Modernizing Public Health to Meet the Needs of

People Who Use Drugs:ACA Opportunities

Amy Killelea & Mariah Johnson, NASTAD

Fernanda Alonso, O’Neill Institute

NASTAD Viral Hepatitis Technical Assistance Meeting, October 21, 2015

The Changing Landscape

2

The Triple Aim

Health Systems Transformation and the Role of Public Health Programs

Holmberg S, et al, NEJM, 2013

Focusing on Interventions on the Drivers of Health

Data from County Health Rankings, 2010

Clinical Care20%

Physical Environment

10%

Health Behavior

30%

Socio-economic Factors

Factors that Impact Health

40%

The Impetus to Focus on Leveraging New Payers and Systems

The Coverage Landscape16.4 million people have gained health insurance coverage through the ACA

New Attention to Population Health by Medicaid and Insurance

A Math Problem

• We cannot fight an epidemic with discretionary funding alone

The White Paper

• Through an Elton John AIDS Foundation grant, NASTAD worked with the O’Neill Institute for National and Global Health Law to do the following:oDefine “drug user health” servicesoAssess the changing landscape for drug user

health serviceso Identify innovative

financing mechanisms for the coverage of community-based drug user health services

Focus on Community-Based Services

Eight Focus States

Key Findings

9

1) It is critical to build coalitions, engage broad stakeholders, and participate in

new decision-making tables and forums

Drug User Health

Medicaid (state

program, MCOs) Insurance

(state commissioner,

plans)

Infectious Disease

Programs

FQHCS and Hospitals

Bureau of Substance Abuse and

Mental Health

ADAP/RW Insurance

Expertise and Infrastructure

2) Trusted communityproviders are crucial to connecting vulnerable populations to coverage

• Messengers matter: efforts that mobilize community-based providers with relationship and ties to community, simplify the process, and cater to vulnerable populations, including the homeless, had the most success

3) Public health programs have animportant role to play to ensure

increased access to naloxone

4) There are new opportunities for coverage of community-based

services that address social determinants

Identifying the Opportunities and Policy Levers

• State Innovation Models and other CMS demonstration projects prioritizing coordinated care and value-based payment

• CMS 1115 waivers (and stay tuned for 1332 “innovation waivers”) testing new ways to provide benefits

• Medicaid State Plan Amendments implementing health homes, additional services

• Medicaid managed care contracts, using flexibility to provide value-added services, include community providers, address quality

• Delivery System Reform Incentive Plan(DSRIP) testing new ways to deliver services and meet population health goals

The Triple Aim

5) Hospitals are key partners in increasing access to drug user health

services

• Hospitals are becoming key partners in community health – including through community benefit programs

Massachusetts General Hospital, Center for Community Health Improvement

Action Steps

16

Action Steps

• Support a strong legal, regulatory, and syringe access foundation

• Use new federal payment and delivery reform initiatives to find and influence state policy decision-making tables and make the case for inclusion of community-based services

• Mobilize harm reduction organizations and syringe services programs to participate in ACA outreach and enrollment activities

• Work with community-based providers to develop relationships with Medicaid MCOs to expand access to naloxone and to support care coordination activities

• Approach safety net non-profit hospitals that serve a large proportion of people who use drugs

THANK YOU!