A National Standard for Assessment/Placement

A National Standard for Assessment/Placement

THE ASAM CRITERIA SOFTWARETM

American Society of Addiction Medicine44th Annual Medical-Scientific Conference:

April 26, 2013, Chicago, Illinois

ASAM Disclosure of Relevant Financial Relationships

Content of Activity: ASAM Medical –Scientific

Conference 2013Name Commercial

InterestsRelevant Financial

Relationships: What Was Received

Relevant Financial

Relationships: For What Role

No Relevant Financial

Relationships with Any

Commercial Interests

David Gastfriend Alkermes, IncRecoverySearch, Inc

Salary, Stock, OptionsRoyalties

Company Officer

Company Officer

Rodney Conrad FEi Systems, Inc Salary Company Officer

Paul Earley Earley Consultancy LLCAlkermes, Inc

Consulting Fees

Honoraria

Software ConsultantSpeaker

A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE

AGENDA Rationale & background for a new standard

of assessment & treatment planning Dr Gastfriend - 15 min

Hands-on experience at the computer Mr Conrad & Dr Earley - 45 min

Interactive discussion Drs Gastfriend & Earley & Mr Conrad - 25 min

ASAM’s plans: Dr Gastfriend - 10 min Participants’ reaction: All - 25 min

Rationale & background for a new standard of assessment and treatment planning ASAM’s Goals HBS’s Report Recommendations SAMHSA’s Open Behavioral Health Information

Technology Architecture Project

A National Standard for Assessment/Placement: THE OPEN-SOURCE ASAM CRITERIA SOFTWARE

Stakeholders in an Information Technology Revolution

Client

Counselor

Supervisor

SystemManaged Care

Employer/Payer

Researcher

Accreditation Body, Government

Society

• National Treatment Center Study - 450 programs (U. of GA)• >70% of respondents using ASAM Criteria by 1996• For-profits: 54% less likely to adopt (p=.02)• Single-level programs: 34% - 42% less likely than multi-levels (p<.01)• Dual diagnosis capable programs: 3.4 times more likely to adopt (p ≤.01)• Programs closing within 24 mos. were less likely to be ASAM adopters in 1996 (p<.05) • Programs closing within 6 mos. – even lower baseline adoption

Corbel (Body)

HARVARD | BUSINESS | SCHOOL

Providers Jerome Rhodes, President, Recovery Division, CRC Health Group Nancy Paull MS, CEO, SSTAR of MA and RI Ron Jackson MSW, Director, Evergreen Treatment Services, Seattle WA

Payers Hyong Un MD, Chief Psychiatric Officer and Head of EAP, Aetna Gary Henschen MD, Chief Medical Officer-Behavioral Health, Magellan David Pating MD, Chief, Addiction Medicine, Kaiser Permanente SF Med Ctr Tom Trabin PhD, Assoc Dir, Adult Care, Alameda County Behavioral Health, CA

Government/Non-Profit Mady Chalk PhD, Dir, Center for Performance-Based Policy, TRI-U of PA Daniel Kivlahan PhD, V.A. Assoc Nat’l MH Program Dir for Addictive Disorders Andrew Saxon MD, Psychiatrist, VA Puget Sound Eric Goplerud PhD, Research Professor, Geo Washington U/NORC Carol McDaid, Principal, Capitol Decisions, Washington DC Douglas Marlowe JD, PhD, Sr Investigator, TRI-U of PA; NADCP Science

Advisor Software Developers

Skip McGaughey, Executive Director, Open Health Tools Simon Budman PhD, CEO, Inflexxion Ken Tubman, CEO, Claricode

Harvard Business School: Experts Contacted


Operates 145 clinics treating 30,000 people Largest behavioral health provider in U.S. Devotes significant resources to payer approval Each center has 3-5 FTEs dedicated to UR ~20% of cases are contested by payers ~30% of MD time is lost interacting w/payers If this administrative time is reduced only slightly,

the PPC software could yield substantial savings. Also, CRC recognizes the benefits

that increased reliance on health IT could provide.

Case Study: CRC Health


Leading concerns:◦ Cost 73% ◦ Time 48%

35% indicated that MDs earning $110,000 or more are conducting assessments; 46% indicated that the assessments take 60-90 min

Significant value if ASAM’s eCriteria can save time with payers: 31% are waiting ≥half a day for insurance authorizations

Treatment centers would find ASAM’s eCriteria a +value proposition if:◦ It improves treatment outcomes – 80%◦ It improves and standardizes assessments – 72%◦ It reduces time spent negotiating with insurance companies – 66%◦ It provides certification as “ASAM compliant” (42%) or CEU credits

(39%)

ASAM Members’ Survey Results (N=95)


For Patients◦ Improves Patient Outcomes

For Payers◦ Improved Patient Outcomes > Lower Long-Term Costs◦ Standardizes approval process◦ IT can facilitate/automate approval process◦ Decreases expensive & unnecessary overtreatment◦ Improves inter-rater reliability

For Providers◦ Facilitates reimbursement process through

fewer disputes, decreased administrative burden, and faster turnaround on payment

◦ Provides training to new counselors◦ Generates sophisticated reports & analyses

PPC Software Value Proposition


Effective, reliable treatment planning requires that both be used together

The ASAM Criteria Software undergoing nationwide release by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)

The ASAM Criteria text is synchronized with the ASAM Criteria Software, such that definitions & specs in the text for the dimensions, levels of care & admission decision rules serve as the reference manual for the ASAM Criteria Software released by SAMHSA

The NEW ASAM CRITERIA Book &THE ASAM CRITERIA Software

• A full, patient-based, computer-driven, counselor tool

• A comprehensive psychosocial, implements all PPC-2R decision rules

• A quantitative, reliable & valid LOC recommendation & justification

• Current Use: Norway (10 sites)

• Goals: International standard & sustainability

• Commercialization: Guided by Harvard Business School Business Plan

– Stakeholder interviews, member surveys, & fiscal models

• SAMHSA’s Open-Source project – nationwide behavioral EHR platform

ASAM’s Criteria Software – Commercial Plan

Via SAMHSA’s OBHITA Open Behavioral Health IT Architecture Project

Meaningful Use Compliant Clinical Decision Support

Software

Can integrate Primary & Behavioral Health Services

Eventually EHR Compliant: HL7, SNOMED, LOINC, ICD-

10, etc.

Integrated with HIT Grants for Primary Behavioral

Health

FEi Systems: Focused e-Health Innovations

Privately held, since 1999. 20-25% growth/yr. 2010 revenues ~$32 mm

150 employees. Contracts with Avalon, Westat, Abt & others in projects at FDA, NIH, and in criminal justice parole & probation.

Contracted to rewrite the Block Grant process for SAMHSA. HIPAA: Secure facility, encryption, security officer, &

business associate agreements with all clients. Expert in data repository de-identification.

Access To Recovery: Serves 15 of 30 state grantees. Commercially manages WITS for 28 states & counties,

Supports 5,500 providers. FEi’s WITS team = 45 staff.

The ASAM Criteria book & Software are companion text and application. The text delineates the dimensions, levels of care & decision rules that comprise The ASAM Criteria

The software provides approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care

The text provides background & instruction for proper use of software. The software enables comprehensive, standardized evaluation.

Text + Software = ASAM Criteria

Hands-on experience at the computer Logging-on Understanding the user-interface Inputting mock data in selected dimensions Reviewing the output reports


Intuitive User Interface

Clean interface and presentation of data elements.

Intuitive User Interface

Data visualization elements.

Enhanced Report

Dynamically driven report with variable content regions.

Enhanced Report

Improved readability and scanning of information.

Meaningful Documentation


The black box barrier is removed, exposing the underlying algorithms.


Enhances understanding of the ASAM algorithm by providing meaning and context.

Clear naming

Traceability

Human Readable Narrative

Aids In Understanding

Algorithm


Facilitates updates and tweaking to the algorithm.

Interactive discussion Understanding the implementation process,

including data privacy issues Anticipating the learning curve Measuring the ROI with

INSTRTM: INSTant Authorization for Reimbursement

Just-In-Time Supervision Accreditation, Certification, Contracting, Grants,

etc.


ASAM’s plans Releasing to the field, training &

endorsement/certification Research: optimizing patient care & recovery

outcomes– The Central Data Repository

QI steps: ASAM’s Coordination & engaging stakeholders – The National Coalition on Placement Criteria


Participants’ reaction Fears: Concerns & obstacles

Hopes: Perceived benefits & needs

Likelihood of testing & adopting the software


David R Gastfriend MD [email protected]


mailto:[email protected]

A National Standard for Assessment/Placement

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