Transcript Eric Goplerud`s Presentation

Center for Integrated Behavioral Health Policy
Department of Health Policy, The George Washington University Medical Center
Addressing Addiction and
Substance Use in National
Health Reform
Eric Goplerud, Ph.D.
Alliance for Health Care Reform
July 17, 2009
Untreated Substance Abuse and
Excess Medical Costs Across 6 States
$3,360/yr
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
W/SA Diag
No SA Diag
Medical Costs
Clark, Samalniev & McGovern, 2009.
Beh. Health Costs
Family Medical Costs for Untreated
Substance Abusers in Kaiser
W/SA Diag
$2,000
$360/yr
No SA Diag
$1,750
$1,500
$1,250
$1,000
Ray, Mertens & Weisner, 2007.
Medical Costs
Identification Rates for Substance Use
Disorders and Other Common Health
Conditions
What
Alcohol and drug
percentage
of
use disorders
affected
individuals
are
Depression
identified?
7% to 18%
45%
Diabetes
65%
Hypertension
70%
Substance Use Screening and
Treatment is grounded in good science
THE NATIONAL QUALITY FORUM
September 2007 Consensus Standards for Substance Use Treatment
Substance Use Treatment
Reduces Medicaid Costs
Modality
Savings per Medicaid
member per month in
Washington State
Inpatient
$170
Outpatient
$215
Methadone
$230
Wickizer, T.M., A. Krupski, et al. (2006). “The effect of substance abuse treatment on
Medicaid expenditures among GA clients in WA State.” Milbank Quarterly, 84(3): 555-76.
Substance Use Treatment Reduces
Employer and Employee Health Care Costs
Parthasarathy, Weisner, Hu and Moore. “Association of Outpatient Alcohol and Drug Treatment with Health Care
utilization and cost: Revisiting the Offset Hypothesis.” Journal of Studies on Alcohol. (2002): 89-97.
Fleming, Mundt, French, Manwell, Stauffacher, and Barry. “Brief Physician Advice for Problem Drinkers:
Long-Term Efficacy and Benefit-Cost Analysis.” Alcoholism: Clinical and Experimental Research. (2002): 36-43.
Cost Effectiveness of Alcohol Screening and
Brief Intervention
• Estimated net health savings of $254 per person offered
screening
• $1,755 per Quality Adjusted Life Year (QALY) saved in
health care costs
• In top 4 most cost-effective US Preventive Service Task
Force recommendations
–
–
–
–
Discuss daily aspirin use: men 40+, women 50+
Childhood immunizations
Smoking cessation advice and help to quit – adults
Alcohol screening and brief counseling – adults
Solberg LI, et al. Primary care intervention to reduce alcohol misuse: ranking its health impact
and cost-effectiveness. Am J Prev Med. 2008;34(2)
Addiction and National Health Reform:
Application to the Tri-Committee and HELP bills
•
Benefit Design –
+
Parity: Equitable and full coverage for treatment of
substance use disorders
+
Universal coverage: Persons with MI and SA twice
as likely to be uninsured, so extension of coverage to
individual and small group markets is essential
+
Medication assisted treatment: Inclusion in drug
discount program (340b)
-
Addiction recovery supports: Not specifically
included in patient centered medical home
Addiction and National Health Reform:
Application to the Tri-Committee and HELP bills
• Prevention –
- No explicit inclusion of substance use prevention
and mental health promotion to wellness and
prevention.
- No explicit inclusion of substance use prevention,
screening or treatment in school-based health
programs
Workforce Infrastructure –
- No explicit inclusion of addictions professionals in
health care workforce programs.
- No explicit inclusion of substance use in training of
primary care workforce.
Center for Integrated Behavioral Health Policy
Department of Health Policy, The George Washington University Medical Center
Eric Goplerud, Ph.D.
Director
2021 K St. NW, Suite 800
Washington, DC
[email protected]
integratedbehavioralhealth .org