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AHCCCS Behavioral Health Medication Initiatives Kristin Frounfelker Behavioral Health Administrator September 19, 2012. Psychotropic Medication for Foster Care Children. Results of GAO December 2011 Report
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AHCCCS Behavioral Health Medication InitiativesKristin FrounfelkerBehavioral Health AdministratorSeptember 19, 2012 Our first care is your health care Arizona Health Care Cost Containment System
Psychotropic Medication for Foster Care Children • Results of GAO December 2011 Report 1) FC children were prescribed psychotropic medications 4 times higher than non foster care children. 2) FC children were prescribed 5 or more psychotropic medications concomitantly 1.3% more than non FCC.(0.07%) 3) FC children were prescribed medications exceeding the FDA approved maximum dosage 3% more than non FCC. (0.16%) 4) FC children ages 0-1 were prescribed a psychotropic medication up to 2% more than non FCC.(0.1-1.2%) Our first care is your health care Arizona Health Care Cost Containment System
Arizona’s Foster Care Children • Arizona Study Results 1) FCC (0-18) were 4 times more likely to be prescribed psychotropic medications than non FCC. 2) FCC were 5 times more likely to be prescribed psychotropic medications exceeding the FDA maximum dosage than non FCC 3) FCC were 9 times more likely to be prescribed concomitant psychotropic medications non FCC. 4) Psychotropic medications for FCC ages 0-1 is an uncommon practice. Our first care is your health care Arizona Health Care Cost Containment System
AACAP Guidelines • AACAP Consent Oversight Consultation Information Sharing Our first care is your health care Arizona Health Care Cost Containment System
Comparing Arizona’s Practice to AACAP Guidelines • ADHS/DBHS in partnership with DCYF and CMDP conducted a self assessment: • Consent • Oversight • Information Sharing • Consultation • Results on ADHS/DBHS website: http://www.azdhs.gov/bhs/documents/children/psychotropic-medication-use-foster-care-az.pdf (19 indicators- 9/Fully Implemented, 9/Partially Implemented, 1/Not Implemented) Our first care is your health care Arizona Health Care Cost Containment System
August 2012 Summit • Because Minds Matter-ACYF State Medicaid, Child Welfare, State Mental Health brought together to discuss: Cross System Collaboration Data Sharing Screening and Assessment Care Coordination Increased Access to EBP Access to Accurate Info Informed Consents/ Assents Youth Engagement Medication Monitoring Clinical Consultation Our first care is your health care Arizona Health Care Cost Containment System
Arizona’s Next Steps • Priority Areas: 1) Strengthen Management of Medication Monitoring 2) Youth Engagement/Assent • Next Steps: DES/DCYF Lead Agency Develop Charter Determine Data Pull Discuss Strategies of Cross Collaboration January 2013- Multi Agency Work Plan Our first care is your health care Arizona Health Care Cost Containment System
Reducing Antipsychotic Usage for Nursing Facility Residents with Dementia • 2010 CMS data found estimated 40% of NF residents with signs of dementia were receiving antipsychotic medications without a diagnosis of psychosis. • 17% were receiving doses exceeding the recommended levels. • There are no FDA approved medications for dementia. • CMS Initiative- 15% Reduction by 12/31/2012 Our first care is your health care Arizona Health Care Cost Containment System
CMS Goals- July 2012 • Develop Hand In Hand training series for NF staff- person centered planning, prevention of abuse • Provide training to State and Federal surveyors • Provide each NF antipsychotic drug use on Nursing Home Compare website • Emphasize non pharmacological interventions such as managing acute/chronic pain, staff consistency, increased exercise/outdoor time, person centered planning • State Coalitions Our first care is your health care Arizona Health Care Cost Containment System
Arizona’s Approach • Coalition Lead-Health Services Advisory Group 1st Meeting- August 28, 2012 Next Meeting: October 4, 2012 at HSAG Coalition Objectives: * Introduce the CMS Initiative * Discus how to collaboratively decrease inappropriate use of antipsychotic medications and improve dementia care in NFs * Establish actions plans * Establish frequency of meetings Our first care is your health care Arizona Health Care Cost Containment System
AHCCCS Action Plan * July 30,2012- Letter to AHCCCS: CEO/CMO/Pharmacy/Directors/Compliance Officers * August 1, 2012- Met with ALTCS Case Managers * Developing a data collection tool for CM’s to use for top 30% of NFs identified by CMS- Nursing Home Compare * Collect data and identify strategies to reduce reliance on antipsychotic medication to manage dementia behaviors * Continuing Statewide monitoring Our first care is your health care Arizona Health Care Cost Containment System
Promote Opportunities Use this initiative to: • Rethink dementia care • Reconnect with residents via person centered care strategies • Restore good health and quality of resident life Our first care is your health care Arizona Health Care Cost Containment System
Questions/Comments For more information: Kristin.Frounfelker@azahcccs.gov 602-417-4037 Our first care is your health care Arizona Health Care Cost Containment System
