CSAT Meeting: Strategic Planning for Providers to Improve Business Practices

1. CSAT Meeting: Strategic Planning for Providers to Improve Business Practices “Welcome” October 21, 2009 Arlington, VA H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services

2. President Barack Obama “…we are at that rare moment when we have been given the opportunity to remake our world for the better; that rare moment where we have a chance to seize our future… That movement doesn't begin in Washington -- it often begins in states.  It begins in neighborhoods.  It begins in communities.  October 1, 2009

3. Why Focus on Process Improvement Now? • Growing interest in how the states are dealing with substance abuse treatment programs. • Monday interview with writer from one of the major national news organizations. Questions included: • How adept are States in evaluating which substance abuse treatment programs are the best and which are not so good? • What are the current challenges in terms of providing enough public funding (state and federal) to meet the need for treatment? • In short, are States part of the problem – or part of the solution?

4. SAMHSA’s Role in Supporting Recovery from Substance Use Problems & Disorders SAMHSA works to ensure that science, rather than ideology or anecdote, forms the foundation for the Nation’s addiction treatment system. SAMHSA serves health professionals and the public by disseminating scientifically sound, clinically relevant information on best practices in the treatment of addictive disorders and by working to enhance public acceptance of that treatment. 4 4

5. Past Month Alcohol Use - 2008 Any Use: 52% (129 million) Binge Use: 23% (58 million) Heavy Use: 7% (17 million) (Current, Binge, and Heavy Use estimates are similar to those in 2007) Source: NSDUH 2008

6. Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2008 Source: NSDUH, 2008

7. Concurrent Illicit Drug and Alcohol Use Illicit Drug Use concurrent with Last Alcohol use among Past Month Alcohol Users aged 12+ Source: NSDUH 2008

8. SAMHSA’s Goals • Promoting Accountability: Establish systems to measure performance and ensure accountability. • Enhancing Capacity: Build, enhance, and maintain treatment infrastructure and capacity. • Assuring Effectiveness: Enable all communities and providers to deliver effective treatment services.

9. In these challenging economic times the value of substance abuse treatment programs and services must be clearly demonstrated through delivery and performance. National Outcome Measures data (NOMS) are used by CSAT to monitor the effectiveness of our programs and progress toward achieving national goals. Our Goal: to encourage the use of such data to help identify areas for improvement and provide evidence of success. Promoting Accountability

10. Enhancing Capacity • Only 9.9% of those (12 and older) who needed treatment for a drug or alcohol use problem in 2008 received it at a specialty facility. • That leaves 90.1% (20.8 million) without treatment -- most because they don’t feel they need it. • Our goal: to reach them through expanding treatment capacity into areas that are underserved – or not served at all – with culturally appropriate services and materials. Source: NSDUH, 2008

11. Assuring Effectiveness CSAT programs use evidence-based practices (EBP) based on research findings and expert or consensus opinion regarding a specific clinical outcome (measurable change in client status). Our Goals: Improve the quality of care through services that are informed by the best available evidence. Use EBPs to increase the likelihood that desired outcomes will be obtained. Employ these practices to ensure available resources are used more efficiently. 11

12. The Challenge: How to Improve our Business Practices • Each of SAMHSA’s goals involves ensuring that infrastructure and business practices – both ours and yours -- are evidence-based and sustainable. “Every system is perfectly designed to achieve the results that it gets” -- Edward Demming

13. Why? The challenges of alcohol and substance abuse remain. According to the 2008 National Survey on Drug Use and Health (NSDUH): In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users. 2.9 million of them were first time users during the past 12 months – an average of almost 8,000 initiates per day. Creating and maintaining a sustainable, evidence-based infrastructure for your program and services is essential to effectively meet these challenges. Source: SAMHSA, NSDUH 2008

14. Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2008 Source: NSDUH 2008

15. The Silent Ones • If the 20.8 million “silent ones” knocked on your doors – what could you do? • If health care reform and parity increase access to substance abuse treatment and services – do you have the infrastructure in place to meet those needs? • If demand for your services and programs suddenly doubled, do you have the workforce trained to respond?

16. “The Times – They are A-Changing” • Parity • Healthcare Reform • Health IT • Integrated Healthcare • Increased certification • Tighter budgets

17. The Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Under the new Law: 149 million people will now have non-discriminatory addiction and mental health coverage under employer based plans, SCHIP and Medicaid. Includes 82 million new individuals under ERISA plans who previously lacked parity protections, since they are not covered by State parity laws. 17 17 17

18. Impact of Parity on the Specialty Substance Use Disorder Treatment System 18 18 The Potential Impact on your business processes: • Increased emphasis on • cost containment, • cost management and • cost effectiveness • Parity may require greater accreditation, certification & licensure of participating specialty programs 18

19. Health Care Reform & Substance Use Disorders or Mental Illness 19 19 • A number of proposals are on the table: • Key themes • Access • Prevention • Cost Containment/Cost Management • Electronic Health Records/Personal Health Records • Business processes and infrastructure need to be ready to meet the additional demands health care reform will create. 19

20. Health Care Reform: SAMHSA’s Core Consensus Principles 20 20 SAMHSA has gathered input from hundreds of stakeholders and consumer groups – as well as national and international experts in the field of mental illness and substance abuse – regarding critical issues facing today’s U.S. population. The goal is to identify opportunities to ensure that health reform efforts include mental health and substance abuse prevention and treatment. Based on this input, SAMHSA has drafted 9 Core Consensus Principles. These principles are in draft form, and we continue to gather input on how to improve them. 20

21. SAMHSA’s Core Consensus Principles 21 21 SAMHSA’s 9 core principles are: • Articulate a National Health and Wellness Plan for all Americans. • Legislate universal coverage of health insurance with full parity. • Achieve improved health and long-term fiscal sustainability. • Eradicate fragmentation by requiring coordination and integration of care for physical, mental, and substance use conditions. 21

22. SAMHSA’s Core Consensus Principles 22 22 SAMHSA’s 9 core principles (cont’d): • Provide for a full range of prevention, early intervention, treatment, and recovery services that embodies a whole-health approach. • Implement national standards for clinical and quality outcomes tied to reimbursement and accountability. • Adopt and fully utilize health information technology (HIT). • Invest in the prevention, treatment, and recovery support workforce. • Ensure a safety net for people with the most serious and disabling mental and substance use conditions. 22

23. Health IT Initiative HIT will accelerate the use of effective health information technology to improve care outcomes, safety, and value. Reduce duplication and enhance coordination. Facilitate standards, recommended care, reporting and transparency. Begin preparing for HIT now. Electronic health records and systems must be able to integrate with the larger HIT system. Personnel and technology must be trained to provide the security and consistency that HIT will require. 23

24. Integrated Health Care • Integrated health care is the provision of prevention, screening, diagnostic treatment and recovery services for one category of disorders in settings that include a focus primarily on other disorders, or on a full range of disorders. • Now is the time to assess how integrated health care will affect your organization. • Integrated health care can: • provide mental health &/or substance abuse services in primary care settings and visa versa. • provide mental health services in substance abuse service settings and visa versa. • provide prevention services in treatment settings and visa versa.

25. Doing More with Less • We are being asked to make major changes during a time when we are also required to work with less funding and smaller staffs. • Improving processes, using evidence-based practices, building and enhancing our infrastructure are effective tools to meet these challenges. • The result: • higher quality substance abuse treatment and services, • Better use of time and resources, and • Evidence of your continuing success.

26. Meeting Overview • Conference objective: to address today’s challenges by developing a strong organization and business approach. • The Goal: the sustainability of each of your programs. • Before you can address sustainability, you must demonstrate the value of your program today… • And prepare to demonstrate your value into the future. Thank you