Transcript PPT - National Labor and Management Conference

Trends In Substance Abuse And
Substance Abuse Treatment
Taft-Hartley Trust Fund established in 1962
Nineteen NY/NJ Teamster Unions participate
Serves approximately 28,000 families
Services provided include:
 Employee Assistance Program
 Admission precertification and case management
 PPO of directly contracted treatment facilities
PRESENTATION TOPICS
How We Got To Where We Are Now
Prescription Drug Abuse
The Heroin Epidemic
Other Popular Drugs Of Abuse
Emerging Trends In Substance Abuse Treatment
Protecting Your Benefit Plans
How We Got
To
Where We Are Now
Affordable
Care Act
 No lifetime or annual limits.
 Mandated coverage for 19-25 year olds
MHPAEA
Financial requirements for mental
health and substance use had to be
equivalent to other health services.
Quantitative treatment limitations
for mental health and substance
use had to be equal to other health
services.
Utilization management techniques
had to be formulated in a manner
similar to that for mental health
and substance use and other services.
Important MHPAEA Details
Complying with Mental Health Parity does not
mean no limitations.
It means limitations on behavioral health simply
cannot be more restrictive.
Prescription
Drug
Abuse
Prescription Drug Abuse
NY Times Report January ‘16
“Drug overdoses are driving up the death rate of young white adults
in the United States to levels not seen since the end of the AIDS
epidemic more than two decades ago”
“The rising death rates for those young white adults, ages 25 to 34,
make them the first generation since the Vietnam War years of the
mid-1960s to experience higher death rates in early adulthood than
the generation that preceded it.”
The Heroin Epidemic
Heroin by the Numbers
39%
Rise In Heroin-related Deaths
Source: NY Times The Numbers Behind America’s Heroin Epidemic
Heroin by the Numbers
90%
Of first-time heroin users are white
Source: NY Times The Numbers Behind America’s Heroin Epidemic
Heroin by the Numbers
75%
Of Heroin Addicts Used
Prescription Opioids Before Turning
to Heroin
Source: NY Times The Numbers Behind America’s Heroin Epidemic
Heroin by the Numbers
325
Opioid-Related Deaths in New
Hampshire in 2014
Source: NY Times The Numbers Behind America’s Heroin Epidemic
Heroin by the Numbers
50%
Increase in Mexico’s Opium
Production in 2014
Source: NY Times The Numbers Behind America’s Heroin Epidemic
Global Heroin Trafficking Routes
Other Popular
Drugs of Abuse
Synthetics
Synthetic cannabinoids
Synthetic stimulants
Synthetic cathinones
Flakka
A dangerous synthetic cathinone drug
called alpha-pyrrolidinopentiophenone
(alpha-PVP)
Flakka crystals can be eaten, snorted,
injected, or vaporized
Like other drugs of this type, alpha-PVP
can cause a condition called excited
delirium that involves hyper-stimulation,
paranoia, and hallucinations that can lead
to violent aggression and self-injury.
Flakka has been linked to both heart
attacks and suicides. It can also
dangerously raise body temperature and
lead to kidney damage or kidney failure .
Xanax
Generic: Alprazolam
Drug Class: Benzodiazepine
Uses: Manage symptoms of anxiety
disorders
Abuse: Frequently taken in
combination with other drugs
After a prolonged period of use, can
cause changes to the receptors in
the brain. Eventually an individual
builds up a tolerance to these
medications and requires more and
more dosages in order to produce
the initial effects.
Emerging Trends In
Substance Abuse
Treatment
Traditional Treatment Center Model
ADMISSIONS
UTILIZATION
REVIEW
BILLING
Emerging Treatment Center Model
ADMISSIONS
BILLING
UTILIZATION
REVIEW
The Rise of
Intensive Outpatient Programs
IOP Basics
Why This Model?
 HCPCS Code: H0015
 Often avoids precertification and
utilization review requirements
 Alcohol and/or drug services;
intensive outpatient (treatment
program that operates at least
3 hours/day and at least 3
days/week
 Offers many financial advantages
over inpatient treatment
 Fewer credentialed/licensed staff
 Allows for frequent drug testing
Deceptive Treatment Program Tricks
Deceptive websites
Hijacking Internet searches
Providing services outside of their
state licensure role
“Last covered day” games
Treatment add-ons billed separately
HIGHLIGHTS FROM AN EMAIL BEING SENT
TO TREATMENT FACILITY ADMINISTRATORS
Currently we are assuming the following amount of remuneration that can be realized per
specimen; Toxicology $330, Blood Testing $100
A small account has revenue of $90,000 a month, we can run a proforma for your set of
conditions.
National companies like Elements, AAC, who are well funded, have opened or are in the
process of building their own diagnostic lab for additional efficiencies.
It is exclusive to you, whether you have 10 Tox screens a month or 1000 doesn’t matter.
Monthly dividends are dependent on collections and reimbursements only.
I can promise you that this opportunity can ……give you a tremendous infusion of
unrealized revenue in a compliant, accountable and transparent way, unprecedented in the
industry.
Common Drug Testing Scams
Testing urine on site, then routinely sending the sample for more sophisticated tests at
other labs, even if the original urine sample showed no sign of drugs
Testing for multiple drugs the client has never used or shown any interest in using
Testing daily or every other day
Frequent testing even after the client has
remained sober for months
How Urine Becomes Gold
1 addict
X
3 tests a week at $3,000 each
 = $36,000 a month
 = $432,000 a year
House six addicts
Rake in $2.5 million annually
Protecting
Your
Benefit Plans
ESTABLISH A GATEKEEPER
Require prior authorization for substance abuse treatment
at multiple levels of care
Authorization should come from a high touch agency that
is both Fund focused AND treatment savvy
Insist on direct contact with the identified patient
 Assess to determine level of care
 Make patient aware of potential out-of pocket costs
REASSESS ALL MEDICAL BENEFITS
Funds are beginning to limit inpatient stay coverage
 120, 90, 60, 45 day limits
Consider requiring prior authorization for non-inpatient levels of care
 Ex. Partial Hospitalization, Intensive Outpatient
Consider setting dollar caps and utilization maximums on out-of-network drug
testing
Review prescription utilization, especially use of opiate-based medication and
benzodiazepines
 Consider hiring third party firm to perform medication monitoring for commonly abused
prescriptions
DEVELOP YOUR OWN TREATMENT NETWORK
Direct contract with at least 3 different inpatient facilities.
Programs need to be state licensed and should be JCAHO accredited.
Insist on all-inclusive per diem rates.
Talk to your peers to find out what facilities they use.
Important – Treatment quality
should be your primary concern.
THREE KEYS TO SUCCESSFUL PLAN REDESIGN:
COMMUNICATE, COMMUNICATE, COMMUNICATE
Repeatedly make your plan participants aware of
any and all changes to the plan rules, policies and
procedures.
Even if you decide to not make any changes to the
plan at this time, at a minimum, you should inform
your participants of the dangers of attending
treatment at out-of-network treatment programs.