Healthcare Reform

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Healthcare Reform The Affordable Care Act
How Will It Affect Substance Abuse Care?
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Population Prevalence
In Treatment 2,300,000
LOTS
Addiction 25,000,000
Diabetes 24,000,000
Harmful 60,000,000 Use
Little or No Use
LITTLE
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Presidents 2012 Budget
Poverty Assist. 17
Defense 19
Healthcare 23
Social Secur. 21
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The Presentation
1 - The Basic Elements 2 Changes Expected 3
The Implications
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2010 Healthcare Reform The Affordable Care Act

• Transformative for MH/SA
• SA care is Essential Service
• Funds full continuum of care
• Prevent, BI, Meds, Spec Care
• Focus on Primary Care
• Part of Medical Home
• Information management

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Purposes

• Insure 45 million uninsured
• Reduce Costs of Healthcare
• Correct Insurance Problems
• Improve Care Quality

32 million newly insured
Admin Costs, Prevention, Tech.
Pre-exist cond, dropping, portability
Ev Based Pract., Technology
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Key Features

• Expanded Insurance
• Health Exchanges
• Medical Home
• Electronic Health Record
• Prevention Emphasis

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Other Issues

• Training Emphasis
• Significant grants for provider training
• On-line Medicaid billing requirement
• Federal/State funding match
• Essential services 100 federal
• Most prevention is 100 federal

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The Presentation
1 - The Basic Elements 2 Changes Expected 3
The Implications
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Addiction
XXXXXXXX
Substance Use Disorders
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1
Conceptual Approach to Addiction

• A Bad Habit not an Illness
• Leads to a Special Approach

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A Nice Simple Rehab Model
Substance Abusing Patient
Treatment
NTOMS Sample of 250 Programs
Non- Substance Abusing Patient
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ASSUMPTIONS

• Some fixed amount or duration of treatment will
  resolve the problem
• Clinical efforts put toward correctly placing
  patients and getting them to complete treatment
• Evaluation of effectiveness should occur
  following completion
• Poor outcome means failure

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Addiction Treatment
Very Frequent Use
In Specialty Treat. 2,300,000
Very Rare Use
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Current Benefit in Addiction

• Detoxification 100
• Ambulatory 85
• Opioid Substitution Therapy 50
• Urine Drug Screen 100
• 7 per year
• Note Great variability state to state

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Addiction Benefits

• Virtually all these are hospital benefits
• Very few are visit benefits almost all are
  program benefits
• Very few care options, little variety within
  options
• Comparatively little acknowledgement of patients
  rights, little help with access

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Treatments For Other Illnesses Why it matters
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A Continuing Care Model
Primary Care
Specialty Care
Primary Continuing Care
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In Chronic Illnesses.
1 There is no Cure - the effects of treatment
do not last very long after care stops 2
Patients who are out of contact are at elevated
risk for relapse Retention is essential
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In Chronic Illnesses.
3 Early, intensive stages prepare patients for
less intensive care ultimately
Self-Management
4 - Evaluation is a clinical duty Good
function continue care Poor function
change care
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Medicaid Benefit in Diabetes

• Physician Visits 100
• Clinic Visits 100
• Home Health Visits 100
• Glucose Tests, Monitors, Supplies 100
• Insulin and 4 other Meds 100
• HgA1C, eye, foot exams 4x/yr 100
• Smoking Cessation 100
• Personal Care Visits 100
• Language Interpreter - Negotiated

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Diabetes Benefits

• Virtually all these are in primary care
• Most are visit benefits not packaged
• The term dual disorder originated here as
  diabetes and hypertension
• Note patients have rights and benefits designed
  to help them access care and to benefit from it

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Medicaid Benefit in Diabetes

• Physician Visits 100
• Clinic Visits 100
• Home Health Visits 100
• Glucose Tests, Monitors, Supplies 100
• Insulin and 4 other Meds 100
• HgA1C, eye, foot exams 4x/yr 100
• Smoking Cessation 100
• Personal Care Visits 100
• Language Interpreter - Negotiated

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Diabetes Benefits

• Virtually all these are in primary care
• Most are visit benefits not packaged
• The term dual disorder originated here as
  diabetes and hypertension
• Note patients have rights and benefits designed
  to help them access care and to benefit from it

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Future Benefit for Substance Use Disorders

• Physician Visits 100
• Screening, Brief Intervention, Assessment
• Evaluation and medication Tele monitoring
• Clinic Visits 100
• Home Health Visits 100
• Family Counseling
• Alcohol and Drug Testing 100
• 4 Maintenance and Anti-Craving Meds 100
• Smoking Cessation 100

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Care Continuum

• 500,000 Primary Care Physicians CNPs
• Prevention Services
• Screening and Brief Intervention - UPHS
• Early Intervention
• Brief Counseling / Treatment
• Office-Based Treatment
• Medications, Monitoring, Management
• Referral to Specialty Care
• Referral Back for Continuing Care

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The Presentation
1 - The Basic Elements 2 Changes Expected 3
The Implications
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Prevention

• New market for prevention research
• Very significant funding in ACA
• new initiatives to drive down cost and improve
  personal responsibility
• Challenge What is prevention just vaccines or
  community focus wellness

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Primary Care

• Need intervention research with PCPs
• Adherence assistance
• Tele-health and Tele monitoring
• New market for medications
• 500,000 PCPs other prescribers
• Research on counseling in primary care
• Behavioral Health focus? Family focus?

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Primary Care

• Adaptation of Health Homes to SUD
• 90 Federal funding for Health Home services
• Emphasis on care integration and transition
• Addition of case management services
• Information exchange and decision support
  research
• New information will be in EMR
• Need standard performance measures

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Specialty Care

• Most treatment funding will come from Medicaid
  and private health insurance
• New populations medical referrals
• New billing requirements reporting requirements
• Emphasis upon Outpatient care integrated into
  Medical Home
• Emphasis on Evidence Based Practices
• What is a profitable outpatient model?

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Specialty Care

• Emphasis/expansion home health services Will
  specialty care fill this role?
• Role of Block Grant could change
• Recovery-Oriented services NOT covered in
  healthcare

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Warning!

• Budget negotiations may change some of this
• State variability will continue but ultimately
  reduce

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Thank You