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

8/16/13 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 2 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 3 1

8/16/13 History of Health Reform for Substance Abuse 1999 – Surgeon General’s Report n – Behavioral health conditions are treatable, co-occur with other illness 2001 – IOM Crossing the Quality Chasm n – Defined quality, 10 new rules for care delivery redesign 2003 – President’s New Freedom Commission Report n – BH = health, system transformation, recovery 2005 – IOM Improving the Quality of Health Care for Mental and n Substance Use Conditions – Applied IOM system quality improvement framework to behavioral health 2007 – AHRQ Report on Hospital Admissions n – 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 4 – Better health; improved quality care; lower per capita cost History of Substance Abuse Treatment n Isolation and Segregation – Stigmatized, marginalized, criminalized – Disenfranchised populations – Separation of delivery systems and isolation of professionals – Definitional issues – Natural history issues – Finances – Culture 5 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 6 2

8/16/13 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 7 Minnesota State Substance Abuse Strategy Minnesota departments/agencies: n – Human Services -- Corrections – Education -- State Judicial Branch – Health -- MN Board of Pharmacy – Public Safety – Labor & Industry Work groups n – Data and Measurements -- SBIRT – Opiate -- Specialty Courts – Prevention Messaging -- Drug Task Forces Opiate work group n – Human Services – Public Health – Safety – MN Board of Pharmacy 8 New and Developing Knowledge/Technology n Neuroadaptations n Operant Conditioning and Reward Pathways n Genetics 9 3

8/16/13 Drug Craving Activates Specific Brain Regions 10 11 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 other chronic diseases n Relapse is common David Friedman, Wake Forrest School of Medicine 12 4

8/16/13 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 13 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 14 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 15 5

8/16/13 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 16 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 17 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 18 6

8/16/13 Consolidated Chemical Dependency Treatment Fund n 121 million from a braided funding stream of 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 19 Navigator and Model of 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 20 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 21 7

8/16/13 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 1 st Quarter 2014 22 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 23 24 8

8/16/13 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 25 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 26 Closing Thoughts n Behavioral health is an integrated part of overall health n We need to sit at the integration/collaboration table with the goal of improving the health of all 27 9

8/16/13 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 28 10