Integration Forum Workforce Committee

Transcription

1 Integration Forum Workforce Committee May 27, 2016 Phone: Access Code: Chairs: Yumi Jarris (Georgetown University School of Medicine) Randy Wykoff (East Tennessee State University)

2 Meeting Agenda: 2:00 pm Welcome Yumi Jarris and Randy Wykoff 2:05 pm Behavioral Health Integration Chris Carroll, Director of Health Care Financing and Systems Integration, Substance Abuse and Mental Health Services Administration (SAMHSA). Alex Ross Sc.D., Senior Behavioral Health Advisor, Office of Planning, Evaluation and Analysis, Health Resources and Services Administration (HRSA) 2:35 pm Q & A /Discussion 2:50 pm Committee Member Updates 2:55 pm Workforce Committee Next Steps Yumi Jarris Next Workforce Call will be Friday, July 29, 2016 from 1-2 ET The next All Partners call is June 9, 2016 from 3-4 pm ET 3:00 pm Adjourn

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4 Agenda REALLY High Level Stuff Importance of Collaboration Two-pronged Approach Macro Micro Meeting in the Middle

5 Leading Change Six Strategic Initiatives Leading Change 2.0: Advancing the Behavioral Health of the Nation To increase awareness and understanding about mental and substance use disorders, promote emotional health and wellness, prevent substance abuse and mental illness, increase access to effective treatment, and support recovery

6 Main Mechanism Health Care and Health System Integration Strategic Initiative Foster integration between behavioral health and prevention, health care, and social supports behavioral health is essential to health Develop and implement new provisions under Medicaid and Medicare to assure treatment available, provide and evidence-based Influence and support efficient use of financing models and mechanisms to address behavioral health behavioral health treatment, services, and activities Finalize and implement parity provisions in MHPAEA & ACA, disseminate information Implementation of quality indicators to advance behavioral health outcomes NBHQF; Delivery System Reform, Section 223

7 Federal Behavioral Health Spending in Billions of Dollars by Category, FY 2015

8 U.S. Department of Health and Human Services Behavioral Health Spending in Millions of Dollars by Agency, FY 2015

9 Remaining Balance of Federal Investments The SSA s budget of $87.2 billion is the largest, representing 51.9% of the federal budget for mental health

10 System Costs 10

11 System Costs 11

12 Increasing Costs 12 Boyd, C., Clark, R., Leff, B., Richards, T., Weiss, C., Wolff, J. (2011, August). Clarifying Multimorbidity for Medicaid Programs to Improve Targeting and Delivering Clinical Services. Presented to SAMHSA, Rockville, MD.

13 Impacts on Physical Health 13 MH problems increase risk for physical health problems & SUDs increase risk for chronic disease, sexually transmitted diseases, HIV/AIDS, and mental illness Cost of treating common diseases is higher when a patient has untreated BH problems, mostly preventable or treatable 24 percent of pediatric primary care office visits and ¼ of all adult stays in community hospitals involve M/SUDs M/SUDs rank among top 5 diagnoses associated with 30-day readmission, accounting for about one in five of all Medicaid readmissions (12.4 percent for MD and 9.3 percent for SUD) Half of Americans will experience M/SUD; half know someone in recovery from SUD Individual Costs of Diabetes Treatment for Patients Per Year $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 With behavioral health problems and diabetes With diabetes alone

14 Federal Initiatives and Efforts to Support Integration (Macro Level Focus) OASH: Co-morbidity working group SAMHSA S Primary/Behavioral Health Integration (PBHCI): Physical health of adults w/ SMI and technical assistance for bi-directional integration (Center for Integrated Health Solutions, w/ HRSA) Primary Care/Addiction Services Integration (PCASI): Proposed (no traction) HRSA FQHCs: Integrating behavioral health screening, brief intervention, and treatment into primary care settings Million Hearts: Wrapping behavioral health into efforts to address ABCS AHRQ Center for Integration Models: Developing models of integrated behavioral health care in primary care settings CMMI Innovative Financing Models for Integration: Grants to test models using SAMHSA and AHRQ indicators and technical assistance Medicare Accountable Care Organizations (ACOs): Payment for integrated care & outcomes (ASPE tracking impacts for behavioral health) 14

15 Selected SAMHSA and Federal Partner Collaborations (Macro Level Focus) 15 Informational Bulletins: Medication Assisted Treatment (MAT); coverage/service design of BH services for youth with serious emotional disturbance (SED); trauma-focused services; prevention and early identification of mental health and substance use conditions; and strengthening management of psychotropic medications for vulnerable populations; others in process Ongoing Interactions: Payment rules; waiver consultation; state plan amendments; regulation review; quality measures; same day billing guidance; and parity Section 223 of the Protecting Access to Medicare Act of 2014: SAMHSA developed criteria for Certified Community Behavioral Health Clinics (CCBHCs) and managing state planning grants; CMS developed prospective payment system; ASPE to evaluate outcomes SAMHSA/HRSA Center for Integrated Health Solutions

16 Service Models, Payment Structures, and Demos to Achieve Better Care and Value (Macro Level Focus) State Innovation Models: Support for development and testing of state-based models for multi-payer payment and health care delivery system transformation Health Homes (Section 2703): Whole person care for Medicaid recipients w/specific characteristics or conditions (50 SAMHSA consultations with 25+ states) Accountable Care Organizations: Coordinating high quality care for Medicare recipients, including behavioral health care Duals Demo: Ensuring Medicare-Medicaid enrollees have full access to seamless, high quality health care that is cost effective Transforming Clinical Practice Initiative: designed to help clinicians achieve largescale health transformation through sharing, adapting and further developing their comprehensive quality improvement strategies. Medicaid Innovation Accelerator Program: Focusing on payment and service delivery reforms to improve health and quality of care for Medicaid beneficiaries; Priority Area SUDs 16

17 Cost of Care Post ACA 17 M/SUD and All-Health Medicaid and Private Insurance Spending M/SUD and All-Health Out-of-Pocket and Medicare Spending

18 SAMHSA Initiatives and Efforts to Support Integration (Micro Level Focus) Assisting providers of care with the tools they need to ensure that key services are available and sustainable Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies Financing Care Transitions for Individuals at Risk for Suicide Telemental Health Guide for Financing Strategies (pending)

19 SAMHSA Initiatives and Efforts to Support Integration (Micro Level Focus) Analyzing specific issues within service provision, coding, and reimbursement Bundled Screening for Behavioral Health in Primary Care Settings CPT Coding Analysis E&M + Psychotherapy Same Day Billing Insurance Assignment rates Changes to PFS Care Coordination Chronic Care Management

20 Delivery Systems Reform { Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system. } FOCUS AREAS Pay Providers Deliver Care Distribute Information

21 Source: Burwell SM. Setting Value-Based Payment Goals HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published online first. A health system that provides better care, spends dollars more wisely, and has healthier people Focus Areas INCENTIVES Description Promote value-based payment systems Test new alternative payment models Increase linkage of Medicaid, Medicare FFS, and other payments to value Bring proven payment models to scale Align quality measures CARE DELIVERY Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access INFORMATION Bring electronic health information to the point of care for meaningful use Create transparency on cost and quality information Support consumer and clinician decision making

22 Delivery System Reform (Incentives) Incentives: Improve the ways providers are paid, now looking to reward value and care coordination rather than volume and care duplication Pay providers for what works, whether something as complex as preventing or treating disease, or something as straightforward as making sure patients have more than one way to communicate w/ the team of clinicians taking care of them o Example: New Medicare payment goals to drive quality and value; many new payment models being testing at the CMS Innovation Center (such as NextGen Accountable Care Organizations) o BH Example: Section 223 Demonstration Improving Quality of Community Behavioral Health Services

23 Section 223 Elements o Criteria for CCBHCs (SAMHSA) o Prospective Payment System (PPS) to pay costs + quality incentive (CMS) o Evaluation to see what difference it makes (ASPE) Timelines/Process o Planning grant RFA issued May 2015 o Planning grant states awarded October 2015 o Demonstration states selected Dec 2017 o Annual Report to Congress re outcomes and recommendations Dec 2018

24 High Powered Budget Incentives Consolidates funding across service lines; moves accountability towards population focus Can reward integration of primary care and specialty behavioral health care Can favor prevention and early intervention approaches Especially for clinical preventive services Challenges Business case relies on savings subject to meeting quality thresholds Behavioral health quality measures are underdeveloped

25 High Powered Levers Making care easier Incentive through reimbursement Workforce attractiveness Measure quality Paying for what works

26 Increasing Access to Behavioral Health Services Improving health and health equity through access to quality services, a skilled health workforce and innovative programs ASTHO Integration Forum Workforce Committee Call May 27, 2016

27 27 Agency Objectives Increase Access to Quality Health Care and Services Strengthen the Health Workforce Build Healthy Communities Improve Health Equity Strengthen Program Operations

28 28 Overview HRSA s National Presence Behavioral Health Services Health Center Program National Health Service Corps Workforce Training and Education HIV/AIDS Maternal and Child Health Federal Office of Rural Health Policy Resources SAMHSA/HRSA Center for Integrated Health Solutions

29 29 HRSA National Activities Nearly 23 million patients are served in 1,300 HRSA-funded health centers and 9,200 health care delivery sites Over 500,000 people living with HIV/AIDS receive services through more than 900 HRSAfunded Ryan White Clinics. Two-thirds are members of minority groups. 34 million women, infants, children, and adolescents benefit from HRSA s maternal and child health programs. 9,200 National Health Service Corps clinicians are working in underserved areas in exchange for loan repayment or scholarships.

30 30 Health Center Behavioral Health Services Almost 69% of health centers provide mental health treatment or counseling services on-site. 36% of health centers provide substance abuse counseling and treatment on-site. In 2014, there were over 13 million mental health visits and over 4 million visits for substance abuse services. More than 7,200 behavioral health providers (physicians, psychologists, LCSW, counselors, etc.) work in health centers (2014). (Data Source: UDS 2014)

31 31 Health Center Behavioral Health Expansion Behavioral Health Services Expansion Grants: Awards made in July and November 2014 Nationally: $105.9 million awarded to 431 health centers Substance Abuse Services Expansion Grants: $94 million to fund 271 awards Maximum of $325,000 per award Awards were made March 1, 2016

32 32 National Health Service Corps Recruits healthcare professionals to provide services to underserved populations, including: Psychiatrists, Psychiatric Physician Assistants, Psychiatric Nurse Practitioners, Health Service Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, and Psychiatric Nurse Specialists. Loan repayment and scholarship programs available. 87% of NHSC clinicians continue to practice in underserved areas up to two years after their service commitment. One-third in behavioral health fields (3,371 out of nearly 9,683 as of 9/2015).

33 33 Health Professions Training and Education Medicine/Nursing/Behavioral Health/Public Health; Behavioral Health Focus: Graduate Psychology Education Grant/Behavioral Health Workforce Education and Training Programs Including internships/field placements to strengthen the clinical field competencies of social workers and psychologists who pursue clinical service with high need/high demand population. Separate grant program training community health workers and peer counselors. Area Health Education Centers continuing education; National Center for Workforce Analysis-Behavioral Health Workforce Analysis Center - provides modeling, and data collection to project current and future workforce demands.

34 34 HIV/AIDS Mental Health Services were provided by approximately 75% of Ryan White HIV/AIDS provider organizations (CY 2014). Substance Abuse Services were provided by approximately 34% of Ryan White HIV/AIDS provider organizations (CY 2014). Medication Assisted Treatment JAIDS, 2011, vol: 56:S98; Integrating Mental Health and Substance Abuse Care into HIV Primary Care Toolkit (AETC National Resource Center); Special Projects of National Significance Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations ( ); AIDS Education and Training Centers (AETCs) - Integrating Care through the Use of Screening and Brief Intervention in HIV Settings - Pacific AETC.

35 35 Rural Health Rural Health Care Services Outreach Grant Program Supports innovative health care delivery systems in rural communities via a consortia model; 22 outreach grantee focused on mental health and/or substance abuse (FY 2013). Publications on behavioral health and substance use in rural America, including: Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices; Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers ( Rural-Urban Chartbook (2014) (numerous health indicators and outcomes, including prevalence of mental illness, substance abuse treatment) Rosenblatt, RA et. al. Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder. (Annals Fam Med. January/February Vol 13, No.1 : 23-27)

36 36 Rural Opioid Overdose Reversal Grant Program Funded by the HRSA Federal Office of Rural Health Policy in September 2015; To reduce opioid overdose related morbidity and mortality in rural communities one year grants to develop community-level partnerships EMS, schools, fire departments, police departments, and other private /public non-profit entities involved in the prevention and treatment of opioid overdoses Nationally: Awarded $1.8 million to 18 grants.

37 Ten Regions One HRSA To improve health equity in underserved communities through onthe-ground outreach, education, technical assistance and partnering with local, state and federal organizations.

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39 SAMHSA/HRSA Center for Integrated Health Solutions Mission of the Center To Build Bidirectional Integration Technical Assistance and Training Center on Primary and Behavioral Health Integration: Integrated Care Models Workforce Financing Clinical Practice Operations & Administration Health & Wellness Improving Access to Primary Care for Behavioral Health Patients & Access to Behavioral Health for Primary Care Patients. Contractor - National Council on Community Behavioral Health Care and a large cadre of partners.

40 SAMHSA/HRSA Center for Integrated Health Solutions Use the Quick Start Guide to Behavioral Health Integration to walk you through some of the questions to consider when integrating primary care and behavioral health and find the resources your organization needs. Use the Standard Framework for Levels of Integrated Healthcare to understand where your organization is on the integration continuum. The Core Competencies for Integrated Behavioral Health and Primary Care provide a reference for the vision of an integrated workforce and the six categories of workforce development so you can have all the necessary providers around the table.

41 SAMHSA/HRSA Center for Integrated Health Solutions Telebehavioral Health Learning Collaborative Divided into six sessions, the training will provide you with the tools and resources necessary to identify and implement a telebehavioral health program. What Makes for an Effective Behavioral Health/Primary Care Team Reviews team development within effective integrated primary and behavioral healthcare teams. The full review identifies four essential elements for effective integrated behavioral health and primary care teams and provides a roadmap for organizations designing their own teams

42 42 SAMHSA/HRSA Center for Integrated Health Solutions Billing/Coding Worksheets CIHS compiled these state billing worksheets to help clinic managers, integrated care project directors, and billing/coding staff bill for services related to integrated primary and behavioral health care. Advancing Behavioral Health Integration Within NCQA Recognized Patient-Centered Medical Homes. Return on Investment Can I Afford Behavioral Health Staff? Addresses the business case for integration of behavioral health into primary care and provides guidance on how to evaluate this business case at an individual Community Health Center. [Find all resources at:

43 CIHS Webinar Billing Effectively (and Accurately) for Integrated Behavioral Health Services Identify billing options for integrated behavioral health services. Ask questions to identify if Medicaid and Medicare numbers are appropriately linked to the mental health services provided. Employ tips for working with clinical and billing staff at the same time. Register for free at: Monday, June 6, 2:00 p.m. Eastern 43

44 44 Resources The website for public UDS data is :

45 45 For More Information Contact: Alexander F. Ross, Sc.D. Office of Planning, Analysis and Evaluation Health Resources and Services Administration U.S. Department of Health and Human Services

46 Next Steps and Announcements: Next Workforce Call will be Friday, July 29, 2016, 1-2 ET The next All Partners call is June 9, 2016 from 3-4 pm ET

47 Thank You! Questions or Ideas?