Implementing the IOM Report: The TRI-State Policy Program

1. Implementing the IOM Report: The TRI-State Policy Program ACADEMY HEALTH Mady Chalk, Ph.D. Treatment Research Institute June, 2006

2. The Presentation • Implementing the IOM Report • Creating an Environment for Exchange of Information and Identification of Priority Policy Concerns in States • Developing a Mutual Assistance Effort • Identifying and Testing Solutions That “Work” • Carrying Out Practical, Real World Evaluations

3. The IOM Report • Health Care Focus, e.g., mainstream medicine • Linking Funding to Quality • Patient-centered Care, e.g., long-term management support, concurrent recovery monitoring • Coordination of care • Data accessibility

4. State Level Policy and Substance Abuse • Discrepancy between what is known and what is delivered • Lack of incentives in public sector funding to drive quality improvement • Disconnected delivery arrangements lead to ineffective treatment • Workforce • Data infrastructure

5. State Priority Concerns • Performance and Outcome Measurement in Collaboration with Treatment Providers • Data Reporting and Management • Collaborative Financing of All Types • Integrating Substance Use and Health Care: SBIRT; PRISM (mainstream medicine); Concurrent Recovery Monitoring

6. State Priority Concerns (Con’t) • Use of Incentives in Purchasing For: • Treatment of priority populations • Implementation of administrative and clinical best practices to improve access and retention • Becoming “co-occurring capable” • Creating a “medication friendly” environment in treatment

7. Creating the Environment In order for States to work together the environment must allow for: • Continuity over time • Unofficial deliberations • Neutrality of sponsoring organization • Moderating presence of some disinterested members

8. Creating the Environment • Access to expert consultation and background papers from research, other businesses with similar issues • Structured opportunity for regular discussion • Practical, real world evaluations

9. Advantages of Mutual Assistance • Practices, policies and procedures have a higher likelihood of success and practicality since they are derived from common experience rather than academic research; • Findings of a consortium of states will have greater political traction than the same findings resulting from a single state’s efforts;

10. Advantages of Mutual Assistance • Multiple issues can be worked on simultaneously because more sources of potential “solutions” are identified; • Documentation of comparative results will become part of the “evidence base” providing greater legitimacy for state policies.

11. The TRI-State Policy Program TRI’s Role: • Providing an Environment for Open Exchange of Information, Identification of Policy Concerns, and Problem-Solving • Focusing on Specific Policy Areas That Will Reform the Treatment System

12. The TRI State Policy Program TRI’s Role: • Providing Strategic Information from Some Other Industries That Can Be Used By State SA Agencies • Evaluating Implementation Experiments • Hosting Long-Term Working Groups to Develop Approaches to Knotty Policy Problems

13. How Will States Work Together? • Prioritize a common set of two or three policy, performance, business, administrative and/or financing issues; • Describe and circulate promising approaches that may have already been tried by member states;

14. How Will States Work Together? • From the promising practices and group discussion create a practical evaluation of an improvement protocol to implement within member states; • Analyze data from the evaluation and produce “evidence” of effective policies and practices that can be disseminated widely.

15. Some of the Issues States Face Data Issues: • Collecting and Using Data to Support Policy Objectives: • Cost Offset Data to Support Re-Allocation of State Dollars • Implementing WEB-Based Data Systems to: • Support Accurate Reporting by and Immediate Feedback to Providers incl., Encounter Data

16. Some of the Issues States Face Working with Governors and Legislatures To: • Remove Regulatory Barriers That Impede Implementation of Cross-Agency Financing Approaches • Remove Barriers to Medication-Assisted Treatment of All Types • Implement Performance-Based Purchasing

17. Necessary, but Not Sufficient • A Continuum of Care from Primary Care, to Specialty Health Care, to Specialty Treatment for Substance Use Disorders and Mental Illnesses • A Bridge Between Research and Tx • So, Is Research Part of the Bridge or Is It Part of the Gap? • Can the Infrastructure Meet the Public’s Demands?

18. Some Thoughts About Quality Improvement • Making the Case for Change • Costs, Cost-offsets, Access • Health Care and Substance Use • Consumer Choice and the Continuum of Care