Download - A National Standard for Assessment/Placement
A National Standard for Assessment/Placement
THE ASAM CRITERIA SOFTWARETM
American Society of Addiction Medicine44th Annual Medical-Scientific Conference:
April 26, 2013, Chicago, Illinois
ASAM Disclosure of Relevant Financial Relationships
Content of Activity: ASAM Medical –Scientific
Conference 2013Name Commercial
InterestsRelevant Financial
Relationships: What Was Received
Relevant Financial
Relationships: For What Role
No Relevant Financial
Relationships with Any
Commercial Interests
David Gastfriend Alkermes, IncRecoverySearch, Inc
Salary, Stock, OptionsRoyalties
Company Officer
Company Officer
Rodney Conrad FEi Systems, Inc Salary Company Officer
Paul Earley Earley Consultancy LLCAlkermes, Inc
Consulting Fees
Honoraria
Software ConsultantSpeaker
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE
AGENDA Rationale & background for a new standard
of assessment & treatment planning Dr Gastfriend - 15 min
Hands-on experience at the computer Mr Conrad & Dr Earley - 45 min
Interactive discussion Drs Gastfriend & Earley & Mr Conrad - 25 min
ASAM’s plans: Dr Gastfriend - 10 min Participants’ reaction: All - 25 min
Rationale & background for a new standard of assessment and treatment planning ASAM’s Goals HBS’s Report Recommendations SAMHSA’s Open Behavioral Health Information
Technology Architecture Project
A National Standard for Assessment/Placement: THE OPEN-SOURCE ASAM CRITERIA SOFTWARE
Stakeholders in an Information Technology Revolution
Client
Counselor
Supervisor
SystemManaged Care
Employer/Payer
Researcher
Accreditation Body, Government
Society
• National Treatment Center Study - 450 programs (U. of GA)• >70% of respondents using ASAM Criteria by 1996• For-profits: 54% less likely to adopt (p=.02)• Single-level programs: 34% - 42% less likely than multi-levels (p<.01)• Dual diagnosis capable programs: 3.4 times more likely to adopt (p ≤.01)• Programs closing within 24 mos. were less likely to be ASAM adopters in 1996 (p<.05) • Programs closing within 6 mos. – even lower baseline adoption
Corbel (Body)
HARVARD | BUSINESS | SCHOOL
Providers Jerome Rhodes, President, Recovery Division, CRC Health Group Nancy Paull MS, CEO, SSTAR of MA and RI Ron Jackson MSW, Director, Evergreen Treatment Services, Seattle WA
Payers Hyong Un MD, Chief Psychiatric Officer and Head of EAP, Aetna Gary Henschen MD, Chief Medical Officer-Behavioral Health, Magellan David Pating MD, Chief, Addiction Medicine, Kaiser Permanente SF Med Ctr Tom Trabin PhD, Assoc Dir, Adult Care, Alameda County Behavioral Health, CA
Government/Non-Profit Mady Chalk PhD, Dir, Center for Performance-Based Policy, TRI-U of PA Daniel Kivlahan PhD, V.A. Assoc Nat’l MH Program Dir for Addictive Disorders Andrew Saxon MD, Psychiatrist, VA Puget Sound Eric Goplerud PhD, Research Professor, Geo Washington U/NORC Carol McDaid, Principal, Capitol Decisions, Washington DC Douglas Marlowe JD, PhD, Sr Investigator, TRI-U of PA; NADCP Science
Advisor Software Developers
Skip McGaughey, Executive Director, Open Health Tools Simon Budman PhD, CEO, Inflexxion Ken Tubman, CEO, Claricode
Harvard Business School: Experts Contacted
HARVARD | BUSINESS | SCHOOL
Operates 145 clinics treating 30,000 people Largest behavioral health provider in U.S. Devotes significant resources to payer approval Each center has 3-5 FTEs dedicated to UR ~20% of cases are contested by payers ~30% of MD time is lost interacting w/payers If this administrative time is reduced only slightly,
the PPC software could yield substantial savings. Also, CRC recognizes the benefits
that increased reliance on health IT could provide.
Case Study: CRC Health
HARVARD | BUSINESS | SCHOOL
Leading concerns:◦ Cost 73% ◦ Time 48%
35% indicated that MDs earning $110,000 or more are conducting assessments; 46% indicated that the assessments take 60-90 min
Significant value if ASAM’s eCriteria can save time with payers: 31% are waiting ≥half a day for insurance authorizations
Treatment centers would find ASAM’s eCriteria a +value proposition if:◦ It improves treatment outcomes – 80%◦ It improves and standardizes assessments – 72%◦ It reduces time spent negotiating with insurance companies – 66%◦ It provides certification as “ASAM compliant” (42%) or CEU credits
(39%)
ASAM Members’ Survey Results (N=95)
HARVARD | BUSINESS | SCHOOL
For Patients◦ Improves Patient Outcomes
For Payers◦ Improved Patient Outcomes > Lower Long-Term Costs◦ Standardizes approval process◦ IT can facilitate/automate approval process◦ Decreases expensive & unnecessary overtreatment◦ Improves inter-rater reliability
For Providers◦ Facilitates reimbursement process through
fewer disputes, decreased administrative burden, and faster turnaround on payment
◦ Provides training to new counselors◦ Generates sophisticated reports & analyses
PPC Software Value Proposition
HARVARD | BUSINESS | SCHOOL
Effective, reliable treatment planning requires that both be used together
The ASAM Criteria Software undergoing nationwide release by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
The ASAM Criteria text is synchronized with the ASAM Criteria Software, such that definitions & specs in the text for the dimensions, levels of care & admission decision rules serve as the reference manual for the ASAM Criteria Software released by SAMHSA
The NEW ASAM CRITERIA Book &THE ASAM CRITERIA Software
• A full, patient-based, computer-driven, counselor tool
• A comprehensive psychosocial, implements all PPC-2R decision rules
• A quantitative, reliable & valid LOC recommendation & justification
• Current Use: Norway (10 sites)
• Goals: International standard & sustainability
• Commercialization: Guided by Harvard Business School Business Plan
– Stakeholder interviews, member surveys, & fiscal models
• SAMHSA’s Open-Source project – nationwide behavioral EHR platform
ASAM’s Criteria Software – Commercial Plan
Via SAMHSA’s OBHITA Open Behavioral Health IT Architecture Project
Meaningful Use Compliant Clinical Decision Support
Software
Can integrate Primary & Behavioral Health Services
Eventually EHR Compliant: HL7, SNOMED, LOINC, ICD-
10, etc.
Integrated with HIT Grants for Primary Behavioral
Health
FEi Systems: Focused e-Health Innovations
Privately held, since 1999. 20-25% growth/yr. 2010 revenues ~$32 mm
150 employees. Contracts with Avalon, Westat, Abt & others in projects at FDA, NIH, and in criminal justice parole & probation.
Contracted to rewrite the Block Grant process for SAMHSA. HIPAA: Secure facility, encryption, security officer, &
business associate agreements with all clients. Expert in data repository de-identification.
Access To Recovery: Serves 15 of 30 state grantees. Commercially manages WITS for 28 states & counties,
Supports 5,500 providers. FEi’s WITS team = 45 staff.
The ASAM Criteria book & Software are companion text and application. The text delineates the dimensions, levels of care & decision rules that comprise The ASAM Criteria
The software provides approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care
The text provides background & instruction for proper use of software. The software enables comprehensive, standardized evaluation.
Text + Software = ASAM Criteria
Hands-on experience at the computer Logging-on Understanding the user-interface Inputting mock data in selected dimensions Reviewing the output reports
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE
Intuitive User Interface
Clean interface and presentation of data elements.
Intuitive User Interface
Data visualization elements.
Enhanced Report
Dynamically driven report with variable content regions.
Enhanced Report
Improved readability and scanning of information.
Meaningful Documentation
Meaningful Documentation
The black box barrier is removed, exposing the underlying algorithms.
Meaningful Documentation
Enhances understanding of the ASAM algorithm by providing meaning and context.
Clear naming
Traceability
Human Readable Narrative
Aids In Understanding
Algorithm
Meaningful Documentation
Facilitates updates and tweaking to the algorithm.
Interactive discussion Understanding the implementation process,
including data privacy issues Anticipating the learning curve Measuring the ROI with
INSTRTM: INSTant Authorization for Reimbursement
Just-In-Time Supervision Accreditation, Certification, Contracting, Grants,
etc.
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE
ASAM’s plans Releasing to the field, training &
endorsement/certification Research: optimizing patient care & recovery
outcomes– The Central Data Repository
QI steps: ASAM’s Coordination & engaging stakeholders – The National Coalition on Placement Criteria
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE
Participants’ reaction Fears: Concerns & obstacles
Hopes: Perceived benefits & needs
Likelihood of testing & adopting the software
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE
David R Gastfriend MD [email protected]
A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE