Health Care Reform and Substance Abuse Services By Dave Hartford, - - PDF document

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Health Care Reform and Substance Abuse Services

By Dave Hartford, Assistant Commissioner

Chemical and Mental Health Services Administration Minnesota Department of Human Services

MARRCH Summit August 16, 2013

Agenda

n Health Care Reform

– Better health and better care at lower cost

n Substance Abuse Services

– Past accomplishments – Present opportunities – Future implications

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Affordable Care Act – 2010

n Expanded Coverage

– Medicaid and insurance marketplaces – 38 million newly covered – 11 million with BH conditions

n Builds on Federal Parity

– Includes SUD/MH in the essential health benefit – Parity protections in the individuals and small group markets

n New Opportunities and Tools

– Improve health care and health = health system – Payment reform, system redesign, technology – Innovation

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History of Health Reform for Substance Abuse

n

1999 – Surgeon General’s Report

– Behavioral health conditions are treatable, co-occur with other illness

n

2001 – IOM Crossing the Quality Chasm

– Defined quality, 10 new rules for care delivery redesign

n

2003 – President’s New Freedom Commission Report

– BH = health, system transformation, recovery

n

2005 – IOM Improving the Quality of Health Care for Mental and Substance Use Conditions

– Applied IOM system quality improvement framework to behavioral health

n

2007 – AHRQ Report on Hospital Admissions

– Documentation of impact of BH disorders on U.S. community hospitals

n 2008 – Wellstone Domenici Act – Federal Parity

– Group health plans must offer MH/SUD comparable to medical and surgical care

n 2009 – IHI Triple Aim

– Better health; improved quality care; lower per capita cost

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History of Substance Abuse Treatment

n Isolation and Segregation

– Stigmatized, marginalized, criminalized – Disenfranchised populations – Separation of delivery systems and isolation

• f professionals

– Definitional issues – Natural history issues – Finances – Culture

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Why Do We Care?

n Economic Cost to Society $559 Billion n Substance abuse and addiction cost

15.7% of State budgets

n $1 spent on effective school base

prevention saves $18 in later problems

n $1 spent on treatment saves $12 in drug

related crime, criminal justice, and health care costs

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Minnesota Leadership in Substance Abuse Treatment

n Minnesota Model (multi-disciplinary model) n Consolidated Treatment Fund n First State to develop certification for IDDT n First State multi-agency substance abuse

strategic framework

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Minnesota State Substance Abuse Strategy

n

Minnesota departments/agencies:

– Human Services

• - Corrections

– Education

• - State Judicial Branch

– Health

• - MN Board of Pharmacy

– Public Safety – Labor & Industry

n

Work groups

– Data and Measurements

• - SBIRT

– Opiate

• - Specialty Courts

– Prevention Messaging

• - Drug Task Forces

n

Opiate work group

– Human Services – Public Health – Safety – MN Board of Pharmacy

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New and Developing Knowledge/Technology

n Neuroadaptations n Operant Conditioning and Reward

Pathways

n Genetics

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Drug Craving Activates Specific Brain Regions

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How Does the Newest Science Inform Policy Making

n Drug addiction is the result of drugs hijacking important brain

circuits

– Some brain changes may not be reversible

n Genetics can predispose people to addiction n The environment plays an important role in addiction

– Epigenetics

n Adolescents are particularly vulnerable to drugs

– Prevention should be targeted to them

n Drug addiction is a chronic disease and should be treated like

• ther chronic diseases

n Relapse is common

David Friedman, Wake Forrest School of Medicine

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New Recovery Movement

n Challenged widespread stigma and

discrimination

n Concept of recovery has evolved

– Disclosure vs. anonymity – Wellness – Physical and emotional wellness – Healthy nutrition

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New Federal Policy

National Drug Control Strategy 2013

• 1. Strengthen efforts to prevent drug use to our

communities

• 2. Seek early intervention opportunities in

health care

• 3. Integrate treatment for substance use

disorder into health care and expand support for recovery

• 4. Improve information systems for analysis,

assessments, and local management

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Current Issues

n Adolescent prevention and treatment

– Opiates and synthetics

n Detoxification services n Housing n Access to services

– Right service – Right time – Right place

n Workforce n Culturally specific and culturally competent

services

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Current Opportunities (In Process)

n State Innovation Model Grant n MNsure n Consolidated Fund n Navigator and Model of Care Pilots n Behavioral Health Home n Minnesota Olmstead Plan

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State Innovation Model Testing

n CMS model testing grant awarded to six

states: Minnesota, Arizona, Maryland, Maine, Oregon and Vermont

n Minnesota is awarded $45.3 million to model

test for three years beginning October 2013

n Accelerate expansion of the Minnesota

Accountable Health Model

– Data analytics/IT Infrastructure – Care delivery and payment transformation – Community integration and partnership

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MNsure

n Subject of ongoing dialogue in Minnesota

since 2006

n Provision within the Federal Affordable

Care Act (ACA) enacted in March 2010

n State-based exchange signed into law by

Governor Dayton in March 2013

n Number of uninsured expected to decline

from 500,000 to 160,000 by 2016 for a 68% reduction

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Consolidated Chemical Dependency Treatment Fund

n 121 million from a braided funding stream

• f a Federal Block Grant, County

maintenance of effort, and Minnesota State appropriation

n People needing to access CCDTF will

decrease

n SAMHSA policy directive to use Block

Grant dollars for services not covered as health care benefit

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Navigator and Model

• f Care Pilots

n Two pilots using local CCDTF dollars for

additional supports (2009 legislation)

n Supports - care coordination and housing

assistance

n Model of care legislative report (March 2013)

called for a transition from an acute care to chronic care approach to substance abuse

n 2013 legislature authorized three pilots to

study new potential services

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New Services for Substance Use and Co-occurring Disorders

n Included in other State Plan Amendments

– Care Management Services – Certified Peer Specialist Services – Recovery Housing – Peer-based Recovery Support Services – Tobacco Cessation Treatment – Telemedicine – 23 Hour Crisis Observation, Evaluation and Stabilization

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Behavioral Health Home

n Medicaid State Plan Option Under Affordable

Care Act

n Currently DHS is developing a framework to

serve people with chronic health and behavioral health issues

n Chronic health conditions identified by ACA

include: mental health, substance use disorder, asthma, diabetes, heart disease, and a BMI 25+

n Plan to submit a State plan amendment to

CMS 1st Quarter 2014

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Minnesota Olmstead Plan

n The Olmstead Act is a Federal law requiring

all states to ensure that persons with disabilities have choices about where they live and are served in community settings more suitable to their needs and desires

n Minnesota is in the process of developing an

Olmstead Plan

n Governor’s subcabinet established and plan

to be developed for 2014 legislature

n Department of Justice Enforcement

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Core Foundation

n Addiction is a Health Problem n Chronic Not Acute Condition

– Purchasers: Will need to change contracts, funding mechanisms and expectations – Providers: Will need to change from acute to chronic care/recovery support design and service delivery

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Implications for Services

n Provide easy access to and transition

between various levels of care

n Use addiction medications as clinically

appropriate

n Develop recovery support services n Continuing care n Use of technology support services

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Closing Thoughts

n Behavioral health is an integrated part of

• verall health

n We need to sit at the integration/collaboration

table with the goal of improving the health of all

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Closing Thoughts (continued)

n Opportunity to help the people we serve

get the services they need

n We have a new equation:

New Science + Technology + New Recovery Movement + New Tools + New Funding = New Minnesota Recovery Model

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