Health Care Reform Primary Care and Behavioral Health Integration John O’Brien

2. Health Care Reform Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA

3. Affordable Care Act Major Drivers More people will have insurance coverage Medicaid will play a bigger role in MH/SUD than ever before Focus on primary care and coordination with specialty care Major emphasis on home and community based services and less reliance on institutional care Preventing diseases and promoting wellness is a huge theme

4. Person Served by SSAs/SMHAs 12 M visits annually to ERs by people with MH/SUD Individuals with schizophrenia have one of the highest rates of smoking (58%–88%) Cardiovascular mortality was 6.6 times higher among SMI clients than the general population 70% of SMI had at least 1 chronic health conditions, 45% have 2, and almost 30% have 3 or more.

5. Primary Care And Coordination Individuals with SMI die on average at the age of 53 years old Barriers include stigma, lack of cross-discipline training, and access to primary care services Have elevated (and often undiagnosed) rates of: hypertension, diabetes, obesity cardiovascular disease Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers

6. Primary Care And Coordination Readmissions 20% of Medicare patients are readmitted within 30 days after a hospital discharge Lack of coordination in “handoffs” from hospital is a particular problem More than half of these readmitted patients have not seen their physician between discharge and readmission

7. Affordable Care Act Opportunities Grants for mental Illness with co-occurring primary care conditions (SAMHSA) Health Homes (CMS and SAMHSA) Prevention Trust Fund and Primary care and Behavioral Health Integration (SAMHSA) Community health teams (CMS/Medicare)

8. SAMHSA Grant Program To improve the physical health status of people with serious mental illnesses (SMI) by supporting community-based efforts to coordinate and integrate primary health care with mental health services in community-based behavioral health care settings

9. SAMHSA Grant Program To better coordinate and integrate primary and behavioral health care resulting in: improved access to primary care services improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease increased availability of integrated, holistic care for physical and behavioral disorders better overall health status of clients

10. SAMHSA Grant Program FY 2010 $28 million to help 56 community behavioral health agencies $5.3 million national resource center (co-funded by SAMHSA/HRSA/HHS)

11. Facilitate screening and referral for primary care prevention and treatment needs Provide and/or ensure that primary care screening/assessment/ treatment and referral be provided in a community-based behavioral health agency Develop a registry/tracking system for all primary care needs and outcomes Offer prevention and wellness support services (>10% of grant funding) Build processes for referral and follow-up for needed treatments that are not appropriately provided in a primary care setting PBHCI: Services Delivery 11

12. Baseline Descriptive Information Personal/family history of: diabetes, hypertension, cardiovascular disease; substance use; tobacco use Medication history/current medication list, with dosages Social supports Health Outcome Indicators (by individual) Weight/Height/Body Mass Index Blood pressure Blood glucose or HbAiC Lipid profile PBHCI: Data Collection and Performance Outcomes (<20% of grant funds) 12

13. PBHCI: Data Collection and Performance Outcomes (<20% of grant funds) Services Outcome Indicators • The number of mental health consumers receiving primary care services • The number of mental health consumers screened for: • hypertension; • obesity; • diabetes; • co-occurring substance use disorders; and • Tobacco product use

14. Training and Technical Assistance Center In partnership with HHS/Health Resources and Services Administration Purpose to serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development provide technical assistance to PBHCI grantees and entities funded through HRSA

15. Training and Technical Assistance Center (TTA) TTA will: Increase the number of individuals trained in specific behavioral health related practices; Increase the number of organizations using integrated health care service delivery approaches; Increase the number of consumers credentialed to provide behavioral health related practices; Increase the number of model curriculums developed for bidirectional primary and behavioral health integrated practice; and, Increase the number of health providers trained in the concepts of wellness and behavioral health recovery.

16. Health Homes Section 2703 Enhanced integration of primary and specialty care for individuals with: At least two chronic conditions One chronic condition and be at risk for another, or Serious and persistent mental illness Chronic conditions include: mental health condition, substance use disorder, asthma, diabetes, heart disease, and being overweight, BMI < 25.

17. Health Homes Health homes (several new services): Comprehensive Care Management Care Coordination and Health Promotion Patient and Family Support Comprehensive Transitional Care Referral to Community and Social Support Services Timing States can submit plans for effective dates as early as 1/2011

18. More Information: http://www.samhsa.gov