FTCC Annual Meeting April 25, 2012

1. FTCC Annual MeetingApril 25, 2012 Mohini Venkatesh, Senior Director, Public Policy National Council for Community Behavioral Healthcare

2. The National Council: Serving and Leading • Represent over 1,950 community organizations that provide safety net mental health and substance abuse treatment services to nearly 8 million adults, children and families • National voice for legislation, regulations, policies, and practices that protect and expand access to effective mental health and addictions services

3. Public Health Imperative • People with mental illness die, on average, at age 53 (Colton & Manderscheid, 2006) • 70% of primary care visits stem from psychosocial issues (Robinson & Reiter, 2007) • Nearly 60% of individuals with bipolar disorder and 52% of persons with schizophrenia have a co-occurring SU disorder (Verduin et al, 2005) • HIV seroprevalence rates among adults in psychiatric settings average 6.9% (McKinnon et al, 2002), compared to .43% in the U.S. general population (McQuillan et al, 2006) • HIV prevalence rates among people with co-occurring MH and SU disorders ranged from 6%-23% (Meade et al, 2007)

4. Public Health Imperative Having an STD in the past year was more common among persons aged 18-25 who used both alcohol and an illicit drugs in the past month than those who used neither, or those that only used one or the other. *note variance by gender

5. Federal Agency Support Anything I’m missing?

6. A Changing Landscape • Health reform rollout: opportunities and challenges • State planning for insurance expansion, demos Enrollment systems • Public awareness, not to mention provider awareness! • Managed care • Health information technology • Uncertainty can hinder progress: • Supreme Court and the ACA • The deficit debate • Future of Medicaid • State budget cuts

7. New Dollars… and New Challenges • When the ACA is fully implemented, Medicaid coverage is expected to increase from 12.4% of individuals with mental illness to 23.3% • Medicaid’s MH spending projected to rise by 49.7%; additional increases for Medicaid SUD spending • National Council analysis: $15 to $23 billion more spending for MH/SUDs from insurance expansion  potential new revenue sources • The vast majority of the new spending will be federal dollars • BUT... Many people served by state MH/SUD agencies will continue to be uninsured Sources: Jeffrey Buck, “The Looming Expansion & Transformation of Public Substance Abuse Treatment under the Affordable Care Act” Health Affairs 30.8 (2011); The Urban Institute/RWJF, “Consider Savings as Well as Costs” (July 2011) http://www.urban.org/uploadedpdf/412361-consider-savings.pdf

8. Disruptive Technology  “An innovation that is disruptive allows a whole new population of consumers access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill.” Clayton M. Christensen, “The Innovator’s Prescription A Disruptive Solution to the Healthcare Crisis”

9. The Three Pillars of “Real” Access to Care Access to Insurance • Robust Benefit Package • Broad Array of Providers Quality of Services Cost Control

10. Access to Insurance? • ACA includes requirement for simplified enrollment in Medicaid, CHIP, and the Exchanges • Creates a “one-stop shop”… But… • Data from Mass. suggests potential for continued lack of insurance among eligible participants: • Half of focus group participants with MH/SUD conditions disenrolled from health insurance in past year • According to CEOs of MH/SUD treatment programs, 20-30% of patients seeking acute services are uninsured (in a state where 97% of population as a whole is insured)

11. Reaching the “Eligible but Unenrolled” • Navigator support at key locations for the most vulnerable populations • Outreach and enrollment efforts that target these populations • Clear, concise, simple instructions disseminated through multiple forms of media • Presumptive eligibility for acute and emergency episodes for those previously enrolled • Exempt children, chronic or long term illness diagnoses, from disenrollment consequence of random verification checks

12. Broad Array of Providers? Do you meet the definition of an Essential Community Provider? “A QHP issuer must ensure that the provider network of each of its QHPs, as available to all enrollees, meets the following standards – • Includes essential community providers in accordance with §156.235; • Maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services [emphasis added], to assure that all services will be accessible without unreasonable delay…” Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers Final Rule, http://www.ofr.gov/OFRUpload/OFRData/2012-06125_PI.pdf

13. Robust Benefit Package? • Essential benefits include mental health and substance use treatment (applies to Exchanges & individuals newly enrolled in Medicaid) • MH and SUD must be offered at parity with medical/surgical benefits This means… • …Most members of the safety net will have coverage, including mental health and substance use disorders

14. A Population Health Approach • Move from a focus on providing services to a single individual… to measurably improving outcomes for the populations in our communities • Key strategies/elements: • Prevention • Care management • Partnerships with primary care providers and others in the healthcare system • Data collection & continuous quality improvement • Clinical accountability

15. Does your organization use an Electronic Health Record?

16. Useful Resources • Kaiser Family Foundation, 2012 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies http://www.kff.org/medicaid/Briefing-2012-Data-50-State-Survey-Medicaid.cfm • Enroll American - An Enrollment Checklist for 2012http://files.www.enrollamerica.org/best-practices-institute/publications-and-resources/2012/2012_Enrollment_Checklist.pdf • Kaiser Family Foundation, State Action Toward Creating Health Insurance Exchangeshttp://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17&source=FS

17. Dedicated to promoting the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.

19. Questions? • Mohini VenkateshSenior Director, Public PolicyMohiniV@thenationalcouncil.org • Website: www.thenationalcouncil.org