Health Care Reform: Planning to Move Ahead

1. Health Care Reform: Planning to Move Ahead Presentation to: CADPAAC Mady Chalk, Ph.D. Treatment Research Institute May, 2010

2. Areas of Focus • Integration • Role of Technology in Delivery • Treatment Interventions • Reimbursement and Revenues • Medical Accountability • Consumer/Family Role • Performance Expectations • Role in Health Care • Access • Value/Cost

3. Medical Accountability • Environment: • Major focus on medical home in primary care setting • Pressure to implement EHRs • Field still struggling with hand-offs and transitions between levels of care/agencies • Co-morbidity (MH/SA and MED/SA) issues are still befuddling payers and providers

4. Medical Accountability • Questions: • As a payer—what are the most important aspects of accountability? • Have you identified some clear expectations that promote accountability? How have or can you make your providers more accountable? • What activities are you promoting in treatment of co-morbid conditions? Have they worked? How do you know?

5. Patient/Family Role • Environment: • Focus on patient centered care – adaptation of treatment services • Increase pressure on offering choice of provider • New eligibles—different age/socio-economic group—maybe more vocal about their treatment and treatment options • Continued expansion of opportunities for consumers to purchase care via vouchers

6. Patient/Family Role • Questions • Have you articulated a role for patients and families? What is it? • How do you ensure that providers reinforce your message? • What is the patient or family’s role in accounting for their care? • How do patient/families participate in your QI process? What have you learned from them?

7. Performance Expectations • Environment • Implementing NQF Standards of Care • Decreasing drop-outs/increasing engagement, retention, and continuing care • Increasing use of medications as part of comprehensive treatment • Continuous monitoring during treatment and use of data to adapt treatment services during treatment

8. Performance Expectations • Questions • Have you disseminated the NQF Standards of Care to your stakeholders? • How are you introducing performance expectations into contracts and funding for treatment? • How are you monitoring performance of treatment providers?

9. Role in Health Care • Environment: • Increase access to treatment through FQHCs • SBIRT is both an NQF Standard and consider important to provide in healthcare settings • Medicaid authorities may (or may not) include SSA in the decision-making process about changes in benefits, providers, services and reimbursement • Pressures by health plans to have credentialed practitioners deliver services • Linking health and specialty care is considered critical

10. Role in Health Care • Questions: • Have you been involved in health care discussions (statewide or locally)? • If so, what has been your role? • How have or will you responded to financial pressures by other payers? • What is your role in supporting your current providers to be ready for competition from healthcare programs? • What are you doing to link health care and specialty treatment providers?

11. Access • Environment: • Access is still a premium to payers • Still defined in fairly traditional terms • Payers/DOI/MCEs will be tracking access for newly eligible patients more closely • Assumes new coverage = new or different utilization patterns and services

12. Access • Questions: • Have you defined “access” for the services you purchase? If so, how is it defined? • How do you track access? • What do you do when there are access problems? • How do you think new sources of financing will affect access to care?

13. Value/Cost • Environment: • Identification of services/practices that add value • Proof or evidence to support purchasing decisions • Payers more likely to define value in terms of savings or offsets—not necessarily on improved health outcomes • Will have to show value to the customer who will have some “skin” in the game (deductibles, co-pays) • State payers are developing “purchasing plans”

14. Value/Cost • Questions: • How have you defined value—what are your measures? • Do you base your purchasing decisions on the value derived from the service or other factors? • What are these other factors? • What evidence do you use when developing or changing your purchasing plan?

15. Integration • Environment: • Developing standards for integrated care • Providers are further along than payers • Still an assumption that carve-ins will get you closer to integration • Reimbursement rules don’t necessarily encourage integration at the practice level • Still focusing on differences versus similarities • Public payer silos continue to thwart integration

16. Integration • Question: • Can you articulate your vision/model for integrated care? • Who shares or understands this vision? • What will it take to implement you vision? • What are some implementation barriers? • What are three current models in your jurisdiction that are truly integrated?

17. Workforce • Environment: • Payers equate a credentialed workforce with quality although a significant portion of workforce is not credentialed • All over the map regarding a definition of competency (versus credentialed) • Good supervision is diverted by productivity expectations and reimbursement • Recovery support providers have momentum and creating formal networks to compete for dollars

18. Workforce • Questions: • What is your workforce development plan? • Does it apply to specialty or primary care settings? • What resources have you dedicated to workforce development? • Who have you identified and enlisted as partners in developing a competent workforce?

19. Role of Technology in Delivery • Environment: • Technology is moving faster than practice • There are simple uses of technology to enhance access (texting reminders) • The “payer jury” is still out on the use of simple technology solutions (e.g. telephone counseling) • Investment in technology in the provider community is spotty

20. Role of Technology in Delivery • Questions: • Have you identified a clear role for technology when purchasing services? • Are your providers using technology for delivering services? Has it produced value? • Do your payer partners understand the use of technology in delivering SUD services?

21. Treatment Interventions • Environment: • Interventions should produce value and we have evidence of what works • Pressures to keep buying the “same old” • Other payers don’t fully embrace newer interventions • We aren’t good at doing the elevator speech in describing interventions (process versus result)

22. Treatment Interventions • Questions: • What is the role of purchasers in promoting current treatment interventions with: • Clients • Providers • Other payers • How do purvhasers identify, spread and sustain preferred treatment interventions?

23. Reimbursement • Environment: • Continued focus by payers on purchasing units of services • Some initial discussion re: purchasing episodes of care versus widgets • Pay for performance strategies not widely used yet • Different payers/different rates/same services

24. Reimbursement • Questions: • Are you getting what you pay for? • What changes would you like to make in your reimbursement methodology? Why? • What barriers will you encounter if you make these changes? • How will these changes impact other public payers?

25. For more information contact: Mady Chalk, Ph.D. Treatment Research Institute mchalk@tresearch.org