Transcript TPHA Conference April 15, 2009 State of Texas Health

Texas Initiative for Program
Success & Sustainability
Leadership Summit
January 10, 2011
David Lakey, M.D.
Commissioner
Texas Department of State Health Services
1
Outline
• Review of recent substance abuse data
• Recent accomplishments related to
substance abuse efforts
• The session
– DDRAC recommendations
– The budget
2
Leading Causes of Death
Texas 2005 and 2001
Heart Diseases
Cancer
Stroke
Accidents
Lower Respiratory Disease
2001
Diabetes
2005
Alzheimers
Flu & Pneumonia
0
10,000
20,000
30,000
40,000
50,000
Number of Deaths
DSHS Center for Health Statistics
3
Actual Causes of Death
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
5000
10000
15000
20000
25000
Chronic Disease in Texas 2007, DSHS
30000
4
The Costs of Substance Abuse
in Texas
• In 2009, ~24,500 Texans died as a result of smoking
• Of the 2,865 newly reported AIDS cases in 2008, 15.5% were
drug related
• ~ 75% of Texas prisoners are involved with alcohol or drugs
• 47% of Texas motor vehicle fatalities (2009) were alcoholrelated
– 23% of fatally injured drivers tested in Texas were found positive for
drugs (2009)
• The cost related to alcohol and drug abuse to Texans (2007)
was ~ $33 billion
– This includes health care, lost productivity, motor vehicle
accidents and crime
– Annual per capita cost for Texas residents: $2,800
5
PAST-MONTH CIGARETTE USE AMONG
ADULTS IN TEXAS AND THE UNITED STATES,
NSDUH, 2002-2007
•
41%
40%
39%
40%
38%
39%
37%
39%
37%
37%
34%
Percentage
30%
25%
25%
26%
25%
24%
24%
26%
25%
25%
24%
20%
10%
0%
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
Survey Year
Texas - 18 to 25 years
US - 18 to 25 years
Texas - 26 years+
US - 26 years+
6
PAST-MONTH CIGARETTE USE AMONG
YOUTH IN TEXAS AND THE UNITED STATES,
2000-2008
25%
23%
20%
21%
18%
Percentage
16%
16%
15%
14%
16%
14%
13%
12%
10%
5%
0%
2000
2002
2004
US*
2006
2008
Texas Total
7
PREVALENCE OF CURRENT CIGARETTE
SMOKERS IN TEXAS AND THE UNITED
STATES (AGE-ADJUSTED), BRFSS, 2000-2009
25%
22%
22%
23%
22%
23%
23%
20%
22%
22%
21%
21%
20%
19%
18%
20%
18%
18%
Percentage
18%
19%
20%
18%
15%
10%
5%
0%
2000
2001
2002
2003
2004
US
2005
2006
2007
2008
2009
Texas
8
PERCENTAGE OF TEXAS MUNICIPALITIES WITH SMOKEFREE ORDINANCES, BY NUMBER OF SMOKE-FREE
SETTINGS, 2000-2009
60%
47%
HP2010
Target
43%
40%
40%
37%
Percentage
34%
36%
27%
25%
20%
17% 17%
17%
20
09
20
08
20
07
20
04
20
01
20
02
0%
20
06
3%
3%
0%
7%
3%
Be
fo
re
20
00
0%
20
00
0%
4%
20
05
2%
HP2010 Target = 51% of
settings with smoke-free
air (settings include public
and private work places,
restaruants, public
transportation, day care
centers, retail stores.)
3 or More Settings Smoke Free
5 Settings Smoke Free
9
Past-Month Binge Drinking among Adults,
2002-2007
45%
40%
42%
41%
42%
40%
41%
41%
40%
42%
39%
38%
35%
Percentage
30%
25%
23%
21%
23%
21%
23%
21%
23%
21%
Source: National
Survey on Drug Use
and Health – State
Estimates, Office of
Applied Studies,
Substance Abuse
and Mental Health
Services
Administration.
22% 22%
20%
15%
10%
5%
0%
2002-2003
2003-2004
2004-2005
2005-2006
Survey Year
Texas - 18-25 years
US - 18-25 years
Texas - 26 years+
2006-2007
HP2010
Target for
adult
binge
drinking =
6%.
US - 26 years+
10
Alcohol Use in the Past Month among Youth (Grade 7
to 12) by Sex, Texas School Survey, 2000-2008
60%
37%
35%
Percentage
40%
35% 34%
33% 33%
31% 32%
30% 30%
2006
2008
20%
0%
2000
2002
2004
Survey Year
Male
Female
Sources: Texas School Survey of Substance Use Among Students: Grades 7-12, Texas Department of State Health Services.
11
Binge Drinking in the Past Month among Youth
(Grade 7 to 12) by Sex, Texas School Survey, 2006
and 2008
60%
Percentage
40%
24%
22%
20%
20%
20%
0%
2006
Survey Year
Male
Female
2008
HP2010
Target for
Youth Binge
Drinking =
2% for youth
ages 12-17
years.
12
Past-Year Illicit Drug Use among Adults in Texas,
Ages 18 to 25, NSDUH 2002-2007
30%
22%
22%
22%
22%
21%
Percentage
20%
12%
11%
11%
10%
10%
7%
6%
7%
7%
2004-2005
2005-2006
6%
0%
2002-2003
2003-2004
2006-2007
Survey Year
Marijuana Use
Cocaine/Crack Use
Nonmedical Use of Pain Relievers*
* The variable of nonmedical use of pain relievers was added to NSDUH State prevalence estimates in 2003-2004.
Source: National Survey on Drug Use and Health – State Estimates, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.
13
Past-Year Illicit Drug Use among Adults in Texas, Age
26 and Older, NSDUH, 2002-2007
10%
Percentage
8%
6%
5%
5%
5%
5%
5%
4%
2%
3%
3%
3%
3%
2%
2%
2%
2%
2%
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
0%
Survey Year
* The variable of nonmedical use of pain relievers was added to NSDUH State prevalence estimates in 2003-2004.
Marijuana Use
Cocaine/Crack Use
Nonmedical Use of Pain Relievers*
Source: National Survey on Drug Use and Health, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.
14
Recent Accomplishments of
the Texas’ SA Programs
• The number of youth served
– Over the past four years has increased from 1 to 1.5 million
• Decrease in smoking rates
– 17.9% for adults and 12.5% for youths grades 7-12
(2009)
• Clinical Management of Behavior Health
Systems
– Rollout began to substance abuse providers December
2009: full deployment was reached in September 2010
• Roll out of the Medicaid Substance abuse
Benefit
15
Medicaid Substance Use Disorder
(SUD) Benefits
• The 2010-11 General Appropriations Act
(Article IX, Section 17.15 of S.B. 1) directs HHSC to:
– provide Comprehensive Substance Abuse Services in
Medicaid to adults with substance abuse disorders;
and
– analyze and provide data to the Legislative Budget
Board (LBB) on the provisions of substance abuse
services and discontinue the benefit if services
increase overall Medicaid expenditures.
16
Service Delivery System and
Eligible Persons
• Applies to all Medicaid recipients
• Applies to all of Medicaid: managed
care and fee for service (FFS)/primary
care case management (PCCM), and
STARHealth
• Some benefits may not be clinically
appropriate for certain age groups
17
The Benefits
• The new benefits were implemented in
2 phases
• Phase I Benefits began on September
1, 2010, and included:
– Assessment
– Ambulatory Detoxification (in STAR and
STAR+PLUS managed care only)
– Outpatient Counseling
– Medication assisted therapy (MAT)
18
The Benefits (cont.)
• Phase II Benefits began on January 1,
2011, and included:
– Ambulatory detoxification (Traditional
Medicaid and Primary Case Care
Management [PCCM])
– Residential Detoxification
– Residential Treatment Services
19
Medicaid Substance Use Disorder
Challenges
• This is a complicated and unfamiliar process
• There are multiple administrative entities
involved: DSHS, HHSC, CMS, CSAT, Texas
Medicaid Healthcare Partnership (TMHP),
Medicaid Managed Care Plans, Providers,
other stakeholders
• Challenges can be overcome with continued
commitment and effort by state staff,
Medicaid payers and provider community
20
Opportunities
• This is an opportunity to
– expand clinically effective, cost efficient services
to a needed population
– expand services
– demonstrate the value of treatment, the impact
that it has on people and society, and elevate the
stature of the profession
• Provides opportunities for providers to
broaden their payor mix and expand their
revenue streams
21
Drug Demand Reduction Advisory
Committee (DDRAC)
• The 77th Texas Legislature (2001) passed
Senate Bill 558 establishing the DDRAC with
a mandate to develop comprehensive
statewide strategy and legislative
recommendations that will reduce drug
demand in Texas
• 16 state agencies must participate in this
effort, as well as 5 at-large members from
different geographical areas within the state
22
DDRAC Recommendations
• Border
• Recruitment and Retention of Service
Professionals
• Uniform Individual Accident and Sickness
Policy Provisional Law (UPPL)
• Texas Prescription Drug Monitoring
Program
• Statewide Indoor Smoking Ben
• Higher Education Alcohol and Other Drug
Enforcement
23
DDRAC Border Recommendation
• Strengthen the prevention and treatment
infrastructure along the border.
– Provide increased security and threat assessment
training for unarmed individuals in high-risk
employment fields.
– Target border counties for Workforce
Reinvestment Act (WIA) funds to incentivize
chemical dependency field.
– Provide additional funding in support of the Rural
Border Initiative (RBI) and other programs that
focus on services to border populations.
24
DDRAC Recruitment and Retention of
Service Professionals Recommendation
• Support recruitment and retention of
quality service professionals in the
field of substance abuse prevention
and treatment by reducing or
eliminating barriers to entering the
workforce and maintaining high
standards of professional development
25
DDRAC Recruitment and Retention of
Service Professionals Recommendation
– Require that local workforce boards be informed
and educated about the substance abuse
profession as a high-demand occupation.
– Establish and disseminate reciprocity guides for
each state and all branches of the military.
– Create an effective strategy to promote the
licensed chemical dependency counselor (LCDC)
profession by increasing public awareness
through state interagency efforts of information
dissemination.
– Promote access to a peer assistance program to
support counselors and aid in career retention.
26
DDRAC Uniform Policy Provision
Law Recommendation
• Remove the exclusion clause for medical expenses from
the Uniform Individual Accident and Sickness Policy
Provision Law (UPPL).
28
DDRAC Smoking Ban
Recommendation
• Passage of a statewide smoking ban to eliminate
smoking in all workplaces and public places
nationwide.
29
DDRAC Prescription Drug
Recommendation
• Expand the Texas Prescription Drug Program
to allow proactive prevention of prescription
drug abuse through web-based real-time
access to data and automatic email alerts of
potential fraud for physicians, pharmacists
and law enforcement
• Work across agencies to inform parents of
prescription drug abuse through a public
awareness campaign
30
DDRAC Higher Education
Recommendation
• Mandate comprehensive alcohol and other
drug reduction strategies targeting college
students that include:
– Enforcing the campus alcohol and other drug policy
violations through
• Alcohol screening and brief motivational enhancement
interviews
• Notifying parents of student violators under age 21
– Appointing campus-wide task forces to address
the substance abuse problems and solutions for
their campus
31
State Agency Budget Reductions
• In January 2010, the Governor's Office of Budget,
Planning and Policy requested state agencies to
identify potential savings totaling 5% of GR for the
FY 2010-11 budgets
– Agencies were urged to identify prudent reductions that
would minimize the impact on direct services
– Substance abuse items were not included by DSHS/ HHSC
• An additional10% in budget reduction options for
2011-13 was requested in May
• December, 2010 letter directed state agencies to
identify an additional 2.5% budget reduction in
current year
– Substance abuse items were not included by DSHS/ HHSC
32
Ten Percent Reduction Options (By Strategy)
Strategy
A.2.1
A.2.1
A.3.1
A.3.1
A.3.1
A.3.3
A.3.3
A.3.3
A.3.4
A.3.5
B.1.1
B.1.2
B.1.4
B.2.1 – B.2.4
B.2.5
B.3.1
B.3.3
B.3.4
C.1.2
C.1.3
D.1.4
E.1.1 – E.1.3
Description
Immunizations – Adult
Immunizations – Children
Children’s Outreach Health Program
Diabetes
Obesity Prevention
Kidney Transportation
Donate Life Registry
Kidney Medical
Children with Special Health Care Needs
Epilepsy
Farmer’s Market
Women & Children’s Services – Dental
Services
Primary Care
Community Mental Health Services
Substance Abuse Intervention
EMS/Trauma
Indigent Health Care Reimbursement to
UTMB
County Indigent
South Texas Health Care system
State Mental Health Hospital System
Massage Therapy
Support Activities
TOTAL
First 5%
1
0
0.5
0.5
1
4.5
0.4
1
0
0.45
0.85
0
Second 5%
0
7.7
0
0.5
0
0
0
6
24
0
0
1.6
Total
1
7.7
0.5
1
1
4.5
0.4
7
24
0.45
0.85
1.6
6
35.3
4
20
4.5
3
47.9
0
5
4
9
83.2
4
25
8.5
6
2.5
30
0
0.7
119.2
0
2.5
14.8
1.5
0.7
119.2
6
5
44.8
1.5
1.4
238.4
FY 2010-11 Appropriations
(By Goal)
$1,000
$900
$800
(in millions)
$700
$600
GR
GRD
$500
$400
$300
$200
$100
$0
Goal A
Goal B
Goal C
Goal D
Goal E
Goal F
Total 10% Reduction Schedule
$120
$100
(in millions)
$80
GR
GRD
$60
$40
$20
$0
Goal A
Goal B
Goal C
Goal D
Goal E
Approach to Exceptional Items
• Maintain current level of services
• Federal and state regulation
• Moving health forward in Texas
36
Exceptional Item Request
Community
Mental Health &
Substance Abuse
1.
2.
3.
Alternative
Incarceration or
Hospitalization
Border Expansion
Behavioral Health
Clinical Management
for Behavioral Health
Services
FY 2012
FY 2013
$9,372,152 $9,199,756
37
Hospital/Jail Diversion Projects
1.
Alternative
Incarceration or
Hospitalization
FY 2012
$7,447,257
FY 2013
$7,449,492
• The proposed jail diversion programs will provide behavioral
health treatment and screen for infectious diseases
• Adult Mental Health – ACT, Supported Housing
• Children’s Mental Health – WRAP around
• Substance Abuse - ATR
38
Expansion for Border Services
2.
Border Expansion
Behavioral Health
FY 2012
$1,150,264
FY 2013
$1,150,264
• In response to high levels of drug trafficking and violence
along Texas’ borders, DSHS also proposes increasing access
to prevention and treatment services in key border
communities
• Increased access to Prevention services
• Increased access to Substance Abuse Treatment services
• Expansion of Rural Border Intervention Activities
39
Enhancement of CMBHS
3.
Clinical
Management for
Behavioral Health
Services
FY 2012
$775,000
FY 2013
$600,000
• DSHS seeks to expand the capacity of CMBHS to support these
projects
• Additional functionality and certifications
• Support for jail diversion activities and voucher management
system
• Physician support functionality, E-Prescriptions Interface and
other required functionality to implement the exceptional item
projects
40
Summary
• Substance abuse continues to be a driver of
– poor health in Texas
– high societal costs
• Progress has been made in some areas, especially in to
tobacco
• Significant challenges still in alcohol and illicit drugs in
Texas
• New opportunities related to Medicaid Substance Abuse
Benefit
• The session
– DDRAC recommendations
– The budget
41
Thank You!
42