Recovery Services in the Era of Health Care Reform: Federal and State Perspectives

1. Recovery Services in the Era of Health Care Reform: Federal and State Perspectives Susan Brandau, Director, Bureau of Recovery SusanBrandau@oasas.ny.gov

2. “Behavioral Health”: SAMHSA • State of mental/emotional being and/or choices and actions that affect wellness; • Includes substance use, misuse, abuse, addiction; SPD; suicide, mental and substance use disorders; • Range of problems- unhealthy stress to diagnosable, chronic diseases (treatable and recovery-oriented) • Systems: emotional health promotion; prevention, treatment and recovery support

3. The Patient Protection & Affordable Care Act: Four Interlocking Strategies • Insurance Reform (parity) • Coverage Expansion (30 million; 1 million in NY) • Delivery System Redesign • Payment Reform (P4P; Value-based purchasing; episodes of care)

4. PCMHs; HHs; ACOsWhat Are They? • The Triple Aim: Better Health; Better Quality; Reduced Costs • Movement from a specialty-driven, FFS, volume-driven system to a primary care, managed system • Reconnect the mind and the body • Improve the overall health of the nation; the effectiveness of the care delivered; at reduced cost (right service at the right time at the right price)

5. Patient-Centered Medical Home The center of the health care delivery system reform: • Integrates pts. as active participants • Personal physician team leader (not the MD’s team– the patient’s team) • Coordinates all aspects of preventive, acute and chronic care • Whole person-oriented care • Pt. satisfaction & experience of care • Quality of care/metrics • Payment reform (incentivizing PCPs) • Integrated Clinical Information Systems (HIT) • https://inetshop01.pub.ncqa.org/publications/product.asp?dept_id=2&pf_id=30004-301-11.

6. Health Homes • Target: one chronic health condition and at least at risk for another (SMI exception) • A longitudinal home; inter-disciplinary array of medical, behavioral health care and community-based social services • 90% FMAP for HH services for two years • 12 states approved SPAs by CMS • 5 states include SMI eligibility • 3 states include SUD eligibility (plus one other chronic condition; NY; OR;MO) • http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/meetings_webinars.htm

7. HH Services Networks provide: • Comprehensive care management • Coordination and Health Promotion • Transitional Care • Referral to social services and community supports • Use of HIT

8. Health and Recovery Plans (HARPs) • Premiums include all MA State Plan services. • Specialized, integrated MC product for individuals with significant BH needs • Enhanced benefit package of medical, behavioral and social benefits • Enhanced access and care coordination standards • RFI—October/November; Final RFQ– Feb. 2014; NYC HARP—Jan. 2015; ROS HARP– July 2015 • Statewide 140,000 HARP eligible; ~37,000 SUD • Eligibility initially based on UR

9. Behavioral Health Organizations (BHOs) in New York • 2011: Introduced managed care operations to MA FFS IP settings (but eventually all BH care settings) • Originally: no UR; no pre-admission review • Discharge planning; concurrent review; provider profiling • 2014: risk-bearing for all BH services

10. 1915(i) Like Services • Part of the 1115 SPA– final submission to CMS in December • Rehabilitation & Habilitation • Crisis Intervention • Educational Support • Support Services • CM; Fam Support.; Training for Unpaid Caregivers; Non-Medical Transportation • Employment Services • Peer Support • Self-Directed Services • Eligibility based on Functional Needs Assessment

11. SUD 1915(i) Like Peer Services (perhaps) MH Administered by trained individual Personal experience of a MH dx. Assist in the recovery process Psychosocial clubs For individuals engaged or not engaged in treatment? Administered by a trained (certified?) individual personal experience of SUD dx. Recovery coaches? Recovery center settings? For individuals not engaged in treatment

12. Peer Services (APGs) • Face- to- face service provided by a peer advocate to an active patient of an outpatient clinic. Peer support services are clinic-based services for the purpose of connecting patients to community based recovery supports consistent with the treatment / recovery plan. • Under rehab option, peer services can be delivered off-site for those in treatment.

13. What Does It All Mean For BH Providers? • Threats and Opportunities • PCMH Opportunity: Outstationing a BH specialist for SBI; the RT function • New business lines • Care management/case management • Behavioral interventions: adherence • SBIRT • Integrated BH and PC services • Peer-based Services • MAT • Clinical & Fiscal Accountability • Performance on Medical as well as Behavioral Metrics • Supervision • EBPs • Risk Sharing? • Mergers and Consolidations • Digital World • HIT Infrastructure

14. ATR as a Prototype for Recovery Support Services • Four year, $13 million CSAT grant • Brooklyn, Rochester, Delaware/Otsego • Co-location with RCCs • Recent expansion: Bronx, Queens, Manhattan • 7,000 participants served to date • Monthly recovery care mgt + access to recovery supports

15. Bringing Recovery Supports to Scale (BRSS) Policy Academy • OASAS, OMH, DOH, Peers, MH & SUD Providers, Managed Care , Housing Providers • Focus: Peer Integration • Four Community Forums • Peer Leadership Training • Mini-grants: Community and Provider

16. Peer Certification • Florida Certification Board • ASAP + FOR-NY • Role Delineation Study-Core Competencies and Skills • January, 2014 • Deeming of Recovery Coaches

17. Peer Integration • Building capacity now to integrate peers • Fixsen’s Implementation Stages: Exploration Activities • Engagement and Retention Challenges • Culture Changes • Job Descriptions and Pay Scales • Supervision & Monitoring • Value of Alumni Associations

18. Client/Participant Surveys • Essential Component of Health Reform • How do we know those we serve are getting what they want and need? • Routine surveys-perception of care linked to CQI • https://www.oasas.ny.gov/poc/index.cfm

19. OASAS’ Adaptation of the SAHMSA-sponsored Modular Survey • 5 Domains : Rating Scales • A. Access and Quality (7 items) • B. Perceived Outcome (6 items) • C. Social Connectedness (7 items) • D. Readiness for Change (2 items) • E. Program Recommendation (2 items) • Open-ended Items (write-ins) • What is the program doing right? • What can be done to improve the program? • Is there anything that annoys you?

20. Content of Survey (Continued) • Best Practices • Patient / Client Rights • Nicotine Replacement Therapy • Medication Supported Recovery • Other Items • Time in Program (months) • Age, Gender, Ethnicity / Race • Presenting Problem (SA, MH, or both) • Prior Treatment • Criminal Justice Mandate • Employment / School Enrollment Status

21. A: Access and Quality 1. When I needed services right away, I was able to see someone as soon as I wanted. 2. This program helped me develop a plan for when I feel stressed, anxious or unsafe 3. The people I went to for services spent enough time with me. 4. I helped to develop my service/treatment goals. 5. The people I went to for services were sensitive to my cultural background (race, religion, language, sexual orientation). 6. I was given information about different services that were available to me. 7. I was given enough information to effectively handle my problems.

22. B: Perceived Outcome As a result of the services (treatment) I have received ... 8. I am less bothered by my symptoms 9. I am better able to cope when things go wrong. 10. I am better able to accomplish the things I want to do. 11. I am not likely to use alcohol and/or other drugs. 12. I am doing better at work/school. (If this does not apply to you, please leave it blank.) 13. I get along with my teachers/boss. (If this does not apply to you, please leave it blank.)

23. C: Social Connectedness 14. There is someone who cares about whether I am doing better. 15. I have someone who will help when I have a problem. 16. I have people in my life who are a positive influence. 17. The people I care about are supportive of my recovery. 18. People count on me to help them when they have a problem. 19. I have friends who are clean and sober. 20. I have someone who will listen to me when I need to talk.

24. D: Readiness for Change • Using alcohol and/or drugs is a problem for me. • I need to work on my problems with alcohol and/or drugs.

25. E: Program Recommendation (Satisfaction) • I would return to this program if I need help in the future • 24. I would recommend this program to a friend or family member.

26. Survey Reports • The Survey System will compile a report based on the most current data; and includes the date on which the report was generated • Reports can be generated at any time during or after data collection • It is important to assure that interim reports do not get confused with reports after data collection is complete. • The report provides tabulations and graphics for each survey item • Refer to the PoCUser Guide section “Interpreting Reports” for examples of reports and tabulations

27. Interpreting Reports

28. Interpreting Reports

29. Acknowledgement • Frank McCorry-graciously allowed some of his slides to be shared-thank you Frank!