Transcript Slide 1

The Affordable Care Act, Integration,
and the Addiction Workforce:
Challenges and Opportunities
David Dickinson
SAMHSA Regional Administrator
DHHS Region X
NAADAC 2014 Annual Conference
Seattle, WA
September 29, 2014
ACA and Washington State
(as of April 2014)
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• 163,207 individuals selected a Marketplace plan between
October 1, 2013 and March 31, 2014
• 420,188 Washington residents have gained Medicaid or
Children’s Health Insurance Program (CHIP) coverage through
the end of March 2014
• 583,395 Total new beneficiaries
• expands mental health and substance use disorder benefits
and federal parity protections for:
• 1,356,515 Washington residents.
http://www.hhs.gov/healthcare/facts/bystate/ca.html
STATE PREVALENCE OF SUD AMONG MEDICAID EXPANSION
POPULATION
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60%
50%
40%
30%
20%
10%
0%
l Line indicates 95% confidence interval
STATE PREVALENCE OF SUD AMONG EXCHANGE
POPULATION
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40%
35%
30%
25%
20%
15%
10%
5%
0%
l Line indicates 95% confidence interval
Mental Health Parity and Addiction Equity
Act of 2008 and ACA
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• Requires group health insurance plans (those with 50
or more insured employees) that offer coverage for
MH/SUD to provide those benefits in a way that is no
more restrictive than all other medical and surgical
procedures covered by the plan.
• DOES NOT require group health plans to cover
MH/SUD benefits.
• Parity extended in 2014 through the Affordable Care
Act for plans sold through the State-based and Federal
Health Exchanges
ESSENTIAL HEALTH BENEFITS (EHB)
10 BENEFIT CATEGORIES
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1. Ambulatory patient
services
2. Emergency services
3. Hospitalization
4. Maternity and newborn
care
5. Mental health and
substance use disorder
services, including
behavioral health
treatment
6. Prescription drugs
7. Rehabilitative and
habilitative services and
devices
8. Laboratory services
9. Preventive and wellness
services and chronic
disease management
10. Pediatric services,
including oral and vision
care
“Integrated Care” Defined
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• Integrated Care
–
the systematic coordination of general
and behavioral healthcare. Integrating
mental health, substance abuse, and
primary care services…
http://www.integration.samhsa.gov/about-us/what-is-integrated-care
Google Search: What is Integrated
Healthcare?
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“About 639,000 results”
Google search results 8-10-14
FOCUS: WORKFORCE CHALLENGES
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Worker shortages and distribution
More than one-half of BH workforce is over age 50
Between 70 to 90 percent of BH workforce is white
Inadequately and inconsistently trained workers
Education/training programs not reflecting current research base
Billing involves increasing licensing & credentialing requirements
High levels of turnover
Difficulties recruiting people to field – esp. from minority
communities
Inadequate compensation
Poorly defined career pathways
Meeting the Challenge
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• Opportunities for partnerships within the
Department of Health and Human Services
• Partnerships and funding to the States, health
centers, and providers
• Engaging service providers in policy
development and implementation
• Evaluating what is working
HRSA Behavioral Health Integration
Initiative July 31, 2014
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“Secretary Sylvia M. Burwell announced $54.6 million
in Affordable Care Act funding to support 221 health
centers in 47 states and Puerto Rico to establish or
expand behavioral health services for over 450,000
people nationwide. Health centers will use these new
funds for efforts such as hiring new mental health
professionals, adding mental health and substance use
disorder health services, and employing integrated
models of primary care.”
http://www.hhs.gov/news/press/2014pres/07/20140731a.html
CMS Medicaid Innovation
Accelerator Program
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Focus Area: Reducing Substance Use Disorders (SUD)
• The IAP will develop technical resources to support
innovation through key functions:
• Identify and advance new models
• Data analytics
• Improved quality measurement
• State-to-state learning, rapid-cycle improvement, and
federal evaluation
http://www.medicaid.gov/State-Resource-Center/Innovation-Accelerator-Program/Innovation-AcceleratorProgram.html
Technical Assistance Center: SAMHSA/HRSA
Center for Integrated Health Solutions (CIHS)
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In partnership with HHS/Health Resources and Services
Administration (HRSA)
• Goal: To promote the planning and development of integrated primary and
behavioral health care for those with SMI, addiction disorders and/or
individuals with SMI and a co-occurring substance use disorder, whether seen in
specialty mental health or primary care safety net provider settings across the
country
• Purpose:
– To serve as a national training and technical assistance center on the
bidirectional integration of primary and behavioral health care and related
workforce development
www.centerforintegratedhealthsolutions.org
BUILDING THE WORKFORCE
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• $56 M in Now Is the Time (+ $ 11 M)
– In collaboration with HRSA
– Adds commitment to BH workforce data
– Maintains most of FY 2014 increase to
Minority Fellowship Program
– Adds commitment to peer/paraprofessional
workforce
HRSA/SAMHSA BHWET Grants
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• Behavioral Health Workforce Education and Training
(BHWET) for Professionals and Paraprofessionals
grants
• Expands the mental health and substance abuse
workforce serving children, adolescents, and
transitional-age youth with or at risk for developing
behavioral health disorders.
• $30 million in FY 2014 grant funding, the program
will annually provide 12 months of training to about
1,800 professionals and 1,700 paraprofessionals.
• www.hrsa.gov/about/news/2014tables/behavioralhealth/
Role of Providers
Develop partnerships with primary care and other
specialty care systems—identify what roles they can play
in or as Health Homes (ACA Section 2703)
Improve their infrastructure
● Operations (e.g. billing)
● Electronic health records
● Compliance
Developing a competent workforce including use of
peers or recovery coaches
Next Steps Providers/Care Systems
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• Be at the table in State EHB Benchmark
conversation
• Understand the Marketplaces
• Translate Eligibility into a Consumer-Friendly
Environment (Coverage-to-Care)
• Assure MH/SUD Service Capacity
• Promote Ongoing Service Innovation
SAMHSA Workforce Initiative
Leading Change 2.0: Advancing the Behavioral
Health of the Nation
2015-2018:
SAMHSA’s recently released Strategic Plan for
2015-2018 has added a new Strategic Initiative
for Workforce Development to help meet our
nation’s ever-increasing demand for behavioral
health services.
Four main goals with the
workforce initiative
1. Develop and disseminate workforce training and
education tools and core competencies.
2. Increase the number of peer practitioners.
3. Develop ways to track behavioral health
workforce needs.
4. Increase funding for the behavioral health
workforce.
Questions?
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Thank you!
Contact Information:
David Dickinson
SAMHSA Regional Administrator
[email protected]
206-615-3893