Transcript Slide 1

Premier Mental Health,
Developmental ,
and Substance Use
Disorders Services in
Virginia’s Communities
Health Care Reform: Legislative
Choices Affecting Virginians
December 13, 2012
Mary Ann Bergeron
VACSB
All The News!
• Ruling of the Supreme Court on the ACA
leaves the ACA intact
• Insurance and payment reforms will
continue
• Health Benefits Exchange will level the
insurance market for low income people
and small businesses
• Medicaid Expansion is now a choice left to
States
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If Virginia Expands Medicaid
• Expanding Medicaid poses serious but
resolvable implementation challenges
• Health care workforce can grow with stable jobs
• Shift to person-centered care, payment reform
for outcomes, and, ultimately, prevention
• Medicaid reimbursements can free state funds
for vital housing, supports, and other wraparound needs
• Behavioral health coverage is given a major
boost and lessens stigma
• Recovery and independence promoted
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Virginia’s Legislative Challenge
• Adopt “business as usual” (no expansion)
strategy that shrinks health care and related
resources, including the health workforce, in and
for Virginia’s communities, and continues the
expensive crisis-orientation in place.
OR
• Use expansion to implement reform that builds
communities and stronger, responsive health
systems, cultivates health care workers, prevents
and intervenes early before acute and extreme
treatments are necessary, and stimulates local
economies
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Currently
• 1,000,000 Virginians are uninsured, an estimated 36%
with behavioral health disorders
• Free Clinics, FQHCs, ERs, and CSBs, as safety net
providers, have capacity limitations in current
environment
• Hospitals providing charity care receive $86 M in federal
DSH payments per year, often helping with diversion
from state psychiatric hospitals
• Lack of behavioral health diversion services shifts
behavioral health costs of 27% of inmates with mental
illness to local jails
• Cost of untreated substance use is $1 B in Virginia
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Also, In Virginia
• Of over 134,000 unduplicated individuals with significant
behavioral health conditions served by CSBs in FY 12,
approximately 30% were uninsured
• Limited local and state psychiatric beds are stretched
with local crises-many due to lack of adequate, available
behavioral health services
• Gaps in critical behavioral health services exist in every
community
• Virginia Health Information Network reports from local
hospitals indicate that psychiatric crises are among the
top 10 reasons for ER visits
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CSBs and Services
• Mandated to provide 24/7 Emergency Services and case
management
• State policy and funding decisions direct CSBs to serve
those with the most significant disabilities
• Capacity to serve others less impaired is limited or
unavailable
• Population of individuals with serious mental illness (SMI)
experience major health disparities, often because of the
very medications that assist in controlling symptoms of
SMI.
• Psychiatry, medication, case management, intensive
services and wrap-around supports are typical services
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Individuals and Services-FY 12
• 232,627 individuals served (unduplicated), many
in long term situations due to the severity of the
condition
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–
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113,552 in mental health services
36,743 in substance use disorders services (SUD)
20,562 in developmental services
15,676 infants and toddlers with disabilities
46,094 in services of a more temporary nature
• Another 1.7 M youth and families served in
prevention activities/effective parenting
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FEDERAL
47,343,188
5%
OTHER
12,598,271
1%
STATE
226,133,085
24%
MEDICAID
415,689,404
45%
LOCAL
231,991,626
25%
FY 2012 Funding Sources
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Integrated Health Home Models
• 9 ANLOL projects involve 13 CSBs and
community safety net providers
• One project, Arlington and Alexandria CSBs and
ANSHI, received the only federal Innovation
Grant so far in Virginia to continue primary care
for SMI clients and expand to those with SUD
• 11 additional CSBs have developed or are
developing health homes for clients with SMI
and/or Substance Use Disorders (SUD)
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Why Health Coverage Matters
• Uninsured have no regular source of care beside
hospital ER and/or safety net providers/CSBs
• Uninsured go w/out screenings and preventive
care and likely diagnosed with advanced stages
of disease
• Uninsured adults die 25% earlier
• Uninsured charged up to 2.5 times more for
medical care
• Behavioral health needs often reach emergency
proportion before attention given
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Vision of the ACA
• More universal access to health care,
including behavioral health care
• Defined benefits for specific services
chosen by each state and a Health
Benefits Exchange to facilitate purchases
• Person-centered care rather than
provider or payer-centered care-helps
instill personal responsibility for health
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Vision of ACA
• Payments for Health outcomes rather than volume of
services
• Shift to disease prevention, early intervention/treatment
and wellness
• ACA Enacted Reforms:
-Children with pre-existing conditions retain insurance-vital
for DD/ID
-Young adults remain on family policies
-Medicare recipients eligible for covered preventive care
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ACA is Critical for Behavioral
Health
• Mandated mental health and substance use
services in essential health benefits-landmark for
consumers with behavioral health conditions
• Mental health and substance use disorders
services to be in parity with medical services
• No insurance denial for pre-existing conditions,
including psychiatric or addictive conditions
• No life time limit on psychiatric care
• Behavioral health site can be health home choice
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Key Decision Points for 2013
Session
• Medicaid Expansion January, 2014 for
420,000 uninsured Virginians to 138% of
FPL
• 30,000-40,000 are existing CSB clients
• Behavioral health services in Essential
Health Benefits will be reimbursed
• Until 2017, payment is 100% federal share
• Phase-in State match to 10% in 2020
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Benefits of Medicaid Expansion
• Medicaid expansion to 138% can mean up to 40,000
existing CSB clients would have essential health
benefits coverage, decreasing crisis and acute episodes
• Medicaid expansion for 420,000 Virginians is estimated
to bring $29 Billion to Virginia’s communities in health
care reimbursements
• For your community, this translates to stable jobs in
health care and related activities and increased
consumer spending now and in the future
• Localities and citizens can benefit from improved access
to health care, stimulated economies, increased
consumer spending and growth of local and state tax
base
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If No Expansion?
• Current economic situation may worsen and
public funding shift to other priorities
• Safety net providers in communities will bear the
pressure, probably more than now
• We will keep competing for same piece of the
shrinking state pie
• How attractive/stable will jobs in health care be?
• USA may not get to the vision of a healthy nation
that can compete in the future global market
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What is Being Said?
• Too many unknowns to go forward
Other states like California, Oregon, Maryland,
Massachusetts are expanding now
• How will the federal government pay for this?
The ACA contains the payment sources
• Let’s Block Grant for flexibility
Virginia is 47th in nation for Medicaid per capitaunwise to block grant, especially now!
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What CSBs Know
• The populations we serve and their
demographics
• The services that work and produce good
outcomes for these populations
• That outcomes can be measured in in
community tenure (avoiding jail, crisis, and
hospitalization), recovery and well-being,
employment, and improved health and quality of
life
• *We are working on the costs of services-a
critical piece to know
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Health Reform Will:
• Align/re-align incentives for care in community
• Use bundled rates rather than FFS to produce
health outcomes
• Reward person-centered effective care rather
than volume –safety net providers are experts!
• Engage individuals in person-centered care
because their outcomes really matter
• Upgrade and use IT to improve outcomes and
get paid
• Make IT and services customer friendly!
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CSBs Will Make Choices
• Expand to meet demand, find new partners, and/or
build on current partnerships to create health homes
at CSB site or with other providers at their sites
• Teach/collaborate with other providers in use of
behavioral health services and maximize and expand
capacity of scarce staff
• Integrate primary, behavioral, and acute care in
partnerships-ANLOL projects can be models for
health homes and/or behavioral health homes
• Help create person-centered “accountable care” in
communities with community partners
• Use technology to make decisions and to support
decisions
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If No Medicaid Expansion
• A “business as usual” decision continues the current
lack of health care for thousands of Virginians,
especially those with behavioral health needs
• Hidden and obvious costs of substance use
disorders will continue to rise
• Economic and health issues in communities persist
and can result in fewer health workers, fewer stable
jobs, more crisis-orientation and expensive treatment
• Hospitals lose DSH payments-will General Funds
make up the difference?
• Health costs and health premiums rise with no
discernable benefits to communities
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Action Steps To Take NOW
• Work with your local CSB to know what your
local expansion numbers are and what health
coverage expansion will mean in your community
for community health, to your local hospital, to
the local economy!
• Use the data to educate local legislators about
impact and to advocate for health reform and
Medicaid expansion with your General Assembly
members-NOW-don’t wait till the Session is
underway.
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Operational Steps NOW
• Know your “niche’ areas and strengthen
them
• Assess your relationship with the local
CSB and strengthen it
• Know your clients’ behavioral health needs
and how those needs impact their primary
care
• What other partners do you need for
“Accountable Care”?
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And Now
Questions!
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Thank You!
Mary Ann Bergeron, VACSB
[email protected]
www.vacsb.org
804.330.3141
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