The Federal Environment Riding the Roller Coaster of Change: Behavioral Health in Transition

1. The Federal EnvironmentRiding the Roller Coaster of Change: Behavioral Health in Transition Chuck Ingoglia,Vice President, Public Policy National Council for Community Behavioral Healthcare January 20, 2012

2. The National Council: Serving and Leading • Represent over 1,950 community organizations that provide safety net mental health and substance abuse treatment services to over six million adults, children and families • National voice for legislation, regulations, policies, and practices that protect and expand access to effective mental health and addictions services

4. Changing Policy and Practice Environment • Increased demand at same time as diminishing federal, state, and local resources • State and local systems undergoing accelerated change in organization and financing • Integrated care becoming expectation for payers, consumers, and families • Health IT linking behavioral health system to the rest of healthcare

5. Changing Policy and Practice Environment (cont.) • Increased demand for and use of peer-driven and delivered services • Worldwide workforce shortages challenging system for innovative solutions • Increased diversity in nation, creating need for culturally and linguistically competent services • Transparency of quality data supporting consumer choice and organizational improvement

6. The Federal Deficit Debate • Joint Select Committee on Deficit Reduction: Goal: $1.2-1.5 trillion in deficit reduction • The Committee recently announcedits failure to reach an agreement… • …Triggering automatic, across-the-board cuts beginning in 2013 • Medicaid, CHIP, & SSI protected from automatic cuts • 7.8% cut to all HHS agencies if cuts are applied equally across all Departments

7. Deficit Reduction: What’s Next? • Discretionary spending caps: $917 billion in spending reductions over the next 10 years • Could the automatic cuts be dismantled? • Cuts were purposefully made to be highly unpalatable • But current anti-spending climate may make them difficult to repeal • Could a new deficit reduction plan be enacted? • Plan would have to go through regular Congressional process • What impact will the 2012 elections have?

8. Supreme Court ACA Challenge • Three key points to be challenged: • Is the individual mandate constitutional? • Can the law stand if the mandate is struck down? • Is the Medicaid expansion an unconstitutional infringement on states’ rights? • Ongoing issues with the sustainability of U.S. health spending… • …mean that states and the federal government will continue to search for solutions regardless of the Supreme Court decision

9. Top 10 Reasons Why Health Reform Won’t be Repealed Questions for health law opponents: Are you committed to repealing the section of the law that… • Prohibits health insurance companies from imposing lifetime or annual benefit caps? • Prohibits health insurance companies from rescinding an individual’s insurance coverage because of an error or misstatement on a coverage application? • Requires health insurances to cover proven clinical preventive services without co-pays or deductibles? • Permits parents to keep their adult children up to age 26 on their health insurance policies?

10. Top 10 List, cont. • Requires health insurers to provide enrollees with a clear summary of benefits and coverage? • Requires health insurers to spend no more than 15-20 cents of every premium dollar on profit &administrative costs? • Sets national standards for administrative simplification to reduce the paperwork burden on patients and providers? • Prohibits health insurers from refusing to cover individuals based on pre-existing medical conditions? • Requires the establishment of health insurance exchanges in each state to provide an easy, online way for consumers to compare and buy health insurance? • Closes the Medicare Part D “donut hole” so that seniors don’t have a gap in their drug coverage? See more reasons from John E. McDonough at http://bo.st/wGQZG4

11. Top 5 Things You Can Do Now to Prepare for the Future

13. 1. Be Accessible Can schools, child welfare, ACOs and healthcare homes get their clients/patients into specialty MH/SU care with same day/next day access, especially for high risk, high need patients?

14. 2. Be Efficient Do you have the ability to identify patients with MH/SUD who represent the top 5% to 10% of high cost consumers of health care and provide effective care management services to help them manage their MH/SU disorders AND their chronic health conditions?

15. Care Management: Missouri Example • Identified the cohort of MO HealthNet participants for whom care management offers the greatest opportunity • Program components: • Outreach and engagement (door-to-door outreach, collaboration with other health providers) • Care coordination by mental health case manager • Nurse training • Chronic disease training • Evaluating outcomes: both process indicators and clinical outcomes

16. Missouri Program Outcomes • Actual pharmacy cost decreased 23%. • Actual general hospital cost decreased by 6.8%. • Actual primary care services increased by 21%. • Independent living increased by 33%. • Vocational activity increased by 44%. • Legal involvement decreased by 68%. • Psychiatric hospitalization decreased by 52%. • Illegal substance use decreased by 52%

17. 3. Connect with Other Providers • Do you use a collaborative care approach to clinical services? • Are you actively pursuing bi-directional involvement in your community as a person-centered healthcare home? • Can you electronically collect and share both demographic and clinical-level data with your partners in the healthcare community?

18. 4. Focus on Episodic Care Needs Do you have well defined assessment processes and defined levels of care based on clinical pathways, functionality in daily living activities, symptom severity indicators, service volumes, etc. to match client need with the type, location, and duration of evidence-based care that increases the likelihood that consumers will get their needs met in a timely and effective manner?

19. Clinical Registry: Sample Summary Report

20. Stepped Care Is your clinical delivery process consumer-centered and supportive of “stepped care”? • The ability to rapidly step care up to a greater level of intensity when needed? • The ability to step care down so that a consumer’s MH/SU care is provided in primary care with appropriate supports? • The ability to offer “back porch” services for consumers who graduate from planned care? • All offered from a client-centered, recovery-oriented perspective?

21. 5. Produce Outcomes Do you use standardized tools to measure improvement (or not) in symptomology, level of functioning, resilience and recovery?

23. Join us in Washington, DC

24. Questions? • Chuck IngogliaVice President, Public PolicyChuckI@thenationalcouncil.org