Implementing the IOM Report: The TRI-State Policy Program

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Implementing the IOM Report The TRI-State
Policy Program
ACADEMY HEALTH Mady Chalk, Ph.D. Treatment
Research Institute June, 2006
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The Presentation

• Implementing the IOM Report
• Creating an Environment for Exchange of
  Information and Identification of Priority Policy
  Concerns in States
• Developing a Mutual Assistance Effort
• Identifying and Testing Solutions That Work
• Carrying Out Practical, Real World Evaluations

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The IOM Report

• Health Care Focus, e.g., mainstream medicine
• Linking Funding to Quality
• Patient-centered Care, e.g., long-term management
  support, concurrent recovery monitoring
• Coordination of care
• Data accessibility

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State Level Policy and Substance Abuse

• Discrepancy between what is known and what is
  delivered
• Lack of incentives in public sector funding to
  drive quality improvement
• Disconnected delivery arrangements lead to
  ineffective treatment
• Workforce
• Data infrastructure

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State Priority Concerns

• Performance and Outcome Measurement in
  Collaboration with Treatment Providers
• Data Reporting and Management
• Collaborative Financing of All Types
• Integrating Substance Use and Health Care SBIRT
  PRISM (mainstream medicine) Concurrent Recovery
  Monitoring

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State Priority Concerns (Cont)

• Use of Incentives in Purchasing For
• Treatment of priority populations
• Implementation of administrative and clinical
  best practices to improve access and retention
• Becoming co-occurring capable
• Creating a medication friendly environment in
  treatment

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Creating the Environment

• In order for States to work together the
  environment must allow for
• Continuity over time
• Unofficial deliberations
• Neutrality of sponsoring organization
• Moderating presence of some disinterested members

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Creating the Environment

• Access to expert consultation and background
  papers from research, other businesses with
  similar issues
• Structured opportunity for regular discussion
• Practical, real world evaluations

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Advantages of Mutual Assistance

• Practices, policies and procedures have a higher
  likelihood of success and practicality since they
  are derived from common experience rather than
  academic research
• Findings of a consortium of states will have
  greater political traction than the same findings
  resulting from a single states efforts

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Advantages of Mutual Assistance

• Multiple issues can be worked on simultaneously
  because more sources of potential solutions are
  identified
• Documentation of comparative results will become
  part of the evidence base providing greater
  legitimacy for state policies.

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The TRI-State Policy Program

• TRIs Role
• Providing an Environment for Open Exchange of
  Information, Identification of Policy Concerns,
  and Problem-Solving
• Focusing on Specific Policy Areas That Will
  Reform the Treatment System

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The TRI State Policy Program

• TRIs Role
• Providing Strategic Information from Some Other
  Industries That Can Be Used By State SA Agencies
• Evaluating Implementation Experiments
• Hosting Long-Term Working Groups to Develop
  Approaches to Knotty Policy Problems

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How Will States Work Together?

• Prioritize a common set of two or three policy,
  performance, business, administrative and/or
  financing issues
• Describe and circulate promising approaches that
  may have already been tried by member states

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How Will States Work Together?

• From the promising practices and group discussion
  create a practical evaluation of an improvement
  protocol to implement within member states
• Analyze data from the evaluation and produce
  evidence of effective policies and practices
  that can be disseminated widely.

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Some of the Issues States Face

• Data Issues
• Collecting and Using Data to Support Policy
  Objectives
• Cost Offset Data to Support Re-Allocation of
  State Dollars
• Implementing WEB-Based Data Systems to
• Support Accurate Reporting by and Immediate
  Feedback to Providers incl., Encounter Data

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Some of the Issues States Face

• Working with Governors and
• Legislatures To
• Remove Regulatory Barriers That Impede
  Implementation of Cross-Agency Financing
  Approaches
• Remove Barriers to Medication-Assisted Treatment
  of All Types
• Implement Performance-Based Purchasing

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Necessary, but Not Sufficient

• A Continuum of Care from Primary Care, to
  Specialty Health Care, to Specialty Treatment for
  Substance Use Disorders and Mental Illnesses
• A Bridge Between Research and Tx
• So, Is Research Part of the Bridge or Is It Part
  of the Gap?
• Can the Infrastructure Meet the Publics Demands?

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Some Thoughts About Quality Improvement

• Making the Case for Change
• Costs, Cost-offsets, Access
• Health Care and Substance Use
• Consumer Choice and the Continuum
• of Care