ADVANCING BEHAVIORAL HEALTH IN A CHANGING HEALTH CARE ENVIRONMENT

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(No Transcript)
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ADVANCING BEHAVIORAL HEALTH IN A CHANGING HEALTH
CARE ENVIRONMENT

• Pamela S. Hyde, J.D.
• Administrator
• Substance Abuse and Mental Health Services
  Administration

NAMI of Southwestern Pennsylvania Pittsburgh,
PA June 14, 2013
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BEHAVIORAL HEALTH

• SOCIAL PROBLEM?
• or

PUBLIC HEALTH ISSUE?
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WHY DOES IT MATTER?

• Public sees social consequences of behavioral
  health rather than health consequences
• Homelessness, gangs, jails, tragedies (e.g., mass
  casualty shootings), disability, lost
  productivity, high government costs
• M/SUDs seen as matter of will instead of diseases
  or conditions to be prevented, treated and
  recovered from
• Compare diabetes
• Teach requirements of first aid for health
  conditions dont teach signs, symptoms and how
  to get help for mental health or substance abuse
  issues

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BH AS A SOCIAL PROBLEM LEADS TO INSUFFICIENT
RESPONSES
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ELEMENTS OF A PUBLIC HEALTH MODEL
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WHY A PUBLIC HEALTH APPROACH?

• BH affects most Americans
• ½ of Americans will meet criteria for a mental
  health condition at some point in their lifetime
• ½ of all adults know someone in recovery from
  addiction
• BH increases risks for other health conditions
• Costs for co-morbid diabetes, hypertension, heart
  disease higher
• Pre-mature death and preventable illnesses
• More BH related deaths than HIV, traffic
  accidents breast cancer
• ½ the deaths from smoking are among those with BH
  conditions
• Persons with M/SUDs die 8 1/2 years earlier

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WHY PUBLIC HEALTH . . .

• High levels of unmet need
• Less than 40 percent of adults get treatment for
  diagnosable mental illness less than 11 percent
  for SUDs
• Less than 1 in 5 children/adolescents get needed
  treatment
• Longer time between symptoms treatment than for
  physical
• Inaccurate public perceptions
• High proportion of inaccurate assumptions of
  danger/risk
• High levels of social discomfort
• High impact of disparities (race, gender,
  ethnicity, LGBT, poverty) and on social costs
  (homelessness, jails/prisons, child welfare)

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SAMHSA A PUBLIC HEALTH AGENCY

• Leadership and voice influencing public policy
• Data and surveillance
• Public education and communications
• Regulation and standard setting
• Financing and practice improvement
• Funding - service capacity/system development
  (esp. to test new approaches)

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SAMHSAS STRATEGIC INITIATIVES
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HEALTH REFORM AND THE CHANGING HEALTH CARE
ENVIRONMENT

• Prevention and wellness rather than illness a
  public health approach
• Role of states increasing, especially in health
  care
• Integration rather than silod care Parity
• Access to coverage and care rather than
  significant parts of America uninsured Parity
• Recovery rather than chronicity or disability
• Quality rather than quantity cost controls
  through better care rather than more care

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PARITY/ACA PROJECTED REACH
Individuals who will gain MH, SUD, or both benefits under the ACA including federal parity protections Individuals with existing MH and SUD benefits who will benefit from federal parity protections Total individuals who will benefit from federal parity protections as a result of the ACA
Individuals currently in individual plans 3.9 million 7.1 million 11 million
Individuals currently in small group plans 1.2 million 23.3 million 24.5 million
Individuals currently uninsured 27 million n/a 27 million
Total 32.1 million 30.4 million 62.5 million
NOTE These estimates include individuals and
families who are currently enrolled in
grandfathered coverage
Source ASPE Research Brief, February 2013
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PENNSYLVANIA STATUS OF DECISIONS ON FFMs, EHBs,
AND MEDICAID EXPANSION

• December 2012 Governor Tom Corbett notified
  federal officials that PA would default to a
  federally-facilitated health insurance
  marketplace (FFM) in 2014
• EHBs PA has not put forward a recommendation -
  states benchmark EHB plan will default to the
  largest small group plan in the state (Perhaps
  Aetna POS)
• Medicaid Expansion PA still evaluating options
  and negotiating with CMS, but has not committed
  to expanding

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PA HEALTH INSURANCE COVERAGE TOTAL
POPULATION, 2010-2011
Source Kaiser Family Foundation
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NATIONALLY PERSONS WHO ARE UNINSURED lt400 FPL
29 with BH conditions
71 without BH conditions
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IN 2014 MILLIONs MORE AMERICANS WILL have
health coverage OPPORTUNITIES

• Currently, 37.1 Million Are Uninsured lt400
  FPL
• 18.5 M Medicaid expansion eligible
• 18.5 M ACA exchange eligible
• 11 M (29) Have BH condition(s)
• Adults age 18-64, Source 2011 American
  Community Survey
• Adults age 18-64, Source 2010 NSDUH

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PA PREVALENCE OF BH CONDITIONS AMONG MEDICAID
EXPANSION POP
CI Confidence Interval Sources 2008 - 2010
National Survey on Drug Use and Health (Revised
March 2012) 2010 American Community Survey
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PA PREVALENCE OF BH CONDITIONS AMONG EXCHANGE
POPULATION
CI Confidence Interval Sources 2008 - 2010
National Survey on Drug Use and Health (Revised
March 2012) 2010 American Community Survey
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AFFORDABLE CARE ACT ENROLLMENT ASSISTANCE
ACTIVITIES

• Navigator Program (2014)
• Include at least one consumer-focused non-profit
• Required for and financed by each Exchange
• FOA for FFM/SPM Navigators out now
• At least 13 states engaged in public planning
  work (Feb. 27, 2013)
• AR, WA, WV, CA, CO, CT, DC, HI, MN, NV, OR,
  VT
• In-person assistance personnel
• State-based or state-partnership marketplaces
  only. State-based grants or contracts. Can be
  funded by marketplace establishment grants
• Certified Application Counselors
• If state permits, federal training and
  certification for FFM and SPM. No dedicated
  funding but can use other Federal grants or
  Medicaid

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SAMHSA ENROLLMENT STRATEGY

• Collaborate with national organizations whose
  members/constituents interact regularly with
  individuals who have M/SUDs to create and
  implement enrollment communication campaigns
• Promote and encourage use of CMS marketing
  materials
• Provide T/TA in developing enrollment
  communication campaigns using these materials
• Provide training to design and implement
  enrollment assistance activities
• Channel feedback and evaluate success

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SIMPLE STREAMLINED APPLICATION PROCESS

• Now

• 2014 (beginning Oct 1, 2013)

• Different applications for different programs
• Denied? Back to the drawing board
• Applications often only available on paper or as
  PDFs if online
• In-person interview requirements

• Regulations require a single application as
  gateway to all coverage programs
• Must be available online, by telephone through a
  call center, by mail, and in person
  (www.healthcare.gov)
• Interview requirements prohibited

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ENROLLMENT RESOURCES

• SAMHSA Enrollment Webpage
• http//www.samhsa.gov/enrollment/
• Healthcare.gov
• http//www.healthcare.gov/marketplace/index.html
• HHS Partners Resources
• http//www.cms.gov/Outreach-and-Education/Outreach
  /HIMarketplace/index.html
• Different types of ACA consumer assistance
• http//www.cms.gov/CCIIO/Resources/Files/Downloads
  /marketplace-ways-to-help.pdf

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PARITY IN AFFORDABLE CARE ACT

• Affordable Care Act (ACA) embraces and goes
  beyond MHPAEA to create broader parity
• Final MHPAEA reg this year
• Essential health benefits must be included
• In non-grandfathered plans
• In individual and small group markets
• Inside and outside of insurance exchanges
  (qualified health plans or QHPs) and
• In benchmark and benchmark-equivalent plans in
  Medicaid expansion
• States oversee and enforce

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ESSENTIAL HEALTH BENEFITS (EHBs)

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder
  services, including behavioral health treatment

1. Prescription drugs
2. Rehabilitative and habilitative services and
   devices
3. Laboratory services
4. Preventive and wellness services and chronic
   disease management
5. Pediatric services, including oral and vision care

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PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS

• SA TREATMENT FACILITIES ACCEPTANCE OF INSURANCE
  PAYMENTS

SOURCE OF FUNDS FOR CMHCS

• Source NSATSS Source 2011 NCCBH BH
  Salary Survey

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FOCUS PROVIDER READINESSBHbusiness Networks

• TA to help 900 provider orgs/year in 5 areas of
  practice
• Strategic business planning in an era of health
  reform
• 3rd-party contract negotiations
• 3rd-party billing and compliance
• Health insurance eligibility determinations and
  enrollment
• Health information technology adoption
• Special focus on providers of peer and recovery
  support services and providers serving
  racial/ethnic minority and other vulnerable
  populations
• http//bhbusiness.org/

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NATIONAL CONFERENCE ON MENTAL HEALTHJUNE 3, 2013
EAST WING, WHITE HOUSE

• President Obama opened Vice President Biden
  closed focus on young people

• HHS Secretary Sebelius, Education Secretary
  Duncan, VA Secretary Shinseki
• Panels of those with mental health experience,
  survivors, and young people with social media
  approaches

• Advocates, educators, health care providers,
  faith leaders, members of Congress and
  representatives from all levels of government
• From all over the country to talk about ways to
  increase understanding and awareness of MH issues

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THE PRESIDENTS PLAN MENTAL HEALTH AS A PUBLIC
HEALTH ISSUE

• Less than half of people w/BH conditions receive
  the care they need
• Presidents plan ?Launch a national dialogue
• Engages everyone general public, elected
  officials, schools, parents, community
  coalitions, churches, health professionals,
  researchers, persons directly affected by mental
  illness and/or addiction their families
• Committed to health of everyone (social
  inclusion/universal)
• Based on facts, science, common
  understandings/messages
• Focused on prevention (healthy communities) and
  earlier intervention

We are going to need to work on making access to
mental health care as easy as access to a gun.
--President Obama
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PRESIDENTS FY 2014 BUDGET 235M IN NEW
PROGRAMS

• Department of Education -- 75 M
• Safer School Climates 50M to help 8,000
  schools implement evidence-based behavioral
  practices to improve school climate and
  behavioral outcomes for all students, and to ?
  problem behaviors, ? bullying and peer
  victimization, ? the perception of school as a
  safe setting, and ? academic performance
• Address Pervasive Violence 25M for grants to
  schools in communities with pervasive violence to
  address the trauma of children who are exposed to
  or victims of violence, and implement conflict
  resolution and other school-based violence
  prevention strategies
• Health Human Services 160 M
• CDC 30M
• Gun Violence Research 10M to understand causes
  and impacts, including relationship between video
  games, media images, and gun violence
• Nationwide Violent Deaths Surveillance System
  20M to increase reporting system to all states

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FY 2014 PROPOSED NEW MENTAL HEALTH PROGRAMS
SAMHSA 130M

• SAMHSA -- 130 M
• Project AWARE (Advancing Wellness and Resilience
  in Education) 55M to reach 750,000 young
  people through programs to identify mental
  illness early and refer to treatment
• Project AWARE State Grants 40M to ensure
  students with signs of mental illness get a
  critical first referral to treatment, and toward
  ensuring local organizations are all coordinating
  appropriately
• Mental Health First Aid 15M to train teachers
  and other adults who interact with youth to
  detect and respond to mental illness in children
  and young adults, including how to seek treatment

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FY 2014 PROPOSED NEW MENTAL HEALTH PROGRAMS
SAMHSA contd

• Healthy Transitions 25M for states to help
  16-25 year olds get treatment and to help
  communities develop an integrated network to
  support schools working w/ law enforcement, MH
  agencies, and other local organizations
• Behavioral Health Workforce 50M (w/HRSA) to
  train 5,000 additional MH professionals to serve
  students and young adults
• Masters level clinical and paraprofessionals
  35M co-administered with HRSAs Mental and
  Behavioral Health Education Training (MBHET)
  program
• Peer professionals 10M with community colleges
  and peer organizations
• Minority Fellowship Program Youth 5M new
  aspect of SAMHSAs Minority Fellowship Program,
  focusing on preparing masters level behavioral
  health professionals serving youth/young adults

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BH AS PUBLIC HEALTH OUT OF THE SHADOWS

• Keeping Americans safe from lost hope is as
  critical a public health issue as keeping them
  safe from bad drinking water, tainted food, and
  infectious diseases