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Healthcare and Substance Use Services a national perspective Prevention and Recovery Conference 2014 November 6, 2014 0

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www.TheNationalCouncil.org Thank you! This morning Healthcare Environment Implications for Specialty Addictions and Mental Health Practice and Public policy agenda 1

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www.TheNationalCouncil.org 2 750,000 staff serving 8 million adults, children, and families with mental illness and substance use disorders 2250 Behavioral Health Organizations in 50 States

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Members are community problem solvers

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www.TheNationalCouncil.org 4 Socially vulnerable patients (income, language, race/ethnicity, health disparities) Clinically vulnerable patients (complex, difficult healthcare needs) Here Caring for complex, costly adults & children

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Change: Not just your state or organization

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www.TheNationalCouncil.org Seminar on Surviving Insurance Exchange Challenges Aetna, AmeriCare, Blue Cross, Lilly, Magellan Maintain profits in environment of health reform & budget uncertainty Capture your share of the soon to expand Medicaid market 6 And its not just our sector

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7 Best of times but complex times as healthcare change is profound and fast paced Parity and the ACA

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Best of timesrecognizing impact of co-morbidities of all hospital stays comorbid mental or substance use disorder Untreated co- morbid conditions generate higher overall costs

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> Leading cause of preventable death in the U.S. > Since 1980, 3.3 million people in U.S. died of addictions, while 600,000 people died of AIDS 9 www.thenationalcouncil.org Contact: communications@thenationalcouncil.org | 202.684.7457 Addiction ravages communities, families, and individuals. Best of Times: Opportunity to Improve Lives

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www.TheNationalCouncil.org 10 Best of times: Increasing awareness and support Addiction as chronic medical disorder that responds to treatment (McLellan and Kleber, JAMA 2000 Block Grant Legislation Media

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www.TheNationalCouncil.org Inconvenient Treatment Truths: #1: We have failed to bend the curve for morbidity and mortality from addictions or mental illness. (Health Homes) #2: More people getting more of todays Rx but outcomes are not any better #3: In spite of progress, we still dont know enough to ensure prevention, recovery, or cure #4: Science is Slow. But we need to use what we already know to correct course! 11

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> Managed care (carve outs/ in) Commercial business models > Relationships with physical health Build it or buy it > Knowing costs/cost-cutting techniques Standardize care > Resources Financing new service lines, facility improvements, HIT, workforce > Collaboration different language with new players > Competition for consumers and payers > Increased compliance scrutiny 12 Operating struggles as we move from silo to equality

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www.TheNationalCouncil.org National Council and SAAS Merger 13 In these complex times

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www.TheNationalCouncil.org Appetite for Experimentation Competition driving Monopoly Economy Demand for Impact enabled by technology revolution Understand Environment 14

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Reform is all about Service Redesign Reduce institutional care Deliver health services within an integrated and connected delivery system Identify and manage high need/cost individuals www.thenationalcouncil.org

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> Integrated Care > Healthcare Homes > Accountable Care Organizations Payers focused on models that integrate medical care, behavioral health and social supports; and take responsibility for a population

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www.TheNationalCouncil.org Increasing Medicaid coverage/spending Increase about 13.2% across the country in FY15 from 18% in 28 expansion states to 5% 18% in 23 states not expanding Medicaid directors - delivery system reforms Rapid shift to managed care carve out and integrated Any willing provider Medicaid health homes; patient-centered medical homes; integrating care; and financing for the dual eligible beneficiaries. States 18 Kaiser Family Foundations Commission on Medicaid and the Uninsured and State Medicaid Directors

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Sustainability*** > Learning Communities FQHC/SUD > SAMHSA-HRSA Center for Integrated Health*** > NY State Geriatric Technical Assistance Center > Ohio Training & Technical Assistance Center > CDC 19 National Council and Bi-directional Integration

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Shared Savings Full Risk Partial Risk Shared Savings Bundled Payment s Traditional Fee-for-Service Pay-for- Performance MinimalSavings Potential for Health Plans and Customers Substantial Episodic Cost AccountabilityTotal Cost Accountability 20 Service Redesign to Payment Redesign RISK

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21 Competition and consolidation Large legacy hospital healthcare systems in acquisition mode to gain market share Behavioral health embedded in primary care; or partnering with hospitals/medical homes to provide care to people with complex conditions New players economy of scale and standardization mergers; private equity Monopoly Economy

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eHealth Revolution Cut costs by 197 billion over next 25 years Big Data Technology in our Hands, Homes or Offices

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Branding - think Nordstrom, Starbucks, Apple, and Amazon Prime Accessible Provides a personal touch Resolves problems well. World Class Customer Service Demand for Impact

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Transparent Standardized Measured Benchmarks Outcomes

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Free standing and Embedded Practice Units Responsible for disease, related conditions, and circumstances Patient Specific Outcomes-based Care Measure full set of outcomes and costs for each patient Bundled Payments preferred provider for chronic conditions Geographical Expansion Affiliations, mergers, and acquisitions = volume Standardize Across Sites Determine scope of service and standardize care across sites Enabling Technology Platform Enable measurement; new reimbursement approaches; tie delivery systems together 25 Experimentation, Competition, Demand for Impact

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The best way to manage change is to lead it.

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Improving the operations and administrative backbone to support clinical practices Improving patient outcomes through implementation of evidence-based and promising practices Developing future healthcare leaders 25-30 initiatives Varied funding sources Range in size: 5 organizations hundreds Primarily only available to members, with some exceptions 1100 organizations 27 Our Quality Initiatives

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World Class Customer Service: Kind words can be short and easy to speak, but their echoes are truly endless. Excellent Outcomes: Take responsibility for making sure I receive the best possible health care. Easy Access: Be there when I need you. Comprehensive Care: Provide or help me get the health care and services I need. Excellent Value: We are accountable for both the cost and quality of care. Behavioral Health Center of Excellence known by the entire community as a great place to get care and a great place to work

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2% of Bills become Laws Analysis The vast majority of bills introduced in the 112th Congress failed to become law, and most never even came close Only 2% of bills introduced in the 112th Congress were ultimately enacted Sources: Library of Congress Legislative Information System; Congressional Research Service. Just over half of bills proposed saw some form of committee consideration; however, most of these actions consisted of pro- forma referrals to relevant subcommittees Only 7% of bills introduced made it to the floor of either the House or Senate, a marker that the bill enjoyed serious deliberation Our Policy Agenda

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MHFA Act (S.153/H.R. 274)* Mental Health First Aid: $15 million in FY 2014

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> SAMHSA: +$144M > Substance Abuse Prevention & Treatment Block Grant: +$19M > Mental Health Block Grant: +$24 million > Primary/Behavioral Health Integration: +$19M 2014 Appropriations

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Breaking Addiction Act H.R. 5136 allows Medicaid for residential substance use treatment, including detox 8-10 states participate in $300 million demonstration program. 15 million Medicaid beneficiaries could gain access to treatment Demonstration is the first step toward broader evaluation of Medicaid payment policy. Reps. Marcia Fudge and Tim Ryan of Ohio, authors of H.R. 5136. Addictions Legislation

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Comprehensive Addiction and Recovery Act Resources for states and local governments combat addiction. Expands prevention and educational; disposal sites for unwanted prescriptions; naloxone to law enforcement Launches evidence-based opioid and heroin treatment program Strengthens prescription drug monitoring programs. Senators Sheldon Whitehouse (D-RI) and Rob Portman (R-OH), authors of S. 2839

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Social Justice Agenda > Ensure ADA, Rehabilitation Act, Fair Housing Act, and other laws protecting against discrimination are enforced. > Eliminate or reduce barriers to SSI/SSDI > Ensure people with drug and/or criminal histories receive food and other assistance they need. > Provide voting rights to individuals no longer incarcerated. > Reduce barriers to people with criminal records or histories of substanceuse and their families living together in public and federally assisted housing.

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www.TheNationalCouncil.org 36 If addiction is a chronic medical condition whats our Medicaid service continuum? Residential Housing Integration; Care Coordination Medications Peer Services; Outreach Work Supports; Family Education If it was any other disease, wed be marching on the streets! Agenda: building capacity

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37 Contact: communications@thenationalcouncil.org | 202.684.7457 The greatest danger in times of turbulence is not the turbulence. It is to act with yesterdays logic. Peter Drucker The greatest danger in times of turbulence is not the turbulence. It is to act with yesterdays logic. Peter Drucker

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