National HealthCare Reform Moving from Slogan to Reality: Where is Addiction Services in this Discus

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National HealthCare ReformMoving from Slogan to
RealityWhere is Addiction Services in this
Discussion?

• Ronald J. Hunsicker
• President/CEO
• National Association of Addiction Treatment
  Providers

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What Well Talk About

• History and Lessons from 1993
• Current Lay of the Land
• What Healthcare Reform Might Look Like
• Issues for Addiction Services
• How Do We Get There?

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History and Lessons from 1993

• The final plan was 1342 pages
• Congress wanted more control/input, leadership of
  key committees not on board in the first place
• Congressional Democrats were divided and pushed
  their own plans
• The administration acted too slowly, introducing
  the bill in Nov 1993. By then the window was
  closing
• Tipper Gore headed a mental health working
  groupaddiction was not included at first but was
  added later
• Good addiction and mental health coverage
  eventually included in all major bills

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Why did the Clinton Plan Fail?

• Too complex (1300 pages) and did not
• include key stakeholders in the process
• Opposed by insurance companies and
• small business (remember Harry and
• Louise?)
• It did NOT fail because of opposition by
• doctors or hospitals

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Current Lay of the Land

• Healthcare is expensive and costs are rising,
  from 7.2 GDP in 1970 to 16.6 GDP in 2008
• 70 million Americans uninsured or underinsured
• About 1 in 3 Americans report their family has
  had problems paying medical bills in the last
  year. Nearly half report someone in their family
  has cut back on care they say they needed due to
  cost.
• Democratic landslides in 2006 and 2008economy
  and healthcare top issues

Sources Statehealthfacts.org and Kaiser Health
Tracking Poll Election 2008. 10/2008 KFF,
Healthcare and the 2008 Elections, 10/2008
Peter R. Orszag CBO Testimony, 6/2008
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Very Important

• Health Care as we now know it is going to change!
• You will pay a larger share of the premiums
• Higher deductibles
• More business will not be able to offer health
  care to its employees

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Structure

• Take out Medicare and Medicaid and our health
  care insurance is built into the economy of
  work
• High unemployment disaster!

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Insured

• Majority Insured 85 of Population
• 43-45 Million Uninsured

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Health Care Costs

• 1.9 Trillion
• 6,400 per person
• Almost 3 Trillion by 2015

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Challenge of Insuring

• Access
• Affordability

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Cost is Reason
Growth Rate Trends for Health Care Services and
Gross Domestic Product (GDP), 1994-2006

• Premiums have increased 87 over 7 years

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Cost Drivers

• Aging Population
• Medical Malpractice
• Life-Saving Treatments
• Chronic Illness

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Medical Practitioners

• Variations in Practice Patterns
• Defensive Medicine

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What does Fix the Health Care System Mean?

• Were talking about a century-long evolution
• here that many seem to forget
• The public wants reform but doesnt agree on
• what kind of reform it wants
• Purchasers, including government, want reform
• but may want something entirely different from
• what the public thinks it wants
• Whatever it is, politicians have to figure out
  how
• to pay for it!
• Its like the blind men and the elephant

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Describe the Elephant
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Lessons To Learn

• We should go beyond tinkering at the margins and
  develop a long-term game plan for a truly
  rational, value-driven health-care system

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Questions

• Do we need to maintain mammoth, redundant
  government bureaucracies to manage many separate
  public financing systems?
• Do we need myriad private plans with similar
  variations or would consolidations reduce
  complexity for physicians and administrative
  expenses for purchasers?

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Questions

• Is it rational to invest more to treat illness
  than to prevent disease?
• Is it better to pay providers based on the volume
  rather than the effectiveness of care?

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The Real Reason that UniversalCoverage is so
Elusive

• There is no agreement on how to do itsupport for
  single payer, individual mandate and employer
  mandate is equally divided among the public
• 85 are covered now and are essentially happy
  with their own doctor and hospital
• People are unwilling to pay more than 150 to
  cover the other 15 who lack insurance
• To cover that 15, everybody else has to give up
  something

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Quality, Cost and Access

• Lets break health care reform down into the
  three basic components quality, cost, and
  access, and talk about how perceptions may
  differ, depending on whom you ask

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Quality to the Patient

• Americans, as individuals, are generally
  satisfied with the quality of care they receive
  from their doctors and hospitals, with the
  exception of concerns about safety. Patients are
  afraid that they will be the victim of medical
  errors. This fact also explains why it is so hard
  to get liability reform.

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And, We DO Spend a Lot onHealth Care

• U.S. spending is 6400 per capita, twice the
  median of industrialized countries
• U.S. hospital day 2434
• Canada hospital day 870
• U.S. average physician income 5.5 times the
  average worker
• UK, Sweden physician income 1.5 times the
  average worker

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Lay of the Land the Economy

• Economic crisis exacerbating healthcare crisis
• Under the current system, when someone loses
  their job they also lose their health insurance
• Need to strengthen the safety net
• Budget crises in almost all states as Medicaid
  rolls swell, leading to cuts
• Healthcare spending effective and needed stimulus

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Healthcare Reform What it might look like

• Public program expansions
• Creation of a new National Health Insurance
  Exchange
• Insurance market reform
• Mandates and subsidies
• Cost-containment

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Major Issues

• Reduce Costs Both health care costs and costs
  for insurance
• Improve quality Outcomes
• Reduce the number of persons without insurance or
  coverage

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Creation of new National Health Insurance Exchange

• Include a range of private insurance options
• Include a new public plan based on benefits
  available to Congress
• Public and private plans available to individuals
  on sliding scale and small businesses
• Oversight by several member Health Board
• President appointed, Senate confirmed
• Regulate plans
• Define Minimum Credible Coverage

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Insurance Market Reform

• Could include a wide range of private insurance
  market reforms, such as
• Eliminating preexisting condition restrictions
• Providing dependent coverage to age 25
• Requiring coverage for preventive services
• Parity!

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Likely Mandates and Subsidies

• Individual mandate
• Federal subsidy to help individuals buy into new
  public plan or other insurance
• Pay or Play Employers will likely be required
  to offer meaningful coverage or contribute to
  cost of public plan

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Road Blocks to Reform

• Everyone has a vested interst in the current
  system
• At the end of the day, everyone wants reform but
  that usually means a bigger piece of the current
  pie for them!

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Likely Efforts to Control Costs and Other Reforms

• Health information technology
• Competition and transparency
• Prevention
• Maintain existing state healthcare reform plans
  if they meet minimum standards of national plan
• ERISA reform to allow states more flexibility to
  define standards
• Support preventive health strategies including
  initiatives in the workplace, schools, and
  communities

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Healthcare Reform How do we get there?

• Healthcare reform will require a long, protracted
  advocacy effort
• Build on success of parity legislation to ensure
  adequate addiction and mental health treatment is
  included in any reform
• We are here to talk about how we can work and
  advocate together

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Addiction Services

• What will it mean to Reform the way we deliver
  Services?
• What will it mean to Reform the way we bill for
  our services?
• What will it mean to Reform the way we manage
  this disease?
• Reform

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Some points to Consider

• Recovery Management System vs. Acute Treatment
• Transfer vs. Discharge

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Disease Management

• What services will it take and how will we
  deliver them to make it more likely that persons
  will experience long term life long recovery?
• Recovery

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What Do we Want

• Ensure Universal Coverage of Health Insurance for
  all
• All persons covered by health insurance receive a
  basic benefit for the treatment of alcohol and
  other drug addictions
• Health care reform should ensure that the full
  range of alcohol and drug intervention,
  screening, diagnosis, treatment and recovery
  support services are available and accessible to
  all who need them

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What Do We Want

• Health care reform should ensure that alcohol and
  drug addiction is viewed, treated, and researched
  as a primary, progressive and chronic disease.
• Increase the focus on providing disease
  management services over the life of the
  individual

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What Do We Want

• Ensure the integration of physical and behavioral
  health care
• Eliminate the behavioral health carve out
  practice
• Integrate the use of HIT with behavioral health
  services

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What Do We Want

• Determinations about who needs what services,
  levels of care, and lengths of stay must be made
  by treatment professionals guided by the
  establishment of best practice principles
• Establish a consensus of specific and measurable
  criteria as to what constitutes positive outcomes
  is an essential element of a reformed U.S. health
  system.

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What Do We Want

• Remove all impediments to accessing specialized
  treatment for addiction services including the
  IMD Exclusion under Medicaid
• By integrating all revenue streams into one
  integrated delivery system, the potential exists
  to greatly reduce or perhaps eliminate a number
  of federal and state funding sources outside of
  the health care system

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Issues along the way

• Electronic Health Record
• Paper Record
• Electronic Medical Record
• Electronic Health Record

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Electronic Health Record

• Issues
• Cost
• Confidentiality 42 CFR

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Brain Disease and Chronic Disease Management

• Very important Concepts
• Does our practice match our language?
• Chronic Disease will mean more emphasis on
  managing the disease over the life of the
  individual

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Recovery Systems of Care

• Systems of Care Vs. Isolated Silos
• Patient of a program or patient of a system

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Recovery

• Sustainable Recovery
• What does this mean?
• How do we measure it?
• How is the best way to get to it?

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Bottom Line

• Benefit everyone needs to have a benefit so
  that they can get treatment for addictions.
• Access access to treatment should be controlled
  by health care professionals
• Reimbursement Payment for addiction treatment
  should be on parity with other health care
  reimbursement.