Transcript HEALTH INSURANCE REFORM – POSSIBILITIES: SHAPING THE

BEHAVIORAL HEALTH 2010
CHALLENGES AND OPPORTUNITIES
ACMHA:
The College for Behavioral Health Leadership
March 24, 2010
Pamela S. Hyde, J.D.,
Administrator, Substance Abuse and
Mental Health Services Administration
U.S. Department of Health and Human Services
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Today It’s About….
PEOPLE
● Making a real & measurable
difference
OPPORTUNITIES
● Focusing on what can be done
● Working with available partners
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PRINCIPLES
 People
● Stay focused on the goal
 Partnership
● Cannot do it alone
 Performance
● Make a measurable difference
 Parity
● Mental and substance use disorders are not
unlike any other health care condition – acute,
chronic or disabling
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KEY MESSAGES
 Behavioral health is an essential part of health
● Improves health status
● Lowers costs for families, businesses and governments
 Prevention works
 Treatment is effective
 People recover
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Key Message:
Behavioral Health is Part of Health
 People with serious mental illness (SMI) are disproportionately
overweight or obese & have shortened life-spans
 Disproportionate cigarette use by individuals with mental illness
(MI) or substance use disorder (SUD)
 ¼ of adult stays in community hospitals involve MI or SUDs;
persons with SUDs have disproportionately high ER use
 High proportion of antidepressants prescribed in health care
settings
 Mood disorders rank 1st in work loss costs, 2nd in total costs &
3rd in health care costs of five highest conditions
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KEY MESSAGE:
Prevention Works
 Cost-benefit ratios for early treatment & prevention for
addictions and mental illness programs range from 1:2 to
1:10
 Substance abuse prevention programs show:
● Decrease in alcohol, tobacco and other drug use (ATOD)
● Significant percentage of students using ATOD stopped using
 School prevention programs show reductions in bullying,
fighting, verbal abuse, alcohol and cigarette use, and
feeling unsafe at school
 Preventive intervention for adolescents can reduce the
incidence of depressive disorders
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Institute of Medicine Report:
Preventing Mental, Emotional and Behavioral Disorders
Among Young People – Progress and Possibilities (2009)
 Positive emotional development, earlier identification &
intervention, multiple interventions sustained over time
can prevent disorders such as substance abuse, conduct
disorders, and depression, and reduce symptoms of
mental illnesses
 Addressing families, individuals & specific disorders
through schools, health care and community programs can
develop emotionally healthy adults
 Prevention requires attention to multiple risk factors
● Biological (family history)
● Psychosocial (family disruptions)
● Social (poverty, violence, safety in schools, access to health care)
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KEY MESSAGE:
Treatment is Effective
 $1 invested in substance abuse treatment has a return of $7 in cost
savings from social benefits
 Treating late-life depression in primary care settings – reduced
prevalence and severity of symptoms or complete remission
 Long-term treatment of adolescents with major depression is associated
with continuous and persistent improvement of symptoms
 Federally funded substance abuse treatment programs improved physical
and mental health and reduced:
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Illicit drug use
Alcohol/drug related medical visits
Inpatient mental health visits
Reduced criminal activity
 SBIRT – 50% increase in abstinence at 6-month post intake
 RAISE research on-going now to address symptom severity and episode
recurrence after first psychotic break in adolescents
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Key Message:
People Recover
 Early treatment reduces disability/recurrences
 Recovering people work, pay taxes, have homes and
relationships, volunteer, contribute, vote
 Recovery rates w/ treatment and/or medication:
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Bipolar disorder 80%
Major depression 65-80%
Schizophrenia 60%
Addiction 70%
 Pathways are highly personal
• Focus on lives restored rather than lives managed or services
provided
 Self-help and peer supports help the recovery process
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SAMHSA’S DIRECTION
 MISSION: To reduce the impact of
substance abuse and mental illness on America’s
communities
 ROLES:
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Voice & Leadership
Funding
Information
Standard Setting/Guidance
Practice Improvement
 10 STRATEGIC INITIATIVES
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10 Strategic Initiatives
1. Prevention of Substance Abuse
7. Health Information
and Mental Illness
Technology for Behavioral
Health Providers
2. Violence and Trauma
3. Military Families – Active,
Guard, Reserve, and Veteran
4. Health Insurance Reform
Implementation
5. Housing and Homelessness
6. Jobs and Economy
8. Behavioral Health
Workforce – In Primary
and Specialty Care
Settings
9. Data and Outcomes –
Demonstrating Results
10. Public Awareness and
Support
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Impact of Strategic
Initiatives
1. Requests for Applications (RFAs) beginning in FY2010 –
block grants and grant programs
2. Public messages; communications; materials
3. Budget requests – FY2012 forward
4. Current fiscal resources – FY2010 and FY2011
5. Human resources – staff time
6. Contracts & technical assistance centers
7. Public forums; meeting time
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Strategic Initiatives Next Steps
1. Draft narrative sometime in April or early May for public
review/input (including posting on website)
2. Public meeting in DC to discuss with key stakeholders
3. SAMHSA’s National Advisory Council (NAC) meeting in May
4. FY2012 budget planning continues in summer 2010
5. Revise and finalize strategic initiatives document/strategic
plan – summer or fall 2010
6. Incorporation of initiatives into SAMHSA’s work – now and ongoing
NOTE: Dates are tentative.
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No. 1 Prevention of Substance
Abuse and Mental Illness
 Reduce/prevent substance abuse & mental
illness through prevention prepared communities
• President Obama’s National Drug Control Strategy,
with ONDCP
• Prescription drug abuse
• Emotional health per IOM report
 Suicides – especially youth, military, tribes
 Underage drinking
 Tobacco use among persons with serious mental
illness and substance use disorders
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Prevention Highlights in
FY 2011 Budget
 Project LAUNCH (Kids 0-8)↑ $12 million to $37 million
 Prevention Prepared Communities (Young people 9-25) $23 million for this
new initiative
 Strategic Prevention Framework/Partners for Success ↓$7 million to
$103.5 million
 Preventing Suicide ↑$6 million to $54 million
 SBIRT ↑$8 million to $37 million
 Prescription Drug Monitoring $2 million
 Stop Act (Sober Truth on Preventing Underage Drinking) $8 million
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No. 2 Trauma & Justice
 Trauma-informed screening and care in behavioral
health, health and justice settings
 Youth & adults with behavioral health needs in
juvenile and criminal justice systems – diversion and
prevention
 Impacts of violence and trauma on youth
 Incidence of community violence
 Prevalence data
 Helping communities reduce violence
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Trauma & Justice
FY 2011 Budget Highlights
 Children’s Mental Health
Initiative (CMHI) ↑$5
million to $126 million
 Transformation grants
 Safe Schools/Healthy
Students $95 million
 Drug Courts ↑$13 million
to $56 million
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No. 3 Military Families - Active,
Guard, Reserve, & Veteran
Suicide
Homelessness
Prevention for families
Access to treatment in
civilian service settings
in partnership with states and VA, DOD, Guard
FY 2011 Budget highlights which could focus on
military families:
● Prevention, Housing, Children’s MH, Suicide
Prevention, Block Grant Increases ATR ↑ $10 million
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to $109 million
No. 4 Health Insurance Reform
 Health Insurance Reform implementation
 Medicaid & Medicare policies and opportunities
 Parity regulation – implementation of interim final rule
• Effective April 4th; comments through May 4th
• Comments & research on scope of services, non-quantitative
treatment limitations, common deductibles, etc.
• Medicaid parity regulation still to come
 Block grants – consideration of future use and
implications
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WHY CARE ABOUT HEALTH
INSURANCE REFORM?
 Rising cost for families,
businesses and government
 Health care quality
 Disproportionate impact on
persons with mental illness
and substance use disorders
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WHAT REFORM GETS US:
 32 million Americans covered (95%)
 $2,000 projected reduction in
premiums for American families
 4,000,000 jobs created as health
costs decline
 $1 trillion+ reduction in federal
deficit in next decade
 $36 billion reduced spending on
uninsured over next decade
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WHAT’S IN REFORM FOR
BEHAVIORAL HEALTH – 1

COVERAGE
● Expands Medicaid to 133% FPL – an estimated 16
million new enrollees of which 1/3 are likely to have
MI/SUD service needs
● Focus grant dollars for recovery support services not
paid for through insurance benefit plans
● Changes in Medicaid to assist youth to maintain
coverage in times of transition
● Allows dependent coverage to age 26
● Elimination of pre-existing condition exclusions & policy
terminations; guaranteed renewability
● Expands possibility of home and community-based
services for individuals with mental health and
substance use disorders
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WHAT’S IN REFORM FOR
BEHAVIORAL HEALTH – 2
 SERVICES
● New home visiting programs for young children—with a focus on
families with substance use disorders
● Programs to expand “medical homes” to include behavioral health
● School-based health clinics to provide mental health and substance
use disorder assessments, crisis intervention, counseling, treatment
● Begin closing Medicare “doughnut hole” for prescription drugs for
seniors and disabled individuals
● Establishes a “Medicaid Emergency Psychiatric Demonstration”
 PARITY
● Parity required in essential benefits plans offered through exchanges
● Employer mandate requires parity in private health plans
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WHAT’S IN REFORM FOR
BEHAVIORAL HEALTH – 3
 PREVENTION
● Prevention research programs and national prevention
plans
● Coverage of preventive services in benefits packages,
including SBIRT, without cost-sharing
● Allowing states to cover prevention services under
Medicaid
● Prevention Trust Fund
 TRAINING & RESEARCH
● Increased patient-centered health research
● Training grants for behavioral health workforce
● Training on MH/SUD for Primary Care Extender
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WHAT’S IN REFORM FOR
BEHAVIORAL HEALTH – 4
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COSTS & FUNDING
● Tax credits for businesses offering coverage
● Tax credits for individuals purchasing insurance
● Vouchers for low-income individuals not eligible
for Medicaid to purchase insurance through
exchanges
● Increased Medicaid and commercial insurance
funding of mental health and substance abuse
services
● Allows SAMHSA block grant and grant dollars to
be focused on recovery support services not
paid for through insurance benefit plans
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WHAT’S IN REFORM FOR
BEHAVIORAL HEALTH – 4
INVOLVEMENT
● SAMHSA consultation on regulations,
demonstrations, implementation
● States that develop health homes must “consult
and coordinate” with SAMHSA regarding the
prevention and treatment of MH/SUD
● Demonstration initiatives within HHS at
discretion of HHS Secretary allow for MH/SA
inclusion
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Behavioral Health must be at the table to
participate in, inform and influence the
future of the Nation’s health care system
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No. 5 Jobs and Economy
 Place-based approach to impacting increasing behavioral
health needs of communities with significant effects from the
current economic conditions
 Employers – role in supporting employees behavioral health
while positively impacting their costs
 Employment – for persons with histories of mental illness or
substance abuse diagnoses or treatment
 Policy, legal, capacity, and knowledge barriers
 FY 2011 Budget:
● Community Mental Health Block Grant at $421 million
● Substance Abuse Prevention & Treatment Block Grant at $1.8 billion
● Community Resilience & Recovery Initiative (CRRI) $5 million
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No. 6 Housing & Homelessness
 Moving from services for homeless persons to permanent supportive
housing for persons who experience chronic homelessness due to substance
abuse and/or mental illness
• Policy barriers
• Financing barriers
• Capacity and knowledge barriers
 Interagency Council to End Homelessness – Report to Congress, Spring
2010
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Families
Youth
Veterans
Adults experiencing chronic homelessness
 FY 2011 Budget:
● PATH ↑$5 million to $70 million
● HUD/HHS demo – ↑ $16 million provision of 10,000 new homeless and special
needs vouchers, 4,000 of which are targeted for persons with mental
illness/substance abuse disorders eligible for Medicaid through creative state
waivers or other programs
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No. 7 Health Information Technology (HIT)
& Electronic Health Records (EHR)
 SA/MH provider capacity to utilize electronic health records,
including access to federal assistance (meaningful use; ARRA)
 Behavioral health outcomes and data using health information
technology – standards
 Privacy/confidentiality of mental health and substance abuse
treatment information while supporting integration of health
and behavioral health care
 April 15, 2010 public meeting with ONC and ASPE, in DC
 FY 2011 Budget:
● $4 million new in the Office of the National Coordinator (ONC) for
Behavioral Health HIT
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No. 8 Workforce
 Numbers and distribution of practitioners with aging workforce
 Behavioral health/primary care integration
 Support for recovery coaches peer and paraprofessional or nontraditional workers
 Evidence-based thinking; evidence-based practices adoption
 Recovery in core competencies and curriculum for education of
all practitioners and workers
 FY2011 Budget: $25 million to HRSA for BH in FQHCs
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No. 9 Data and Outcomes –
Demonstrating Results
 Consolidation of fragmented and multiple SAMHSA
data systems
 Consistent data requirements for states and grantees
– block grants and grant programs
 Common National Outcome Measures (NOMS) across
funding streams for state mental health, substance
abuse, and Medicaid agencies
 Common approach to evaluation and services research
 FY 2011 Budget:
● National data collection ↑ $33 million to $136 million – DAWN & New CEMS
● Internal work regarding common data elements and approaches
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No. 10 Public Awareness and
Support
Consistent messages, focusing on key
messages, principles and 10 strategic
initiatives
Redesign and consolidation of websites
Utilization of social marketing mechanisms
Increase understanding of where and how to
seek help
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KEY MESSAGES
 Behavioral health is an essential part of health
● Improves health status
● Lowers costs for families, businesses and governments
 Prevention works
 Treatment is effective
 People recover
34
PRINCIPLES
 People
● Stay focused on the goal
 Partnership
● Cannot do it alone
 Performance
● Make a measurable difference
 Parity
● Mental and substance use disorders are not unlike
any other health care condition – acute, chronic or
disabling
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Partnership:
Service Agency
Administrators
Cannot do it alone
Consumers &
States,
Researchers
Recovery
Territories &
Community
Tribes
Military
Substance
Individuals,
Use
Medical
Educators
Families
&
Treatment
Community
Communities
Media
Providers
Faith &
Criminal Community- Mental Health Practitioners
Treatment
Justice
based
Community
Providers Policy
Makers
Providers
Advocates
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THE ONLY FAILURE
IS FAILURE TO AIM HIGH
“Not failure, but low aim is sin.”
– Benjamin E. Mays
“Not failure, but low aim, is crime.”
– James Russell Lowell
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