer incarcerated. Reduce barriers to people with criminal records or histories of substanceuse and their families living together in public and federally assisted housing.
Agenda: building capacity www. The. National. Council. org “If it was any other disease, we’d be marching on the streets!” If addiction is a chronic medical condition what’s our Medicaid service continuum? • Residential • Housing • Integration; Care Coordination • Medications • Peer Services; Outreach • Work Supports; Family Education 36
The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday’s logic. Peter Drucker Contact: communications@thenationalcouncil. org | 202. 684. 7457 37
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