2013 iAWARDS: Innovation, integration, implementation

By Kim Johnson, Deputy Director, NIATx

The 2013 NIATx Summit and SAAS National Conference is fast approaching: July 14-16 in San Diego. Again this year, with funding from SAMHSA, we’re recognizing several organizations with the Innovation in Behavioral Healthcare Services Award, otherwise known as the iAWARD. The two winning organizations have been selected, from a very competitive pool. Four others were selected as Honorable Mentions. Each of the six embodies this year’s conference theme: “Innovation, integration, implementation: the business of behavioral healthcare.”

Winning organization Drug Abuse Comprehensive Coordinating Office (DACCO) of Tampa, Florida focused on the community’s growing problem of opioid dependence among pregnant women. The Comprehensive Coordinated Care program it developed in collaboration with the nearby University of Florida College of Medicine integrated substance abuse treatment with primary care, promoted implementation of evidence-based practices such as medication-assisted treatment, and improved care for pregnant women and their newborns.

Technology plays a key role in health care innovation—as the iAWARD winner Holy Cross Hospital of Taos, New Mexico demonstrates. Holy Cross partnered with local primary and specialty care providers to reduce high-utilization of its ER by people with co-occurring disorders. The hospital’s information technology developed an automatic email that alerts social worker whenever patients from this high need population appear in the ER. Improved communication allows a social worker to connect patients to treatment and other resources before they leave the ER.

Four other organizations were selected for 2013 iAWARD Honorable Mentions:

·  The Zucker Hillside Hospital, Queens, New York

·  Kentucky River Community Care Inc., Hazard, Kentucky 

·  McLeod Addictive Disease Center, Charlotte, North Carolina

·  Christus St. Vincent Regional Medical Center, Santa Fe, New Mexico

All will present their innovations during a special session at the Summit. We hope you’ll join us in San Diego to recognize them, spend a few days with us, share new ideas on innovation, integration, and implementation, and connect with your colleagues from across the country.

See you in San Diego?   

Healthcare reform: Implications for organizational systems

By Todd Molfenter, NIATx Deputy Director

One of the goals of the Patient Protection and Affordable Care Act (ACA) is to lower the cost and improve the quality of care for everyone. Behavioral healthcare providers may be uncertain about the future of the legislation and what impact it will have. But the national trend toward fee-for-service and managed care—which also aims to lower the costs and improve quality of care—is requiring behavioral healthcare leaders to develop the same competencies they’ll need to be fully prepared for the changes anticipated with healthcare reform. 

These competencies include understanding and implementing health information technology (HIT), especially electronic health records (EHR) to improve quality, contain costs, and give patients greater control of their personal health.

Integration with primary care, another component of the ACA, is already happening, as behavioral health works to operate in conjunction with the broader health system.  In the HealthReform Readiness Index survey administered by NIATx, the percentage of behavioral health organizations that offer primary care increased from 6% to 15% from 2010 to 2012.

The movement toward managed care and fee-for-service reimbursement has been accompanied by changes in state funding. Behavioral healthcare providers are learning to expand their payer mix and their business skills, developing new systems for billing, managing accounts receivables, and reducing claim denials. Providers will need to have these systems firmly in place to accommodate both the Medicaid expansion anticipated with ACA and the Health Insurance Exchanges that will emerge—the new competitive markets that will allow consumers to purchase affordable private insurance plans.

·      Enrollment: Changes in state funding are requiring providers to help their patients determine their eligibility for public or private insurance coverage.  Efficient enrollment systems will also be essential with Medicaid expansion and HIEs.   

·      Workforce development: Today’s changes in funding and reimbursement are also driving the need for a workforce with the credentials and clinical competence that payers require.

·      Using outcomes to influence clinical decision-making: State governments and managed care increasingly require documentation that demonstrates quality indicators are being tracked and  a plan to continuously improve performance.

Whether or not the ACA is fully implemented as designed, behavioral health care providers who are working on these areas are setting themselves up for success in a funding environment that’s changing rapidly.

If you haven’t yet embarked on making the transition to this new environment, or if you’re not sure where to begin, take a look the HealthReform Readiness Index (HRRI) that NIATx developed. It’s a quick (under 15 minutes) survey that will let you know immediately where you are on the readiness spectrum. You might find that you’re in the early stages in one area, but well on your way in another. The HRRI is just one of many tools that you can use to help plan how to adapt your organization’s systems to the transformation of the behavioral healthcare field.

Ready or Not, Here it Comes: Health Reform

Kim Johnson, Deputy Director, NIATx

With Election Day fast approaching, healthcare reform is a hot topic. Many believe the election results will determine the future of the Affordable Care Act, which is designed to extend health insurance coverage to more than 30 million Americans.  Yet regardless of who wins in November, behavioral healthcare providers need to adapt to changes that are already taking place and are not likely to be reversed.

The Mental Health Parity and Addiction Equity Act, passed in 2008, requires insurance plans that offer coverage for mental illness and substance use disorders provide those benefits at the same level as medical and surgical procedures. The Affordable Care Act will require all insurance plans to provide coverage for mental illness and substance abuse disorders. Both pieces of legislation present behavioral health providers with the option of billing third-party payers for the services they provide—for some new sources of revenue to replace rapidly shrinking state and federal grant funds. 

While some states oppose making changes required to prepare for the ACA, others are moving forward with Accountable Care Organizations and Health Insurance Exchanges. Treatment organizations need to stay on top of what’s happening in their states. Rather than “wait and see,” the best approach may be build capacity to bill for services, because no matter who gets elected, grant funds are not likely to increase.

States across the country have slashed funding, and we can’t assume that the federal block grants for mental health and substance abuse treatment are going to continue at their current level, especially with the “fiscal cliff” of tax increases and spending cuts looming ahead of us at the end of 2012 if Congress doesn’t act. It’s likely that we’ll see more cuts. Finding other sources of revenue will be even more crucial.  

Aside from healthcare reform, other forces are driving change in the addiction treatment field. The Partnership at Drugfree.org recently reported that visits to physicians for substance use disorders, primarily opioid abuse, increased by 70% between 2003 and 2009. With an increase in the awareness of addiction as a treatable disease, more people will seek treatment from their primary care providers. Specialty treatment programs need to consider partnering with these providers, or addiction treatment may go the way of depression treatment–with most people seeking medication, and counseling becoming an ancillary service.

The health reform ball has been rolling for some time now for behavioral health providers. What happens in November may slow it down or adjust its course, but not stop it.  Now’s the time to prepare.

Where are we with parity?

This month marks the anniversary of the Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law on October 3, 2008. Behavioral health care providers welcomed this legislation. It requires group health plans that cover mental illness and substance use disorders to provide those benefits at the same level as medical and surgical benefits.

While MHPAEA was intended to eliminate unequal coverage and inequities in access to behavioral health treatment, providers and their patients continue to face challenges in making sure the law is fully understood and implemented.

Patrick Gauthier, Director of AHP Healthcare Solutions, addressed these issues in a recent presentation for NIATx, “Parity & Equity Compliance Checker: Disputing the Decisions that Affect Your Bottom Line.”  

 “MHPAEA was and continues to be an important victory for all Americans,” said Gauthier. “It’s as much a civil rights success story as it is an insurance reform. Viewed in relation to the Affordable Care Act…MHPAEA is our gold standard for behavioral health benefits. We should all be actively involved in its implementation and enforcement. That work must happen at the state and community levels.”

The October 15 issue of Alcoholism and Drug Abuse Weekly discusses problems with parity implementation in the article “Some payers still defy parity law with ‘fail-first’ and reviews.”   Do you work with any health plans that fail to adhere to the federal parity law?  If so, what action have you taken in response?  

What makes a great conference?

The 2012 SAAS National Conference and NIATx Summit in New Orleans reminded me once again what makes a great conference: people, of course.

As always, the attendees at our conference helped make it great. Your dedication to the field and the clients you serve really energized the event. I’d like to thank you for attending and helping make this conference a success.

Other people helped make this a great conference, too. That includes the conference advisory committee, co-chairs, and members of the NIATx, SAAS, and Site Solutions Worldwide teams involved in the planning and execution of the conference: from choosing a location, to selecting and scheduling presenters and workshops, to producing the conference program, and just in general, taking care of the hundreds of details involved in hosting a national event.

In New Orleans, these teams and the Blue Crew once again came through with their characteristic flexibility, making quick adjustments behind the scenes when necessary-so if there was a glitch anywhere, you never knew it. This year's exhibitors presented another great array of products and services, and the staff at the New Orleans Marriott showed us the hospitality the city is famous for. And some pretty good food, too!

You can find the conference workshop and Deep Dive materials on the conference web page, along with details of next year’s event in San Diego, July 14-17. I hope to see you there!

Of course we want next year to be even better. So post a comment and let us know your thoughts. And again, thank you for attending.

Using a smartphone app to intervene before relapse into alcohol abuse: preliminary results

ACHESS is a mobile phone-based relapse-prevention system that offers support to alcohol dependent people when and wherever it is needed. Developed at the Center for Health Enhancement Systems Studies (CHESS), of which NIATx is a part, the ACHESS smart phone app is now being studied in a randomized clinical trial.

CHESS Researcher Andrew Isham presented some initial findings on the study at the 2011 Medicine 2.0 Congress last September. Click here to read a summary of his presentation.

Interested in using ACHESS? Click here for more information on using ACHESS through the CHESS Health Education Consortium.

Process Improvement and Technology

Process improvement increases efficiency, and so does technology. As NIATx Director Dave Gustafson pointed out in his January 23 blog post, communications technology is playing a bigger role in efforts to increase efficiency and serve customers better. Technology can help close the gap between the 20 million people in the United States who need treatment for a substance use disorder and the three to four million who actually receive it.

Kentucky River Community Care is one organization that is using both process improvement and technology to meet customer needs. This organization serves eight counties in eastern Kentucky, and was a grantee in the first NIATx initiative, Paths to Recovery. “Technology and process improvement go hand in hand in helping us adapt to the rapidly changing behavioral healthcare environment,” says KRCC Director Mike Kadish, who credits NIATx with helping his organization create a culture of change. Read more about KRCC’s innovations in the February 6, 2012, issue of Mental Health Weekly.