Transcript Healthcare Reform

© Daniel E. Dawes, Esq.
“Mental Health and Substance Abuse Care in a Reformed World”
January 25, 2014
Families USA 2014 Health Action Conference
Behavioral Health Disparities
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People with SMI die on average 25 years earlier than the general population at 53 years of age.
(SAMHSA, 2013).
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The suicide rate among American Indians and Alaska Natives (AI/AN) is 50% higher than the
national average (HHS, 2001).
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Blacks are 30% more likely to report having serious psychological distress (CDC, 2007).
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Latino/Hispanic youth experience disproportionately more anxiety-related and delinquency problem
behaviors, depression, and substance use (HHS, 1999).
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Asian women have the highest suicide rate of all women over age 65 (HHS, 2001).
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Lesbian, gay, and bisexual individuals are approximately two and a half times more likely than
heterosexuals to have a mental health disorder in their lifetime (Cochran, 2003).
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Racial and ethnic minorities experience a greater burden from mental illness (HHS, 2001). Within
the same diagnosis, minorities report more severe symptoms and experience more persistent
disorders (Breslau, 2006; Williams, 2007; HHS, 2001).
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Behavioral health services meet the needs of only 13 percent of racial and ethnic minority children
and youth. (Stagman & Cooper, 2010). Despite the fact that minorities are less likely to receive
mental health services, when they do access services, those services tend to be ineffective and of low
quality. (Cooper & Knitzer, 2008).
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Racial and ethnic minority groups experience
disproportionalities
• 83,000 deaths per year
• $300 billion in costs to the country
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Health disparities are not isolated issues
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Negative health outcomes and disparate treatment in
health care impact the economic and social vitality
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Policy is a driving force for helping us eliminate health
disparities
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3rd Anniversary of the
Affordable Care Act
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Sweeping changes to
health care
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Implemented over the next
several years in the following
areas:
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Expanded coverage, parity, and MH & SU
benefits
Data collection & reporting
Prevention & wellness including
depression and substance use screening
Comparative effectiveness research for
behavioral health disparities
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Delivery system reforms,
(including PCMH, ACOs,
bundled payments)
Payment system reforms
Workforce development
Attack fraud and abuse
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HIE (incentives, navigators, and notices)
Data Collection & Reporting
Behavioral Health Workforce Cultural Competence
Nondiscrimination
Quality Improvement
Nonprofit Hospital Requirements
Prevention and Public Health Fund
Elevating Minority Health in the Federal Agencies –
state minority health office
 National
Health Disparities Strategy
 National
Quality Strategy
 National
Prevention and Wellness Strategy
 National
Health Literacy Strategy
 Federal
HIT Strategy
 National
HIV/AIDS Strategy
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SAMHSA expects Block Grants to:
Reduce disparities in access, services provided, and behavioral health outcomes
among its diverse subpopulations. Grantees should collect and utilize data to:
 (1) identify subpopulations vulnerable to health disparities, and
 (2) implement strategies to decrease the disparities in access, service use, and
outcomes both within those subpopulations and in comparison to the general
population.
 Submit health disparity impact statements
Support a reduction in disparities relative to limited English proficiency
Provide flexibility in the use of EBPs and alternative practices for minorities.
Prioritize special attention to certain populations.
Services should also take into account ethnic- and culture-specific services for
minorities.
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Block Grant funds directed for four areas:
◦ 1. priority treatment and support services for those
without insurance or for whom coverage terminated
◦ 2. priority treatment and support services not covered by
Medicaid and Medicare, or private insurance
◦ 3. primary prevention: universal, selective, and indicated
prevention activities and services
◦ 4. performance and outcome data
◦ Strategic partnerships with diverse stakeholders to
ensure inclusion of behavioral health
◦ Ensure that mental health and substance use services
are appropriately included in health plans
◦ Ensure mental health and substance use providers are
included in networks
◦ Ensure the prioritization of behavioral health equity as
states develop and implement their own plans for
addressing health inequities
◦ Certified Application Counselors for HIE and healthcare
navigators
◦ Cultural and Linguistic Competence Trainings
◦ Incentivizing Health Disparities Reduction Activities
◦ Community Health Needs Assessments
◦ Shared Decision-Making – creating patient decision-making aids
◦ Community Health Workers/Promotoras/Healthcare Navigators
◦ Hospitals will be penalized for preventable readmissions and
hospital acquired conditions, could work with hospitals to limit
the impact
◦ Hospitals, community health centers, and physicians may
participate in shared-savings under ACOs, PCMHs, bundled
payments, etc – may be able to provide expertise to them
◦ Create a Patient-Centered Medical Home
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Undocumented Immigrants ineligible for ACA benefits
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DACA beneficiaries, despite special status, ineligible
for ACA benefits – may still get through employers
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Documented Immigrants/Permanent Legal Residents –
5 year waiting period for Medicaid, immediate benefits
for HIEs, or through employers.
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(Special Note: Permanent Legal Residents below 100%
FPL would be eligible for subsidies to purchase
coverage via HIE)
Moving Forward
“We need advocates who care enough, know
enough, do enough, and persist enough”
Dr. David Satcher, 16th U.S. Surgeon General
HEALTH EQUITY FOR ALL!
Questions?
For more information, please contact Daniel E. Dawes, Esq.
[email protected] or [email protected]
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