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Leading Change: SAMHSA Taking Action

Leading Change: SAMHSA Taking Action. Pamela S. Hyde, J.D. SAMHSA Administrator. AMERSA 34 th Annual Conference Health Policy Luncheon Bethesda, Maryland • November 5, 2010. SAMHSA VISION - A HIGH-QUALITY, SELF-DIRECTED, SATISFYING LIFE IN THE COMMUNITY FOR EVERYONE.

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Leading Change: SAMHSA Taking Action

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  1. Leading Change: SAMHSA Taking Action Pamela S. Hyde, J.D. SAMHSA Administrator AMERSA 34th Annual Conference Health Policy Luncheon Bethesda, Maryland • November 5, 2010

  2. SAMHSA VISION - A HIGH-QUALITY, SELF-DIRECTED, SATISFYING LIFE IN THE COMMUNITY FOR EVERYONE This life in the community includes: A physically and emotionally healthy lifestyle (health) A stable, safe, and supportive place to live (a home) Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society (a purpose) Relationships and social networks that provide support, friendship, love, and hope (a community)

  3. Mission: To reduce the impact of substance abuse and mental illness on America’s communities Roles: Leadership and Voice Funding - Service Capacity Development Information/Communications Regulation and Standard setting Practice Improvement Leading Change - Strategic Initiatives SAMHSA’s DIRECTION

  4. Context for Change

  5. Health Care Reform In 2014 → 32 million newly insured (1/2 Medicaid) 6 to 10 million will have moderate to substantial MH and SUD treatment needs – previously not served or not identified Previously ineligible for Medicaid or commercial insurance Previously untreated/received few services or served through states with federal block grants and state funds Today 8+ million youth & adults are served thru two federal block grants and related state funds 39% of individuals currently served by SMHAs currently uninsured 61% of individuals currently served by SSAs currently uninsured

  6. Health Care Reform In 2014 → not all people will be insured; not all BH services will be covered 15 million+ will remain uninsured; 1/3 to 1/5 will have MH or SA service needs Benchmark plans in Medicaid and essential benefits in insurance exchanges will not cover all services necessary to support recovery Both BGs require recasting in who they serve and services they fund BGs need to fund individuals & services not funded by other sources (Medicaid; commercial insurance) States will have to manage “coordination of benefits” and “wrap around” services States will require more direction re use of BG dollars and reporting requirements Untreated M/SUDs increase health care as well as disability, insurance and social services costs for business & government payers Best evidence-based services need to be employed by states

  7. Loss of State Service Capacity 43 States were eligible for MOE waiver in FY 2010 25 States/Territories lost over $940 million in State mental health services between SFY 2008-2009 22 States/Territories lost over $51 million in State substance abuse funding between SFY 2008-2009 Net loss of $677 million for both MH and SA Net loss of $741 million for mental health funding Net increase of $64 million for substance abuse funding Based on current info → 43+ states will be eligible for MOE waivers in FY 2011 w/o increases in SA funding Anticipate a net loss of ~ $800 million or more

  8. Funding for MHBG is ↓ from 10 years ago costs ↑ and funding for SAPTBG has not kept pace with inflation need ↑ (increasing uninsured; increasing cost of care) High Point Low Point 2008-2011 * High Point * Low Point * President’s Request

  9. Emerging Science Prevention – top priority based on science in IOM Report Screening, Brief Intervention and Referral to Treatment Address emerging issues and move EBPs to scale Demonstration and implementation programs should strategically support moving EBPs to wide-scale adoption via public and private payers/systems Need flexibility to address emerging issues Necessity for quality data and public information for SAMHSA, BH field, Congress and the public Surveillance and evaluation, quality and outcome data need to detect emerging issues, inform program priorities, and help determine when to move an issue or practice to the next phase along the change continuum

  10. SAMHSA’s Theory of Change Surveillance and Evaluation

  11. Leading Change – SAMHSA’s Strategic Initiatives 12 • Prevention of Substance Abuse and Mental Illness • Trauma and Justice • Military Families • Health Care Reform Implementation • Housing and Homelessness • Health Information Technology • Data, Outcomes, and Quality • Public Awareness and Support

  12. SAMHSA STRATEGIC INITIATIVES FY 2011-2014 Goal 1.1:↑emotional health: prevent substance abuse/mental illness Goal 1.2:Underage drinking/adult problem drinking Goal 1.3:Suicide Goal 1.4:Prescription drug misuse/abuse Prevention of Substance Abuse and Mental Illness

  13. 4. HEALTH CARE REFORM IMPLEMENTATION Goal 4.1:HCR implementation Goal 4.2:Medicaid/Medicare Goal 4.3:Parity Goal 4.4:Block Grants Goal 4.5:Integration of primary & BH care SAMHSA STRATEGIC INITIATIVES FY 2011-2014

  14. IMPACT OF AFFORDABLE CARE ACT More people will have insurance coverage Medicaid will play a bigger role in MH/SUD than ever before Focus on primary care & coordination with specialty care Major emphasis on home & community based services & less reliance on institutional care Preventing diseases & promoting wellness is a huge theme 15

  15. SERVICES Allows state Medicaid programs to establish health homes for those with chronic illnesses – states must consult/coordinate w/SAMHSA Grant dollars will be for community prevention, wellness & support services not paid for through insurance benefit plans Parity required in essential benefits plans offered through exchanges & in private health plans that choose to offer MH/SUD Grants to community MH programs for co-locating primary & specialty care services Establishes CLASS Program – voluntary, self-funded long-term care insurance program for currently employed – flexible funds for support services to people w/disabilities, including mental illness Establishes a “Medicaid Emergency Psychiatric Demonstration” WHAT’S IN AFFORDABLE CARE ACT FOR BEHAVIORAL HEALTH? 16

  16. FOCUS ON PRIMARY CARE 5 different medical home initiatives to focus on coordinating primary and specialty care Enhanced Federal incentives (Medicaid and Medicare) for these initiatives Significant grant funds to educate primary care FOCUS ON HOME AND COMMUNITY-BASED SERVICES Expansion of Medicaid to additional HCBS services and for individuals in institutional care (PRTFs/IMD 65+) WHAT’S IN AFFORDABLE CARE ACT FOR BEHAVIORAL HEALTH? 17

  17. TRAINING & RESEARCH Increased patient-centered health research Training grants for behavioral health workforce Training on MH/SUD for primary care extender SUPPORT FOR WORKFORCE DEVELOPMENT Funding for residencies for BH included w/other disciplines (HRSA) Loan repayment programs Push towards more national certification standards & re-licensure/re-certification Primary care/behavioral health integration (both directions) WHAT’S IN AFFORDABLE CARE ACT FOR BEHAVIORAL HEALTH? 18

  18. Consultation regarding health homes Developing quality measures for HCR Home Visiting Program Specific work regarding post-partum depression (HRSA has lead) Prevention! Prevention! Prevention! Regulations Focused strategies for adding services to USPSTF Health information technology changes Primary care/behavioral health integration (both directions) ACA IMPLEMENTATION SAMHSA’s ROLE 19

  19. $26.2 million in grants to support and promote better primary care & behavioral health services for individuals with MI/SUDs Includes up to $20.9 million to help 43 community behavioral health service agencies integrate primary care into their services 13 grants were awarded last year + the 43 new grants = 56 grants at work Includes $5.3 million to establish a national resource center to support the bi-directional integration of primary and behavioral health care regardless of which setting consumer access services Funded jointly by SAMHSA and HRSA Will provide training and technical assistance Will facilitate workforce development INTEGRATION OF BEHAVIORAL HEALTH & PRIMARY CARE 20

  20. ACA ImplementationSAMHSA’s ROLE Includes: Good & Modern Services → paper & service definitions Roadmap for States to use to plan for ACA implementation Strengthening SAMHSA’s authority regarding States’ use of Block Grant funds → regulation in process Shift in SAMHSA staff functions to support & provide TA to States as they move through changes Increased collection of performance & outcome data for evaluation and planning

  21. 7. DATA, OUTCOMES, AND QUALITY Goal 7.1:Integrated approach for data Goal 7.2:Common standards Goal 7.3:Program evaluations & services research Goal 7.4:↑ quality & accessibility of surveillance, outcome/performance, & evaluation information SAMHSA STRATEGIC INITIATIVES FY 2011-2014

  22. People Stay focused on the goal Partnership Cannot do it alone Performance Make a measurable difference SAMHSA PRINCIPLES 23

  23. Behavioral health is an essential part of health Prevention works Treatment is effective People recover from mental and substance use disorders SAMHSA KEY MESSAGES 24

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