National Council for Behavioral Health June 4, 2018

Transcription

1 National Council for Behavioral Health June 4, 2018 Plans are only good intentions unless they immediately degenerate into hard work. Peter Drucker

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3 This morning... Environment Practice, Policy, Public Education Building a Movement - CCBHCs

4 Environment Heightened attention to addictions and mental health For profit culture in midst of technology revolution Fragile community behavioral health services

5 Politicians of all stripes are talking about addiction and mental illnesses

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7 Mood disorders 1st in work loss costs - depression 400 billion Most common reason for SSD 1 in 8 ED visits 39% of adult stays in U.S. hospitals readmission driver

8 Opioid deaths

9 School shootings

10 Climbing suicide rates Suicide deaths jumped 24% from 1999 to 2014, from 10.5 to 13 per 100,000 people

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12 Working people have little access to community care Escalating deductibles/copays make community treatment out of reach. Equally destructive are stagnant insurance reimbursement that make it cash only businesses.

13 Follow the Money 2011 to 2015, insurers payments to hospitals, laboratories, treatment for behavioral health from $32 million to $446 million a 1,375% increase. Retail clinics replacing traditional primary care; CVS replacing neighborhood pharmacy; venture and private equity investing in inpatient, residential, MAT multiple locations/consolidations

14 Flood of Capital Can technology solve... Access Staffing Quality

15 Fragile to Failing Community Safety Net States reliance on commercial Medicaid managed care - Financial Integration: carve out to carve in No parity in the safety net: FQHCs cost based reimbursement Plans using real-world data for decisions - optimize cost savings; manage value/riskbased contracts; map utilization patterns for care management programs; & identify highperforming provider networks. Limited reserves, margins, access to capital - One in eight NFPs insolvent (source: state association survey, 2017)

16 Staffing Crisis: low salaries and high turnover: 2000 to 2016, private sector employment grew by 9.8%, health care employment grew by 42.0%. Now full employment w w w. T h e N a t i o n a l C o u n c i l. o r g Psychiatrists, APNs, PAs? Have you seen a Psychologist? Occupational therapist? Experts for new science based practice? Supervisors and Mentors? Technologies that extend staff reach Family education and support? Assessment and management of risk?

17 Value Based Purchasing

18 The National Council 2,900 Organizations Serving 10 million + adults, children and families with mental illnesses and/or addictions.

19 The Crazy Talk About Bringing Back Asylums NYTimes Create A Movement...

20 Practice Improvement teleconference trainings 1,400 individuals reached Build on Quality practice improvement projects 10 consulting products 1,100+ non-duplicated organizations reached

21 Highlights CMS Care Transitions Network: Value-based payment readiness initiative with over 85 NYS behavioral health organizations SAMHSA Center for Integrated Health Solutions CIHS: promotes integrated primary and behavioral health services Center for Financing Reform & Innovation CFRI: Analysis on healthcare financing and resource use for behavioral health Bringing Recovery Supports to Scale, Technical Assistance Center Strategies BRSS TACS: Promote adoption of recovery supports, services, and systems for people in recovery CDC National Behavioral Health Network for Tobacco and Cancer Control Behavioral Health Strategic Plan Development Reducing Rx Drug Abuse HIV/AIDS and Behavioral Health Behavioral Health Training for Health Officials

22 Highlights SBIRT Change Packages for adults (SAMHSA) and youth and young people (Conrad Hilton Foundation) Geriatric Technical Assistance Center-GTAC (NYS OMH) Technical assistance to 8 partnerships, covering topics including SUD, SBIRT, smoking cessation, community engagement, outreach to underserved populations, and addressing social isolation and loneliness Trauma-Informed Services Work with diverse service sectors including primary care, MCOs, states and counties, communities, and trauma-informed schools Same Day Access MTM Delta Center (Robert Wood Johnson Foundation) Technical assistance to state primary care associations and behavioral health associations to inspire innovation and change in value-based care and payment

23 Recovery Housing Toolkit Recommendations for States: 1. Adopt a common definition of recovery housing and establish a recovery housing certification program based on national standards; 2. Incentivize recovery housing operators to adhere to nationallyrecognized quality standards; and 3. Support investment in and technical assistance for recovery housing. The Toolkit highlights three main sections: 1. Protecting Recovery Housing 2. Supporting Recovery Housing in Practice 3. Sample Legislative Language

24 Recovery Month Luncheon September, SAMHSA asks nation to observe Recovery Month to increase understanding of addictions and mental illness and celebrate people in recovery National Council will host 2018 Recovery Month Luncheon, in Washington, DC on September 6 Invitation - only event brings together champions of the recovery movement

25 Supporting Leaders Continuing investment in middle managers via Addressing Health Disparities Leadership Program and Middle Management Academy Executive Leadership Dialogue Series New ways of thinking and representing as a leader Podcasts - Bring attention to thorny problems and when solutions exist what s needed to make those solutions real for patients and families Our perspective on hot button issues

26 School to Prison Pipeline... Adolescents Criminal Justice

27 Foundations Our Value: thought partner in behavioral health Increase exposure in the foundation sector through special events and NATCON Offering field insights and historical context Brokering connections to people and events RWJF Delta Center for Thriving Safety Net Adolescent Mental Health Other possibilities Convenings on safe consumption sites Supporting use of SBIRT in schools Trauma preparedness for disaster relief workers Raising awareness of lack of parity in safety net

28 Educating the Public 150,000 First Aiders trained during Lady Gaga s Joanne World Tour between August 2017 and January 2018!

29 Over 475 police departments have pledged the One Mind Campaign!

30 Mental Health First Aid for Fire/EMS

31 Mental Health First Aid: A Longitudinal Research Study At three and six months post-training, participants reported significant increases in confidence and likelihood to perform the Mental Health First Aid action plan. Participants with minimal or no past mental health training gained the most knowledge. Participants reported increases in referrals and assessing suicidality and safety at three and six months post-training.

32 have an ask Policy Agenda

33 Trump s Health Care Team We commit to... a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet... the needs of their Medicaid population Alex Azar, Secretary of HHS Seema Verma, Administrator of CMS Dr. Elinore McCance-Katz, Assistant Sec. for Mental Health

34 Medicaid Waivers... Work requirements 10 states - approved in Kentucky, Indiana, Arkansas (Non-exempt individuals complete 20+ hours/week of work, job training, job search or community engagement activities) Drug testing Higher cost sharing Use of HSAs Special enrollment and lockout periods Time limit on coverage

35 Appropriations FY Massive omnibus spending bill passed in March +$10.1 billion for federal health spending SAMHSA, NIH, CDC receive increases $4 billion dedicated to addressing opioid crisis Key programs: CCBHCs (+$100 million) Opioid STR grants (doubled to $1 billion) PIPBHC (level funding) Mental Health First Aid (+$5 million)

36 House and Senate Opioid-Related Legislation Reauthorize the Opioid State Targeted Response Grant Program Make medication-assisted treatment (MAT) available via telemedicine Increase access to MAT with more prescribers Require HHS guidance on recovery housing best practices Spur development for new pain and addiction treatments Loosen Institution for Mental Disease (IMD) rule on residential substance use disorder (SUD) treatment Loosen privacy rules governing SUD treatment records And a lot more

37 Behavioral Health IT Improving Access to Behavioral Health Information Technology Act (S.1732/H.R.3331) Comprehensive care coordination and comparable health IT in behavioral and physical health is needed to combat opioid epidemic. Bill to assist behavioral health providers in adopting electronic health records (EHR) by adding them to CMMI s list of models to test and giving them needed resources. Sponsors include: Senators Whitehouse (RI) and Portman (OH) and Representatives Jenkins (KS) and Matsui (CA) Current status: Approved by the full Senate and by the House Energy & Commerce Committee

38 Excellence in Mental Health and Addiction Treatment Expansion Act Sens. Roy Blunt and Debbie Stabenow Reps. Leonard Lance and Doris Matsui

39 SAMHSA and CCBHCs SAMHSA released funding opportunity for FY 2018 Certified Community Behavioral Health Clinics (CCBHCs) Expansion Grants. SAMHSA anticipates awarding 25 providers up to $2 million annually to increase access and improve quality through CCBHC expansion. CCBHCs and community behavioral health providers in eight CCBHC demonstration states (MN, MO, NV, NJ, NY, OK, OR, PA) and planning grant states (AK, CA, CO, CT, IA, IL, IN, KY, MA, MD, MI, NC, NM, RI, TX and VA) are eligible. Applications due July 9, 2018

40 CCBHCs

41 The CCBHC Movement Are CCBHCs really improving access to services, or are we just paying more for business as usual? This is a demonstration program, right? We really shouldn t expand it until we see the formal evaluation results.

42 In the First Six Months of Implementation including: CCBHCs added 1160 new positions to their staff 72 psychiatrists 64% hired peer recovery specialists

43 In the First Six Months of Implementation of CCBHCs reported an increased number of patients served, representing up to a 25% increase in total patient caseloads for most clinics

44 Prior to becoming a CCBHC, one of our clients who received psychiatric care at Swope Health Services, then would have to drive a 250-mile round trip for Suboxone treatment for his opioid addiction. During this time, this client was struggling to maintain a job and attend other treatment services. Now that we are a CCBHC, he can now get this MAT service at Swope, much closer to home. Mark Miller, Vice President of Behavioral Health Services at Swope Health Services in Kansas City, Missouri

45 Telehealth Technology w w w. T h e N a t i o n a l C o u n c i l. o r g CA.

46 Sustainability Planning for CCBHCs National Evaluation Federal Grant Funding Federal Legislation State Medicaid options Private payers & APMs

47 Mergers and Acquisitions

48 IPAs

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