2/26/13 Webinar Facilitator Eric Goplerud Senior Vice President - PDF document

2/26/13 Webinar Facilitator Eric Goplerud Senior Vice President Substance Abuse, Mental Health and Criminal Justice Studies The BIG Hospital SBIRT Initiative NORC at the University of Chicago Monthly Webinar Series 4350 East West Highway 8th Floor, Bethesda, MD 20814 goplerud-eric@norc.org Wednesday, February 27, 2013 http://hospitalsbirt.webs.com Asking Questions Ask questions through the Questions Pane 1

2/26/13 First Presenter SBIRT Partnerships Les Sperling Chief Executive Officer Central Kansas Foundation lsperling@c-k-f.org Les Sperling Central Kansas Foundation www.c-k-f.org Salina, Kansas CKF STRATEGY Central Kansas Foundation CKF is a not-for-profit corporation whose mission, since Become integral part of Health Home 1) its inception in 1967, has been to provide both quality and Implement SBIRT in Primary and Acute Care Settings affordable alcohol and other drug education and 2) treatment services. Reduce recidivism to High Cost Care Settings 3) — Community Based — 65 employees Demonstrate impact of SUD on general health 4) — 5 locations Increase capacity for SUD patients to access primary health 5) — Services include: All levels of Outpatient Therapy, and oral health care Detox, Medication Assisted Withdrawal, Residential Treatment, and Prevention/Education Programs Full integration of SUD services into Primary and Acute Care 6) Settings 2

2/26/13 Salina Family Healthcare/Smoky Hill Salina Regional Health Center Outcomes Outcomes Residency Program • Re-admission DRG moved from 2 nd • 199 Bed Acute Care Regional Health — 10,000 unique patients, 13 Family • 23% screening positive on Audit-C to 13th Center-Level III Trauma Center Medicine Residents, 10 dental • Average daily census in treatment • 70% of alcohol/drug withdrawal chairs • 27,000 ED presentations per year groups is 12.5 LOS were 3 days or less — Universal Screening of every • Alcohol/Drug DRG was 2 nd most • Residents and other practitioners • 83% of SUD patients triaged in ED patient annually frequent re-admission becoming interested in SUD were not admitted interventions — ASAM Level I and II provided on- • Services provided • 58% of patients recommended for site further intervention attended first • Level III Person Centered Medical ü 24-7 coverage of ED two appointments (warm hand off) Home accreditation received — 2 FTE Licensed Addiction ü Full time SUD staff on medical • Adverse patient and staff incidents Counselors located at FQHC. • SUD staff a key component of and surgical floors decreased by 60%. Medical Home ü Warm hand off provided to all • CKF detox admissions increased SUD/MH services 450% in first year ü Universal Screening and SBI • 300% increase in commercial beginning in 2013 insurance reimbursement Personnel Essential Staff Attributes SBIRT in Kansas • Licensed Addiction • Trained in motivational Counselors interviewing and brief Effective 1-1-2013, SBIRT billing codes are active for Kansas Medicaid intervention. (Stages of • Licensed Clinical Marriage Codes are available on both medical and behavioral health sides change, FRAMES) and Family Therapists Eligible SBIRT Provider Panel: Physicians, P . A., A.R.N.P , Psychiatrist, Registered Nurse, any behavioral health professional licensed by the Kansas Behavioral Sciences • Able to thrive in fast paced • Licensed Specialist Clinical Regulatory Board (includes Licensed Addiction Counselors), and Health Coaches medical settings Social Worker Training requirements vary from 2 hours for Physician to 12 hours for Health Coaches • Understand medical cultures • Person Centered Case and can adapt Active Codes Managers H0049 Screening $24 • Recovery Coaches and Peer H0050 Brief Intervention $24/15 min. (Capped at 4 hours annually) Mentors (Recovery Health 99408 Screening $24 99409 Brief Intervention $24/15 min. (Capped at 4 hours annually) Coaches) 3

2/26/13 5) Be prepared to do the administrative 1) Research and understand the external work and be the “go to” person for all and internal constraints experienced by problem solving. safety net clinics and acute care hospitals. 6) Be persistent, but lean instead of push. Double the time you think it will take to CKF LESSONS 2) Understand reimbursement and funding CKF LESSONS operationalize. challenges for clinics and hospitals. LEARNED LEARNED 7) Don’t waste medical staff’s time. Be 3) Develop a champion within the clinic prepared for meetings. Keep e-mail and staff. Ultimately has to be MD or CEO, other communications focused and but tell your story to nurses and mid- brief. Always respond to their requests level practitioners. immediately. 4) Request data and use it. 8) Focus on addiction as chronic illness Contact Information Prepare and use cost-benefit data. 9) Les Sperling 10) Have a good plan to increase income over the long term with specific billing Central Kansas Foundation codes, grants, etc. to shoot for. CKF LESSONS 1805 S. Ohio LEARNED 11) Increase your capacity to effectively treat and manage co-occurring and Salina, KS 67401 chronic illness. 785-825-6224 12) Build mental health services capacity via contract or staff. 620-242-7923 cell lsperling@c-k-f.org 4

2/26/13 Questions? Second Presenters Marla Oros Colleen Hosler President Senior Associate Mosaic Group Mosaic Group moros@groupmosaic.com hosler1@umbc.edu IMPLEMENTATION PLANNING Need for SBIRT in Baltimore FOR SBIRT IN HOSPITAL AND 20 20 HEALTH CARE SETTINGS — Significant disparity between those needing treatment and those in treatment: 19 ¡ Baltimore estimates 70,000 individuals needing treatment and only 22,000 received in FY 2008 M A R L A O R O S , R N , M S ¡ According to National Survey on Drug Use and Health, close to 10% of C O L L E E N H O S L E R , M A Baltimore’s population reported illicit drug use in the past month F E B R U A R Y 2 7 , 2 0 1 3 ¡ Heroin remains the number one drug associated with treatment admissions and accounts for 60% of intoxication deaths 5

2/26/13 Readiness for SBIRT in Baltimore City Planning Process Goals 21 21 22 22 — Select early adopter health settings with committed — Baltimore Buprenorphine Initiative: leadership and interest ¡ Increase in physicians with waiver to prescribe- 50 in 2006, — Institutionalize SBIRT into existing patient flow without over 200 in 2011 significant new staff resources ¡ Engage all city health center physicians as continuing care — Develop model clinical protocols using evidence-based providers tools ¡ Develop new models of induction in primary care — Develop training materials — State and city focus on integration of behavioral — Develop program documents — Pilot program and evaluate for full implementation and health with primary care expansion Scale of SBIRT in Baltimore City Need for SBIRT Hospital Program in Baltimore 23 23 24 24 — BSAS, through its consulting partner, The Mosaic Group, had been — Older Adult Needs Assessment- 2011 hospital data analysis planning and delivering SBIRT programs in community health centers, high schools and nursing homes across Baltimore for the past 18 ¡ Approximately 43,000 patients are admitted per year to months: Baltimore City hospitals and in 2010 52.5% of those ¡ 24 health centers patients had a substance abuse related diagnosis ¡ 4 high schools — Healthy Baltimore 2015 Goal to reduce hospital admissions ¡ 1 hospital related to substance abuse — The results of these programs were: — New initiative for hospitals to reduce 30 day re-admission ¡ Integration of SBIRT as a routine practice rates ¡ Incorporation of SBIRT into health center EMRs ¡ Catalyst for behavioral health integration with primary care at a number of sites ¡ Development of enhanced systems to support fast track referral to treatment ¡ Development of new partnerships with referral sources to expand access 6