Presented by: Joan Kenerson King RN, MSN, CS Kathleen Reynolds, LMSW

1. Maryland Addiction Director’s Council: Integrated Behavioral Health and Primary Care Learning Community Technical Assistance Session Presented by: Joan Kenerson King RN, MSN, CS Kathleen Reynolds, LMSW

2. Today’s Call • Project Overview: purpose and rationale • What is a learning community • Project timeline • Questions????

3. Why this project? • Standing on the threshold or crossing over into transformational change in health care • Build on the strengths of individual providers (SUD, MH and primary care) by creating a context for partnership development or expansion • Addressing the current context:

4. The Affordable Care Act: Four Key Strategies U.S. health care reform, with or without federal legislation, is moving forward to address key issues 4

5. Medicaid Expansion: 2014

6. Healthcare Models of the Future • Coverage expansions are ONLY sustainable with delivery system reform • Collaborative Care • Patient Centered Healthcare Homes • Accountable Care Organizations • Accountability and quality improvement are hallmarks of the new healthcare ecosystem

7. Primary Care and Behavioral Health • Most PCPs do a good job of diagnosing and beginning treatment for depression (Annals of Internal Medicine, 9/07) • 1,131 patients in 45 primary care practices across 13 states • PCPs did less well following up with treatment over time—less than half of patients completed a minimal course of medications or psychotherapy • Lowest quality of care occurred among those with the most serious symptoms, including those with evidence of suicide or substance use • “Right now PCPs don’t have the tools necessary to decide which patients to treat and which to refer on to specialized MH care”

8. Morbidity and Mortality in People with Serious Mental Illness • Persons with serious mental illness (SMI) are dying 25 years earlier than the general population • While suicide and injury account for about 30-40% of excess mortality, 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases • People with co-occurring SUD die at age 45

9. Co-morbidity and Substance Abuse • Inhalant use among 12‐17 year olds and depression are increasing; • Patients in chemical dependency programs are 18 times more likely to have major psychosis, 15 times more likely to have depression and 9 times more likely to have an anxiety disorder; • Substance use increases the risk for hypertension (x2) , congestive heart failure (x9) and pneumonia (x12); • HIV patients with a substance use disorder are more likely to be non‐adherent; • Medicaid patients with a substance use disorder are more likely to be readmitted to a hospital within 30 days;

10. Co-morbidity and Substance Abuse • Substance use creates increased rates of complications with hip replacements; • Patients treated with medication for alcoholism had fewer detoxification, alcohol related inpatient days and emergency room visits; • High cost Medicaid recipients with HIV had an average annual cost of $157,000; including 40% costs more for treatment comorbidities with MH/SA disorders as the most common comorbidity; • Treating patients with substance abuse related medical disorders in an integrated setting can achieve cost savings

11. Co-morbidity and Substance Abuse • Almost 25% of general healthcare patients report they have a co-morbid substance use conditions likely related to the physical sequelae that result from untreated substance misuse and dependency (NSDUH, 2005) • Substance use conditions often complicate management and treatment of other chronic diseases in primary care such as diabetes, hypertension, asthma and others (PRISM, 2008)

12. Co-morbidity and Substance Abuse • More than 1.7 million visits to hospital EDs are related to some form of substance misuse or dependency (DAWN, 2006) • Drug and alcohol disorders are associated with about 3% of hospital stays and $12 billion in costs. (HCUP, 2006, 2007)

13. New Paradigm – Primary Care in Behavioral Health Organizations Funding starting to open up for embedding primary medical care into CBHOs, a critical component of meeting the needs of adults with serious mental illness

14. Addressing the need: MADC learning community Primary Goal: to increase the adoption of bi-directional integration for the treatment of individuals with substance use disorders in primary care, substances use treatment and community mental health programs as a means to encourage their sustained recovery and improved health across safety net settings.

15. Addressing the need: MADC learning community Secondary Goals: • Create sustainable local community teams consisting of community health centers, specialty substance use treatment settings and community mental health treatment programs. • Improve communication, collaboration and coordination among the teams and the organizations they represent. • Improve selected local community’s capacity to provide bi-directional integration

16. What is a Learning Community? • Collection of like-minded organizations and/or individuals with a common mission related to a common topic • The expertise is generally available within the group • Expert facilitators organize and manage the meeting and bring needed expertise if it is not available in the group • Active involvement of all parties – need people at all levels of implementation

17. Benefits to Learning Community Participation • Reduce the amount of time it takes to bring research into practice • Learn from others in areas of need • Teach others from your successes • Consistent support and coaching from facilitators • Webinars on topics critical to development • Access to the National Council’s National Integrated Health Resource Center • List serve

18. Next Steps: • Applications from teams of three due January 7, 2013 • Notification will be made by January 28, 2013 • Total team cost for participation: $1800 • One day kick off Feb. 5, 2013 (face to face) • MADC conference May 2013 • Mid point meeting June 2013 (face to face) • Webinars • Coaching calls • Individual consultation

19. Questions? Contact: Jackie McNamara madcworkforce@gmail.com 443-310-4250