A National View: Healthcare 2008
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Transcript of A National View: Healthcare 2008
A National View: A National View: Healthcare 2008Healthcare 2008
CBHC Annual Training CBHC Annual Training ConferenceConferenceOctober 5, 2008October 5, 2008
Charles Ingoglia, MSWCharles Ingoglia, MSWVice President, National Council for Vice President, National Council for Community Behavioral HealthcareCommunity Behavioral Healthcare
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Today…talk aboutToday…talk about Opportunities and ChallengesOpportunities and Challenges 2008 National Healthcare 2008 National Healthcare
DebateDebate National Council Public Policy National Council Public Policy
and The State of Medicaidand The State of Medicaid Taking Charge – relationships, Taking Charge – relationships,
quality and communicationsquality and communications
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The National CouncilThe National Council Not for profit association of 1500 Not for profit association of 1500
+ mental health/addiction + mental health/addiction treatment and rehabilitation treatment and rehabilitation organizationsorganizations
Member organizations employ employ 250,000 staff and provide services 250,000 staff and provide services to 6 million adults and children to 6 million adults and children in communities across the in communities across the countrycountry
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MembershipMembership
732 752
10071075
11961277
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200
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FY02 FY03 FY04 FY05 FY06 FY07 FY08YTD
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Our Vision – the big Our Vision – the big picturepicture
A nation where there is A nation where there is prevention and early detection of prevention and early detection of mental illnesses and addictions; mental illnesses and addictions; and and everyoneeveryone has access to the has access to the effective treatments and effective treatments and supports essential to live, work, supports essential to live, work, learn and participate fully in learn and participate fully in their communities.their communities.
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Our JobOur JobThe National Council is the The National Council is the
interface between practice and interface between practice and policy.policy.
We are the national voice for We are the national voice for legislation, regulations and legislation, regulations and policies that protect, strengthen policies that protect, strengthen and expand access to mental and expand access to mental health and addictions services.health and addictions services.
Your job is to support others, our Your job is to support others, our job is to support you.job is to support you.
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Members – Top IssuesMembers – Top Issues Funding, Medicaid, MedicareFunding, Medicaid, Medicare Reform – privatization, Reform – privatization,
competition, managed carecompetition, managed care WorkforceWorkforce Health IntegrationHealth Integration TechnologyTechnology
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Time of opportunityTime of opportunitySurgeon General Satcher, President Surgeon General Satcher, President
Bush’s New Freedom Commission, Bush’s New Freedom Commission, and The Institute of Medicine all and The Institute of Medicine all agree that: agree that:
mental health and freedom from mental health and freedom from addictions are vital to overall addictions are vital to overall healthhealth
effective treatments exist and effective treatments exist and recovery is possiblerecovery is possible
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OpportunityOpportunity Up to 90% of people with a mental Up to 90% of people with a mental
illness that are treated with a illness that are treated with a combination of medication and combination of medication and therapy experience substantially therapy experience substantially reduced symptoms, enhanced quality reduced symptoms, enhanced quality of life & increased productivityof life & increased productivity
Science has revolutionized our Science has revolutionized our understanding of addictions – understanding of addictions – treatment has been shown to cut treatment has been shown to cut drug use in half, reduce crime by 80% drug use in half, reduce crime by 80% & reduce arrests up to 64%.& reduce arrests up to 64%.
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ChallengesChallenges Each year 100,000 + Americans die Each year 100,000 + Americans die
from alcohol and drug abuse.from alcohol and drug abuse. 50% jail/prison inmates have mental 50% jail/prison inmates have mental
health problem, 75% substance abuse.health problem, 75% substance abuse. 2/3 homeless - chronic alcoholism, drug 2/3 homeless - chronic alcoholism, drug
addiction, mental illness or addiction, mental illness or combination.combination.
25% of all hospital admissions have 25% of all hospital admissions have mental illness or addictions disorder.mental illness or addictions disorder.
25% social security payments are for 25% social security payments are for mental illnesses.mental illnesses.
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Challenges Challenges Staffing crisis - low prestige and salaries/ Staffing crisis - low prestige and salaries/
high turnoverhigh turnover Limited use of outcome data to refine Limited use of outcome data to refine
treatment/research based practicestreatment/research based practices Limited use of knowledge based Limited use of knowledge based
technology/neuroscience and biological technology/neuroscience and biological advances advances
Low rates of access, retention & adherence
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ChallengesChallenges Ambivalence about healthcare: Ambivalence about healthcare:
chronic illnesses v. recovery; chronic illnesses v. recovery; integration?integration?
Complexity of serious mental Complexity of serious mental illnesses – early mortality – povertyillnesses – early mortality – poverty
Protecting individuals with mental Protecting individuals with mental illness from harm v. protecting illness from harm v. protecting societysociety
Late detection – complex U.S. systemLate detection – complex U.S. system
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ChallengesChallenges No uniform standards of care and No uniform standards of care and
layers of regulation and oversight layers of regulation and oversight Multiple hospital and community Multiple hospital and community
providers with fierce competition providers with fierce competition for Medicaidfor Medicaid
Dependence on Medicaid and Dependence on Medicaid and limited to no access for non – limited to no access for non – MedicaidMedicaid
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The Healthcare DebateThe Healthcare Debate
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U.S. Healthcare SystemU.S. Healthcare System The financing system isThe financing system is
InefficientInefficient Inequitable, andInequitable, and Fiscally unsustainable.Fiscally unsustainable.
The delivery system isThe delivery system is FragmentedFragmented Not designed to care for chronic diseasesNot designed to care for chronic diseases Haphazard and poor qualityHaphazard and poor quality High use of unproven, marginal High use of unproven, marginal
therapies.therapies.
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CostsCosts In 2006, the U.S. spent In 2006, the U.S. spent
$2,100,000,000,000 --$2.1 $2,100,000,000,000 --$2.1 trillion –on health care.trillion –on health care.
$1 out of every $6 spent in $1 out of every $6 spent in the U.S.the U.S.
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CostsCostsHow Big is a Trillion?How Big is a Trillion?
1 million seconds1 million seconds Last weekLast week
1 billion seconds1 billion seconds Richard Richard Nixon’s Nixon’s resignation resignation
1 trillion seconds1 trillion seconds 30,000 BCE30,000 BCE
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CostsCosts 47 million without health insurance47 million without health insurance 16% of GDP – no other country above 16% of GDP – no other country above
10%10% Fragmented array of insurers and Fragmented array of insurers and
providers drive high administrative providers drive high administrative costs: 25-35% compared to 15% costs: 25-35% compared to 15%
$5,711 per person, Switzerland $3,847; $5,711 per person, Switzerland $3,847; 31st in life expectancy31st in life expectancy
Insurance premiums doubled since 2000 Insurance premiums doubled since 2000
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Costs Costs We pay hospitals and doctors moreWe pay hospitals and doctors more Rely on specialists, using high cost Rely on specialists, using high cost
diagnostics & interventions offering diagnostics & interventions offering possibility of improvementpossibility of improvement
Little to no use of comparative Little to no use of comparative effectiveness/No budgeteffectiveness/No budget
75% of costs by 4-5% with chronic 75% of costs by 4-5% with chronic illnesses and at end of life.illnesses and at end of life.
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CostsCostsExtremely wealthy country; most like Extremely wealthy country; most like
their providers – change for everyone their providers – change for everyone else, butelse, but
By 2028, health care will consume 28% By 2028, health care will consume 28% of GDP. This is as much as all federal, of GDP. This is as much as all federal, state and local governments currently state and local governments currently spend.spend.
By 2050, Medicare and Medicaid will By 2050, Medicare and Medicaid will consume all federal taxes.consume all federal taxes.
““Even in fantasy, no one has yet come up Even in fantasy, no one has yet come up with a way to pay for Medicare.”with a way to pay for Medicare.”
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Solutions?Solutions? Managed care: largely unable to Managed care: largely unable to
reform care delivery/hated by allreform care delivery/hated by all Control drug costs, allow Medicare to Control drug costs, allow Medicare to
negotiate: small piece of the pie negotiate: small piece of the pie Pay for Performance: more to Pay for Performance: more to
providers already doing the right providers already doing the right thing, others won’t change for thing, others won’t change for additional 2% or 5%additional 2% or 5%
IT: IT: long termlong term can reduce paperwork can reduce paperwork burden, errors and repeated testsburden, errors and repeated tests
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Solutions?Solutions? Prevention/Disease Prevention/Disease
management/Medical homes: not management/Medical homes: not clear if or when get savings:clear if or when get savings:
Skin in the game: 1974 to 1982 Rand Skin in the game: 1974 to 1982 Rand study - 30% saving when people paid study - 30% saving when people paid with same outcomes, exception low with same outcomes, exception low income people in poor healthincome people in poor health
Close hospital beds: match lower Close hospital beds: match lower spending regions save 20% to 30%spending regions save 20% to 30%
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Healthcare ReformHealthcare Reform True health care reform must fix True health care reform must fix
both the financial and delivery both the financial and delivery systems.systems.
Unfortunately, most public Unfortunately, most public discussions focus exclusively on the discussions focus exclusively on the financing system and getting to (or financing system and getting to (or close to) universal coverage. They close to) universal coverage. They ignore delivery system reform.ignore delivery system reform.
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Incremental ReformIncremental Reform Incremental reform is business Incremental reform is business
as usual.as usual. If you like the current system, If you like the current system,
you like incremental reform.you like incremental reform. Builds on a broken system.Builds on a broken system. Fails to achieve universal Fails to achieve universal
coverage, no cost control, no coverage, no cost control, no improved delivery system.improved delivery system.
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Political FeasibilityPolitical FeasibilityMany barriers to change:Many barriers to change:
1) 1) Rule ofRule of SatisfactionSatisfaction—85% of —85% of Americans have health insurance and Americans have health insurance and many are satisfied.many are satisfied.2) 2) James Madison Rule ofJames Madison Rule of GovernmentGovernment—American government was designed —American government was designed with many places for special interests with many places for special interests to kill legislation. With 16% of the to kill legislation. With 16% of the GDP, health care has many special GDP, health care has many special interests.interests.
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Political FeasibilityPolitical Feasibility
A majority of Americans are A majority of Americans are for health care reform. for health care reform. But they are divided among But they are divided among many different plans. After many different plans. After their preferred reform, their preferred reform, their second choice is the their second choice is the status quo.status quo.
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2007 Lobbying Leaders US Chamber of Commerce
$52,750,000 General Electric $23,660,000 Pharmaceutical Rsrch & Mfrs of
America $22,733,400 American Medical Assn $22,132,000 American Hospital Assn $19,734,545 AARP $19,540,000 Exxon Mobil $16,940,000
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Healthcare Lobbying in 2007
Pharmaceuticals/Health Products $226,757,501
Hospitals/Nursing Homes $91,208,297
Health Professionals $70,378,540 Health Services/HMOs
$52,990,044 Misc Health $4,985,719Total spending:
$446,320,101
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What we must do…What we must do… Broad, strong, engaged membership.Broad, strong, engaged membership. Assertive/focused policy agenda. Assertive/focused policy agenda. Strategic alliances - industry leadership. Strategic alliances - industry leadership. Reputation for quality - expert education Reputation for quality - expert education
& practice improvement initiatives.& practice improvement initiatives. Effective communications with Effective communications with
members, media, advocates, members, media, advocates, policymakers & public.policymakers & public.
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The National CouncilThe National Council
An assertive, focused An assertive, focused policy agendapolicy agenda
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Assertive, focused policy Assertive, focused policy agendaagenda
Understanding and Defending MedicaidUnderstanding and Defending Medicaid Parity/ MedicareParity/ Medicare VeteransVeterans Criminal Justice: Mentally Ill Offender Criminal Justice: Mentally Ill Offender
Treatment and Crime Reduction Treatment and Crime Reduction Act/Second Chance Act Act/Second Chance Act
Community Mental Health Services Community Mental Health Services Improvement Act Improvement Act - - Primary care in Primary care in behavioral sitesbehavioral sites
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Assertive, focused policy Assertive, focused policy agendaagenda
The State of MedicaidThe State of Medicaid
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In 2007, Over 2/3 of States In 2007, Over 2/3 of States Offered New ProposalsOffered New Proposals
Governors in 34 states offered plans to Governors in 34 states offered plans to reduce uninsured children, parents, reduce uninsured children, parents, adults, aged and disabled in their state adults, aged and disabled in their state throughthrough Medicaid expansionsMedicaid expansions SCHIP expansionsSCHIP expansions DRA waiversDRA waivers Comprehensive Section 1115 waiversComprehensive Section 1115 waivers Prevention and better management of Prevention and better management of
chronic conditionschronic conditions
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2008 Response:2008 Response:
Expansion plans in Expansion plans in jeopardy or delayedjeopardy or delayed
States once again States once again freezing or cutting ratesfreezing or cutting rates
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Illustrative Medicaid Dynamics; Ohio Department of Mental HealthState General Fund and MedicaidFY 1990 – FY 2007
millions
$200
$150
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$0
-$50
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$200millions
$150
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$50
$0
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-$1501990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Medicaid FFPMedicaid MatchRemaining GRF
20072006The Squeeze
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Federal Regulations Reflect Federal Regulations Reflect Federal GoalsFederal Goals
Make Medicaid look like Make Medicaid look like commercial health insurance.”commercial health insurance.”
““Medicaid should not be a Medicaid should not be a financing option for other financing option for other public systems for non-public systems for non-Medicaid purposes.”Medicaid purposes.”
““Rein in federal health Rein in federal health spending.”spending.”
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It’s Raining Regulations!It’s Raining Regulations! 10 new regs in first six months of 10 new regs in first six months of
federal fiscal year (15+ in last 2 federal fiscal year (15+ in last 2 years)years)
Most issued as either “interim Most issued as either “interim final” regulations or with final” regulations or with shortened public comment periods shortened public comment periods
Fighting new regs – Congressional Fighting new regs – Congressional moratoriumsmoratoriums
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Council Leadership - Rehab Council Leadership - Rehab Option/Case ManagementOption/Case Management
In DRA, Congress rejected Bush In DRA, Congress rejected Bush efforts to legislate changes - President efforts to legislate changes - President uses administrative measures for $6.1 uses administrative measures for $6.1 billion savings over next 10 yearsbillion savings over next 10 years
Council – member political heat, Council – member political heat, member testimony, rallying partners member testimony, rallying partners
Achieved moratoriumAchieved moratorium Working with Congress on legislation Working with Congress on legislation
to address rehab and case to address rehab and case management regs management regs
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Assertive, focused policy Assertive, focused policy agendaagenda
ParityParity
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Commercial ParityCommercial ParitySenator Paul Wellstone Mental Senator Paul Wellstone Mental
Health Parity Act of 2007 – Health Parity Act of 2007 – parity parity for both mental health and for both mental health and addictions treatment servicesaddictions treatment services
Senate - introduced by Senators Edward Kennedy Senate - introduced by Senators Edward Kennedy (D-MA), Michael Enzi (D-WY), and Pete Domenici (D-MA), Michael Enzi (D-WY), and Pete Domenici (R-NM)/House - introduced by Representatives (R-NM)/House - introduced by Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) Patrick Kennedy (D-RI) and Jim Ramstad (R-MN)
Rally on 9/17; ad campaignRally on 9/17; ad campaign Agreement on content, added to Agreement on content, added to
rescue/tax bill (AMT)rescue/tax bill (AMT)
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ParityParityUse The Toll-Free Parity Hotline: 1-866-Use The Toll-Free Parity Hotline: 1-866-
parity4parity4 (1-866-727-4894, the Parity Hotline reaches (1-866-727-4894, the Parity Hotline reaches the U.S. Capitol switchboard, which connects the U.S. Capitol switchboard, which connects you to your Senators' offices.)you to your Senators' offices.)
"I'm calling to ask that the Senator vote "I'm calling to ask that the Senator vote YES on the energy and tax package that YES on the energy and tax package that includes parity for mental health and includes parity for mental health and addiction services. This legislation must addiction services. This legislation must pass this month before Congress pass this month before Congress adjourns."adjourns."
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MedicareMedicare Historic milestone – Congress ( HR 6331) Historic milestone – Congress ( HR 6331)
ending discrimination of outpt. mental ending discrimination of outpt. mental health benefits between 2010 and 2014health benefits between 2010 and 2014
Re-authorization of SCHIP - 2 provisions Re-authorization of SCHIP - 2 provisions related to Medicare:related to Medicare:1.marriage&family therapists and licensed 1.marriage&family therapists and licensed professional counselors as providersprofessional counselors as providers
2. additional covered services including 2. additional covered services including case management, ACT, rehabcase management, ACT, rehab
Vetoed by President but passage by Vetoed by President but passage by Congress is important legislative record Congress is important legislative record moving forwardmoving forward
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Assertive, focused policy Assertive, focused policy agendaagenda
VeteransVeterans
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Veterans authorizationVeterans authorization S. 38 calls for the VA to contract with S. 38 calls for the VA to contract with
community providers to meet needs of community providers to meet needs of reserves and National Guardreserves and National Guard
Recent VA directive to all VISN'S that Recent VA directive to all VISN'S that describes expectations for access and describes expectations for access and services and calls for individual medical services and calls for individual medical centers to contract with community centers to contract with community providersproviders
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Veterans appropriationsVeterans appropriations$100 million to be allocated to $100 million to be allocated to
community mental health community mental health organizations in the Veterans organizations in the Veterans Administration’s health care Administration’s health care budget line-item to increase budget line-item to increase mental health care for National mental health care for National Guard members, reservists, and Guard members, reservists, and family members of veterans with family members of veterans with service connected mental disordersservice connected mental disorders
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Assertive, focused policy Assertive, focused policy agendaagenda
Community Mental Community Mental Health Services Health Services Improvement ActImprovement Act
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Community Mental Health Community Mental Health Services Improvement ActServices Improvement Act
Primary care in behavioral sites ***Primary care in behavioral sites *** Co-occurring disorders funding demoCo-occurring disorders funding demo Workforce improvements, salary studyWorkforce improvements, salary study Paperwork reduction - elimination of Paperwork reduction - elimination of
regulatory redundancyregulatory redundancy Advancing tech. & electronic health Advancing tech. & electronic health
recordrecord Rural behavioral health treatment Rural behavioral health treatment
incentivesincentives
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Assertive, focused policy Assertive, focused policy agendaagenda
Coming soonComing soon
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Coming Soon Coming Soon Federal funding stream to cover the mental Federal funding stream to cover the mental
health treatment costs of the uninsured health treatment costs of the uninsured Restore eligibility for social security Restore eligibility for social security
disability for people with addictive disability for people with addictive disordersdisorders
Cost based re-imbursement that supports Cost based re-imbursement that supports salaries that can attract and retain salaries that can attract and retain skilled skilled staff staff
Chronic disease management project – Chronic disease management project – medical home medical home
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Strategic relationshipsStrategic relationships Chronic Disease, Healthcare, Medicaid Chronic Disease, Healthcare, Medicaid
Coalitions, Medicaid DirectorsCoalitions, Medicaid Directors Addiction Treatment Advocacy and Addiction Treatment Advocacy and
Criminal Justice LeadershipCriminal Justice Leadership Mental Health Groups – Campaign, Mental Health Groups – Campaign,
NAMI, MHA, Consumers, NASMHPD, NAMI, MHA, Consumers, NASMHPD, GuildsGuilds
Feds – SAMHSA, HRSA, CMSFeds – SAMHSA, HRSA, CMS Presidential Election – Whole Health Presidential Election – Whole Health
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Reputation for quality – Reputation for quality – Member BenefitsMember Benefits
Promoting Wellness - Promoting Wellness - Saving Saving LivesLivesSurvey on medical servicesSurvey on medical servicesHealth & Wellness RoundtablesHealth & Wellness RoundtablesPrimary Care and Behavioral Primary Care and Behavioral Health Learning Community - Health Learning Community - 23 organizations ***23 organizations ***
Primary Care/Behavioral Health Primary Care/Behavioral Health Collaborative Project ***Collaborative Project ***
Medical/healthcare homes ***Medical/healthcare homes ***
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Primary Care/Behavioral Primary Care/Behavioral Health Collaborative ProjectHealth Collaborative ProjectObjectives:Objectives:
Safety net population in every community Safety net population in every community has seamless access to both mental has seamless access to both mental health/addiction and physical healthcare health/addiction and physical healthcare services. services.
Strong working partnership among mental Strong working partnership among mental health/addiction and physical healthcare health/addiction and physical healthcare providers, with roles defined, referral providers, with roles defined, referral protocols in place, and cross-placement of protocols in place, and cross-placement of clinical staff.clinical staff. Phases I and II : 12 sites in 10 statesPhases I and II : 12 sites in 10 states Phase III – 4 additional sitesPhase III – 4 additional sites
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Project Goals Diagram
Primary Care Clinic Screen all patients for depression Screen all depressed patients for bipolar,
suicide, substance use Refer per protocols for specialty MH,
referral includes medical co-morbidity information
Provide depression care and care management for those not referred
Use PHQ – 9 for proactive follow-up and management of depression
Access to psychiatry to support PCP and care management and assure stepped care
Provide primary care services Support/information from PCPs to MH
regarding health status, joint planning for patients with medical co-morbidities
Data tracking regarding care processes and patient status
Current Referral Chasm Only 50% get to MH upon referral Little information flows between PCP and MH Patients get pushed back and forth, rather
than jointly served
Improved Referral Process Agree on who needs specialty MH and 100% of
them get there and get engaged Information flows between PCP and MH Patients are collaboratively cared for, with attention
to medical co-morbidities exacerbated by SGAs
Community Mental Health Provider Expedited support for referrals and
engagement Psychiatry training and support for PCPs Psychiatric evaluation and treatment for
referrals Track weight, lipids, glycemia for patients
on SGAs Support/information from PCPs regarding
health status, joint planning for patients with medical co-morbidities
Evidence based MH services and case management
Transition stable patients back to PCP per protocols
Data tracking regarding care processes and patient status
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Reputation for quality – Reputation for quality – Member BenefitsMember Benefits
Continuity of Care -Access, Continuity of Care -Access, Engagement and Adherence ProjectEngagement and Adherence Project
Six Sigma Initiative ***Six Sigma Initiative *** Recruitment and RetentionRecruitment and Retention Psychiatric Leadership Project ***Psychiatric Leadership Project *** Middle Management and Leadership Middle Management and Leadership
Development – Culture diversity Development – Culture diversity National Benchmarking Project ***National Benchmarking Project ***
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Access and EngagementAccess and EngagementExecutive Staff Walkthrough Objectives: Experience Intake,
Assessment, and First Appointment Process from Client’s Perspective; Identify Barriers; and Identify Strategies for Improvement
Requirements: Site Teams Work in Pairs (One Client, One Observer/Recorder); and Mock Clients Complete All Paperwork/ Processes Client Completes
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Access and EngagementAccess and Engagement Number of data elements collected in
the process = 1,854 Number of redundant elements = 564 Number required = 957 Staff time required to administer
original flow process = Four hours ten minutes
Staff time required to administer revised flow process = One hours twenty minutes
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Quality – Member Quality – Member BenefitsBenefits
Criminal Justice Leadership Criminal Justice Leadership ForumForum
Project Helping Hands*** Project Helping Hands*** Awards of Excellence***Awards of Excellence*** JoBankJoBank International Community and International Community and
“Passport” program ***“Passport” program *** Mental Health First Aid ***Mental Health First Aid ***
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Few are bigger, none are Few are bigger, none are betterbetter
National Council National Council ConferenceConference
The Hyatt RiverWalkThe Hyatt RiverWalk San Antonio, TexasSan Antonio, Texas April 5 - 8, 2009April 5 - 8, 2009
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Conference AttendanceConference Attendance
607 697
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2002 2003 2004 2005 2006 2007 2008
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Effective Effective CommunicationsCommunications
Electronic and PrintElectronic and Print Public Policy Update Public Policy Update Technical Assistance NewsletterTechnical Assistance Newsletter State Policy FocusState Policy Focus National Council Magazine National Council Magazine Letter from LindaLetter from Linda Journal of Behavioral Health Services & Journal of Behavioral Health Services &
ResearchResearch Addictions/Co-occurring Disorders Addictions/Co-occurring Disorders
NewsletterNewsletter
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Communications – Communications – messaging and marketingmessaging and marketing
National Council Live National Council Live Marketing - Message piece/ Policy Marketing - Message piece/ Policy
Guide/Annual ReportGuide/Annual Report Print Media – member stories and voices: Print Media – member stories and voices:
news, letters, op-eds and magazine news, letters, op-eds and magazine articles in trade and mainstream pressarticles in trade and mainstream press
Redesigned website, Redesigned website, www.nationalcouncil.org Offering stories of recoveryOffering stories of recovery Sharing member writingsSharing member writings National Council resourcesNational Council resources Special interactive sectionsSpecial interactive sections
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How do we move our How do we move our agenda…agenda…
Change requires 4 things to coalesce:Change requires 4 things to coalesce:1) A 1) A problemproblem attracts widespread public attracts widespread public and political attention. and political attention. 2) A 2) A proposalproposal to solve the problem is agreed to solve the problem is agreed on by the major actors. on by the major actors. 3) There is a major actor or set of actors 3) There is a major actor or set of actors who vigorously who vigorously championchampion the policy the policy proposal.proposal.4) A 4) A transforming political eventtransforming political event creates an creates an open policy window to enact the agreed open policy window to enact the agreed upon proposal. Political opportunity is upon proposal. Political opportunity is unpredictable. We must be ready when the unpredictable. We must be ready when the policy window opens.policy window opens.
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What do we need to succeed?
An organized and effective grassroots
Congressional champions
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What we must do What we must do politically…politically…
Be informed, Be informed, www.thenationalcouncil.org -understand and influence the national -understand and influence the national dialogue: mental health and freedom dialogue: mental health and freedom from addictions are vital to overall from addictions are vital to overall health and effective treatments existhealth and effective treatments exist
Tell our story - Tell our story - commit to using our commit to using our influence: Congress doesn’t know us influence: Congress doesn’t know us very well and CMS doesn’t always like very well and CMS doesn’t always like usus
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Build relationships with Build relationships with policy-makerspolicy-makers
• Meet them in Washington or the Meet them in Washington or the DistrictDistrict
• Get to know their staffGet to know their staff• Help them — contribute to their Help them — contribute to their
campaign, attend a fundraiser, put campaign, attend a fundraiser, put up yard signs, serve as a content up yard signs, serve as a content expert etc.expert etc.
• Maintain contactMaintain contact
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Political action is the highest responsibility of a citizen.”
John F. Kennedy
“
“Political action is the highest responsibility of a citizen.”
John F. Kennedy
Hill Day: June 9 and 10 Hill Day: June 9 and 10