Transcript Slide 1

1
2
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
BEHAVIORAL HEALTH
3
SOCIAL
PROBLEM?
or
PUBLIC HEALTH
ISSUE?
WHY DOES IT MATTER?
4
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;
don’t teach signs, symptoms and how to get help for
mental health or substance abuse issues
BH AS A SOCIAL PROBLEM LEADS TO
INSUFFICIENT RESPONSES
5
Increased
Security &
Police
Protection
Tightened
Background
Checks &
Access to
Weapons
Legal
Control of
Perpetrators
& Their
Treatment
More Jail
Cells,
Shelters,
Juvenile
Justice
Facilities
Institutional
System &
Provider
Oversight
ELEMENTS OF A PUBLIC HEALTH MODEL
6
WHY A PUBLIC HEALTH APPROACH?
7
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
WHY PUBLIC HEALTH . . .
High levels of unmet need
8
• 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)
SAMHSA – A PUBLIC HEALTH AGENCY
9
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)
SAMHSA’S STRATEGIC INITIATIVES
10
1
Prevention
2
Trauma and
Justice
3
Military
Families
4
Recovery
Support
5
Health
Reform
6
Health
Information
Technology
7
Data,
Outcomes
& Quality
8
Public
Awareness
& Support
HEALTH REFORM AND THE CHANGING
HEALTH CARE ENVIRONMENT
11
Prevention and wellness rather than illness – a public
health approach
Role of states increasing, especially in health “care”
Integration rather than silo’d 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
PARITY/ACA: PROJECTED REACH
12
Individuals who
Individuals with
will gain MH, SUD, existing MH and SUD
or both benefits
benefits who will
under the ACA
benefit from federal
including federal
parity protections
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
PENNSYLVANIA: STATUS OF DECISIONS ON
FFMs, EHBs, AND MEDICAID EXPANSION
13
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 - state’s 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
PA: HEALTH INSURANCE COVERAGE
TOTAL POPULATION, 2010-2011
14
Source: Kaiser Family Foundation
NATIONALLY: PERSONS WHO ARE
UNINSURED <400% FPL
15
29%
with BH conditions
71%
without BH conditions
Source: NSDUH
IN 2014: MILLIONS MORE AMERICANS WILL
HAVE HEALTH COVERAGE OPPORTUNITIES
16
 Currently, 37.1 Million Are Uninsured <400% 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
PA: PREVALENCE OF BH CONDITIONS
AMONG MEDICAID EXPANSION POP
17
Uninsured Adults Ages 18-64 with Incomes
< 139% of the Federal Poverty Level (Pennsylvania: 482,704)
25%
Prevalence Rate
20%
15%
National
Pennsylvania
10%
I Confidence
Interval
5%
0%
7.0%
5.8%
Serious Mental Illness
PA CI: 3.6% - 9.1%
U.S. CI: 6.3% - 7.7%
14.9% 14.1%
14.2% 16.4%
Serious Psychological Substance Use Disorder
Distress
PA CI: 11.4% - 23.2%
PA CI: 9.9% - 19.7% U.S. CI: 13.2% - 15.2%
U.S. CI: 14% - 15.9%
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012); 2010 American
Community Survey
PA: PREVALENCE OF BH CONDITIONS
AMONG EXCHANGE POPULATION
18
Uninsured Adults Ages 18 - 64 with Incomes Between
133- 399% of the Federal Poverty Level (Pennsylvania: 559,571)
25%
Prevalence Rate
20%
National
15%
Pennsylvania
I Confidence
10%
Interval
5%
0%
6.0%
4.0%
13.3% 12.6%
14.6% 16.0%
Serious Mental Illness Serious Psychological
Substance Use
PA CI: 2.2% - 7%
Distress
Disorder
U.S. CI: 5.5% - 6.6%
PA CI: 9.2% - 17.1%
PA CI: 12.2% - 20.6%
U.S. CI: 12.5% - 14.2% U.S. CI: 13.7% - 15.6%
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012); 2010 American
Community Survey
AFFORDABLE CARE ACT
ENROLLMENT ASSISTANCE ACTIVITIES
19
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
SAMHSA ENROLLMENT STRATEGY
20
 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
SIMPLE STREAMLINED
APPLICATION PROCESS
21
Now
2014 (beginning Oct 1, 2013)
Different applications for
different programs
Regulations require a single
application as gateway to all
coverage programs
Denied? Back to the
drawing board
Applications often only
available on paper or as
PDFs if online
Must be available online, by
telephone through a call
center, by mail, and in
person (www.healthcare.gov)
In-person interview
requirements
Interview requirements
prohibited
ENROLLMENT RESOURCES
22
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-andEducation/Outreach/HIMarketplace/index.html
Different types of ACA consumer assistance
• http://www.cms.gov/CCIIO/Resources/Files/Downloads/mar
ketplace-ways-to-help.pdf
PARITY IN AFFORDABLE CARE ACT
23
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
ESSENTIAL HEALTH BENEFITS (EHBs)
24
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
PROVIDERS ACCEPTING HEALTH
INSURANCE PAYMENTS
25
SA TREATMENT FACILITIES ACCEPTANCE SOURCE OF FUNDS FOR CMHCS**
OF INSURANCE PAYMENTS *
*Source: NSATSS
**Source: 2011 NCCBH BH Salary Survey
FOCUS: PROVIDER READINESS
BHbusiness Networks
26
TA to help 900+ provider orgs/year in 5 areas of practice
1.
2.
3.
4.
5.
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/
NATIONAL CONFERENCE ON MENTAL HEALTH
JUNE 3, 2013 • EAST WING, WHITE HOUSE
27
 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
THE PRESIDENT’S PLAN: MENTAL
HEALTH AS A PUBLIC HEALTH ISSUE
28
 Less than half of people w/BH conditions receive
the care they need
 President’s 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
“We are going to need to
understandings/messages
work on making access to
mental health care as easy • Focused on prevention (healthy communities)
as access to a gun.”
and earlier intervention
--President Obama
PRESIDENT’S FY 2014 BUDGET:
$235M IN NEW PROGRAMS
29
Department of Education -- $75 M
1.
2.
Safer School Climates: $50M to help 8,000 schools implement evidencebased 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 schoolbased violence prevention strategies
Health & Human Services – $160 M
CDC – $30M
1. Gun Violence Research: $10M to understand causes and impacts, including
relationship between video games, media images, and gun violence
2. Nationwide Violent Deaths Surveillance System: $20M to increase
reporting system to all states
FY 2014 PROPOSED NEW MENTAL
HEALTH PROGRAMS: SAMHSA $130M
30
SAMHSA -- $130 M
1.
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
FY 2014 PROPOSED NEW MENTAL
HEALTH PROGRAMS: SAMHSA – cont’d
31
2.
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
3.
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
HRSA’s 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 SAMHSA’s
Minority Fellowship Program, focusing on preparing masters level behavioral
health professionals serving youth/young adults
BH AS PUBLIC HEALTH
OUT OF THE SHADOWS…
32
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