Behavioral HealthIntegration in Alaska Lessons Learned

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Behavioral Health Integration in
Alaska Lessons Learned

• Bill Hogan, Commissioner
• Alaska Department of Health and Social Services

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Behavioral Health In Alaska

• When and How Should Idaho Integrate Substance
  Abuse and Mental Health from a Structural
  Perspective?
• When the Majority of Consumers (Clients,
  Patients) experience a Co-Occurring Disorder
  Initial Data in Alaska indicated 65 of those
  Served in Separate Systems had Both Problems
• Does Idaho have this Data? Or some way of
  determining the extent of the Problem?

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Behavioral Health in Alaska

• When Family Members and Advocates consistently
  talk about consumers falling through the cracks
  and being shuffled between the Substance Abuse
  system and Mental Health system.
• When Providers have already moved in this
  direction In Alaska many of our frontier,
  rural, remote and Alaska Native providers had
  already moved in this direction out of necessity
  and based on the people they were serving.

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Behavioral Health in Alaska

• What Oversight Structure is Needed to Sustain
  Transformation?
• Alaska created a Behavioral Health Integration
  Steering Committee designed to provide Executive
  Oversight Membership included the Governors
  Office AK HSS / Division of Behavioral Health
  Director Executive Directors of the AK Mental
  Health Trust Authority, the Mental Health Board
  and Advisory Board on Alcoholism and Drug Abuse
  Started with a Charter Document

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Behavioral Health in Alaska

• Alaska created an Internal Planning Committee
  to integrate the Divisions of Mental Health and
  Alcohol and Drug Abuse, the Office of Fetal
  Alcohol Syndrome (FAS) and to bring the various
  Medicaid Management and Oversight Functions into
  the new Division
• Alaska created an External Stakeholders Group
  to develop an Integrated Behavioral Health
  Service Delivery System Members included
  Consumers, Family Members, Advocates, Providers,
  the University, Alaska Native providers,
  Legislators, Community Health Centers, Hospitals,
  etc.

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Behavioral Health in Alaska

• Describe Logical Steps through System Re-Design
• Create an Integrated Division of Behavioral
  Health using Vision, Mission and Values process
  and a Functional Organizational Structure
  designed to support the Integrated Behavioral
  Health Service System you envision.
• Focus on the Continuum of Services Prevention,
  Early Intervention, Treatment and Recovery

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Behavioral Health in Alaska

• Behavioral Health Statute
• Integrated Behavioral Health Regulations
• Quality Standards Focus on Competencies/Credenti
  aling Change Agent as Implementation Strategy
• Identify the Population to be Served
• Design the System From the Ground Up
• Financing Be Creative Grants, Fee for
  Service, Case Rate, Capitation, etc.
• Information Exchange AKAIMS
• Outcomes and System Performance Start with the
  Client Client Status Review (CSR) but also
  consider population measures i.e. Suicide

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Behavioral Health in Alaska

• Need a Full Time Coordinator/Manager Someone
  who gets up every morning focused on this
  Initiative
• Develop a Work Plan
• Establish Clear Goals and Benchmarks Create
  Short Term Successes
• Use Data and Measure what you are doing
• Modify and Adjust
• In other Words Adopt a Continuous Quality
  Improvement (CQI) Philosophy
• Communicate, communicate, communicate to
  Legislators, stakeholders, the public.

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Behavioral Health in Alaska

• What Other Thoughts or Perspectives Might Alaska
  Have re This Type of Initiative?
• Integration occurs Locally at both the Clinical
  and Administrative Level
• Adopt a No Wrong Door Philosophy Consider
  One Stop Shop / Behavioral Health Home
• Develop Standardized Screening
• Everyone Should get a Comprehensive Treatment
  Plan that addresses both problems
• Services should be provided by the same agency
  where practical and feasible

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Behavioral Health in Alaska

• When Considering Administrative Integration
  think about Creating Efficiencies, talk openly
  about Consolidation and Mergers
• Stay Focused on the End Goal / Outcomes
• Ensure you have Solid, Consistent Leadership
• Perseverance Addressing Change Fatigue
• Manage Expectations When will we be done?
• Identify and Work with Legislators who are
  Champions

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Behavioral Health in Alaska

• How Does Alaska Manage for Quality Assurance and
  Accountability?
• Accreditation
• Performance Based Contracting/Funding
• Ongoing Technical Assistance
• Audits
• Modifying or Altering Regulations
• Certification and Licensing

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Behavioral Health in Alaska

• What Systems and Structures Need to be in Place
  to Implement an Outcomes-Based/Managed Care
  System?
• General Agreement and Understanding of what
  Outcomes Providers are Expected to Achieve
  Client Outcomes Productivity/Employment,
  Housing, Staying out of the Criminal Justice
  System, Social Connectedness, etc.
• Beginning to discuss what Constitutes a Healthy
  Community and what role do Behavioral Health
  Providers play in creating a healthy community

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Behavioral Health in Alaska

• Need to be able to Receive and Send Data
  Analyze the Data, etc. AKAIMS
• Re Managed Care there is Essentially No
  Managed Care in Alaska
• Alaska has used various Managed Care Strategies
  i.e. Prior Authorization, Limits on Services,
  Utilization Management/Review, etc. but for the
  most part Alaska has been quite resistant.
• One exception SouthCentral Foundation in
  Anchorage

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Behavioral Health in Alaska

• How does Alaska ensure People are being served
  Effectively and Efficiently?
• Effectively Based on Client Outcomes and
  reduced rates of Suicide, Fetal Alcohol Spectrum
  Disorder, Crimes and Accidents where Alcohol and
  Drugs were involved, etc.
• Efficiently Reviewing Cost Data, Provider
  Productivity Standards, Consolidating
  Administrative Functions, etc.

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Behavioral Health in Alaska

• Recommendations re Draft Approach?
• Vision, Goals, etc.
• Oversight Structure Need to Institutionalize
  it Does the BHTWG/Board serve as this Entity?
• Continuum of Services / Core Services
• Comprehensive Focus
• Regional Authorities?
• Provider Networks?
• Workforce?
• Primary Care / Behavioral Health Integration?

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Behavioral Health in Alaska

• Comments?
• Questions?
• Documents you would like to see?
• People you would like to talk to?
• Thanks
• Bill Hogan, Commissioner, Alaska Dept. of Health
  and Social Services William.Hogan_at_alaska.gov
  907-465-3030