Health Care Reform: Implications for Behavioral Health Providers
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Health Care Reform: Implications for Behavioral Health Providers

Rebecca: (inaudible) …welcome to
the National Council Live Webinar, Healthcare Reform: Implications
for Behavioral Health Providers. My name is Rebecca Farley. I’m the Policy Associate at the
National Council for Community Behavioral Healthcare and I will
serve as your moderator today. We would like to
thank Charlene (LaFove), (Najay Saleem), Deborah (Stone)
and John O’Brien from SAMHSA for sponsoring this webinar. Before I introduce the speakers and
turn the mic over to John O’Brien for introductory remarks, I’d
like to draw your attention to some important webinar logistics. Today’s webinar is being recorded and
you are currently in a listen only mode. If you’re listening on your phone,
please enter on your telephone keypad the audio pin number from the control
panel on the right of your screen. You may send us questions for the
speakers at any time during the webinar. Simply type your question into the
dialogue box at the right of your screen and send it to the organizer. Depending on the question, I
may type an answer back to you, interrupt the speaker to ask
it, or save it for the end. We’ll answer as many of
your questions as time allows. An audio version of the
entire webinar and a PDF of the presentation will be available
on the National Council’s website following the webinar. If, at any point, during the webinar
you experience technical difficulties, please call Citrix tech
support at 888-259-8414. And now, on to the topic of today’s webinar. Today’s webinar will provide information
and guidance to plan and prepare for clinical and fiscal changes, including
those related to Medicaid and discuss the implications of the Patient
Protection and Affordable Care Act for the behavioral health system. Our agenda includes introductory
remarks from John O’Brien, Senior Advisor to the Administrator
on Health Finance at the Substance Abuse and Mental
Health Service Administration and then a presentation from
our two speakers followed by a Q & A session with the audience. Charles Ingoglia has
worked as a provider, advocate and educator for government
and public sector organizations for more than fifteen years. In his current role, Mr. Ingoglia
directs the federal affairs function of the National Council as well as
its policy and technical assistance outreach to more than one thousand
seven hundred member organizations across the nation. Most recently, his efforts have
centered on key issues such as parity, healthcare reform and
increasing access and retention in community behavioral healthcare. Dale Jarvis brings a diverse background
as administrator, author and educator to healthcare organizations
throughout the western United States. He has served as the
financial director for healthcare organizations in
Washington and Michigan. He also taught Healthcare Financial
Management at the University of Washington, School of Public Health. Before our presenters begin, John
O’Brien, Senior Advisor to the Administrator on Health Finance at the
Substance Abuse and Mental Health Services Administration will provide
introductory remarks on the importance of primary and
behavioral health integration. John has extensive experience in the
design and implementation of system reform initiatives and has
provided consultations to more than thirty-five states and local
human services authorities. He has worked with
Medicaid, Child Welfare, State Behavioral Health and
Mental Retardation authorities. His primary focus is assisting
states in developing state plan amendments for mental health
services, federal Medicaid waivers, managed care vendor procurement
and financing mental health, substance use and child welfare
services and the research of children’s behavioral health systems. And now, it is my pleasure to turn
the webinar over to John O’Brien. John, you may begin. John: Thank you. Well, welcome everyone. I’m a little bit overwhelmed by the number
of people that have been interested in this webinar and right around
two o’clock we actually maxxed out in terms of the number of folks who
could present or who could participate. So, we will — we welcome the folks
that are on and future presentations we will probably get more lines but let
me thank our presenters in advance. This topic is very interesting to
many people and we thought that this would be our first foray into the
SAMHSA sponsored webinars on various elements of healthcare reform. I also want to thank AHP for
organizing this webinar and thank all of you who are listening. This is our first of our Fall
learning sessions that SAMHSA is sponsoring regarding basic
concepts on healthcare reform. Over the past several months, SAMHSA
has an environmental scan of our stakeholders to identify what
were some of the concepts that they wanted more information on. This first session is focused on
the concept of health homes and accountable care organizations. Over the next two weeks, SAMHSA will
have calls on several other topics, including one and two days. On the 23rd at two o’clock Eastern
time on health insurance exchanges and on September 30th at two
o’clock on high-risk pools. So, let me talk a little bit about
what we want to accomplish today. As indicated in the prior conversation,
we have some interest in offering some basic information on health homes
and accountable care organizations. I think that there’s lots of interest. In some respects, there is some
misconceptions about what those are and we thought we would use this webinar, at least, as a start to hopefully provide
some good information and hopefully, dispel some of the
misconceptions around health homes and accountable care organizations. We are going to talk a little bit about
why these approaches are important. Why the concepts and maybe
the nomenclature seems new. The concepts and the approaches are
not necessarily new and they’ve been around for awhile and we want to
talk a little bit about not only their history but
why are we doing this, why is it important now to
pay attention to this is. I did want to mention that this
session is not about the specifics of the health home provisions
and the Affordable Care Act. I’m actually getting some feedback. Female: Yes, we can hear her. Female2: Is that who that was? Female: Yeah. John: Anyway, the session is not about the
specifics of the health home provisions in the Affordable Care Act, which
is Section 2703, as you know. SAMHSA and CMS is partnering
on that particular part of the affordable care act. We are in the process of
working together on providing some additional guidance to states on
that provision and hope to have this out to states soon. We know that there is a lot of interest
in this so we won’t be discussing this provision on this call or
we won’t be able to answer questions on this call related to that section. We will offer that opportunity
later on after we can get some guidance out about it. So, why is integration of primary
care and behavior health important? Some context that we at SAMHSA
have been using as we’ve been talking about primary care and
behavioral health integration is some of the important statistics. We know that a few
years ago in 2007, almost twelve million of the ninety
million visits annually to emergency rooms were by people with a mental
illness or substance use disorder. We also know that forty-four percent
of all the cigarette consumption that is in the United States are
done by individuals with mental health and substance use disorder. And in a number of places,
there have been studies, which have shown that seventy
percent of the individuals with significant mental health and
substance use disorder have either one or more chronic conditions. And so, those statistics and as well
as many other statistics underline the need to have a connection
between primary care and behavior health integration. If we go to the next slide, I
just want to talk a little bit about SAMHSA’s primary care behavioral
health initiative project. We had launched the project last fall
and really the project represents SAMHSA’s approach to primary care
and behavioral health integration. SAMHSA believes that it is important
to have a bi-directional approach to primary care and behavioral
health integration which means both behavioral health professionals,
behavioral health services in primary care settings like
federally qualified health centers, community health centers as
well as large practices but also, the importance of being able to have
primary care in behavioral health settings, community
mental health centers, substance abuse treatment providers,
other behavioral health providers whom individuals with serious mental
illness and/or significant substance use disorders have often seen those
organizations as their health home, as the organization that’s
accountable for their care. So, we wanted to make sure
that we framed it as really a bi-directional approach. The Primary Care Behavioral Health
Initiative Project has thirteen sites. More sites will be awarded. They are going to be
awarded this week. We are actually waiting towards the
end of the week where the secretary will announce these sites. And in addition, she will announce
a technical assistance center that SAMHSA and HRSA is co-funding in
order to provide mental health and substance abuse providers with
primary care integration strategies. So, we’re really excited not only
about this webinar but about our efforts as it relates to primary
care behavioral health integration. They’re expanding. They’re expanding quickly and we
felt that regardless of what was in the Affordable Care Act that this
is something that we needed to pay attention to because it was
certainly the wave of the future and therefore, wanted to get this
information out to folks sooner rather than later. So, I’ll stop there and I’ll turn
it over to the National Council who will walk through some important
questions and really take you through the rest of
the presentation. Male: Chuck, if I could
interrupt just for a second. Dale, are you on the line? Dale: Yes, I am. Can you hear me? Male: Yes, thank you. Okay, go ahead, Chuck. Chuck: Well, John, thank you so much
for that introduction and we’re so grateful to SAMHSA for all the
leadership that the agency has provided in this area,
the area of integration. And obviously, your new
grant program that pays for the co-location of primary care capacity
within mental health — within behavioral health organizations is
critically important both for the people who need those
services as well as I think, the message that it sends to the
broader field about the importance of bi-directional care and the fact
that mental health and substance abuse really are part of
healthcare and need to be connected. So, we’re very greatful to administrator
Hyde for all of her leadership and the great work that you do, John, at SAMHSA setting a course for the field
as we move into our future. As John indicated, today’s webinar
is trying to kind of get at some basics of the affordable care act
and what we’re hoping to do in the course of today’s webinar is answer
two questions which we think are really important to understanding
the design implementation and implications of healthcare reform. So the first question really is will healthcare reform really
change the healthcare system. What do we have — you know, kind of —
what is in there that holds implications for consumers or families or
providers for authorities as they think about their future as part
of the larger healthcare system. The second question really has to
do with how does the answer to the first questions affect the lives
of people with mental health and substance use disorders and the
organizations that serve them. I think an interesting — we find
ourselves at an interesting point as a field that for years we’ve been
asking to be part of healthcare. That we wanted the broader healthcare
community to recognize the importance of the provision of mental
health and substance use treatment. And I think with the passage of
the Affordable Care Act and its many provisions, I think that we got
what we always had been asking for. Where we are seen as part of
healthcare and now the question really comes down to how
will this impact our system? So I just want to — we’re
going to use some words and/or some abbreviations in the course of the
Webinar and I just wanted to kind of go over those to make sure
that we’re all on the same page. So you might see the initials
SMI and we’re using that as an abbreviation for
serious mental illness. The kind of —
current term being used. Substance use describes the broadest
context of alcohol and other drug (services) and disorders
so we tend to use that. We use the term behavioral health to
describe services that are for — or mental health and substance use
disorders and you might see a reference to co-occurring disorders. And we use the definition for
that as a presence of both a mental disorder and a
substance related disorder. So let’s turn then,
to our first question. Will health care reform really
change the healthcare system? And this is not an insignificant
question and it’s not insignificant because of the fact that in
the United States right now, we really have a story of the best
and the worst healthcare system. Obviously, we spend a significant
amount of money in the provision of healthcare and yet, if you look at
the rate of preventable deaths in industrialized nations, it’s almost
counterintuitive that the country that spends the most on healthcare
also has the highest rates of avoidable deaths compared to
other industrialized nations. That then takes us right to the
question about healthcare spending and the serious problem confronting
us as a nation which is if healthcare expenditures continue to
increase at the rate they have been, they will continue to consume an
ever larger amount of gross domestic — represent a consistently
larger amount of our domestic — gross domestic product and will
really make the United States non-competitive in the rest of the
world that as — the healthcare will consume so much of our spending
that it really will present — put businesses in an awful position. And also, from a — the position
of the amount of money available. If you think about the role of the
Federal government and states have in paying for healthcare that as
those expenditures continue to increase, the amount of money
available for other programs decreases at the same time. In his introductory
remarks, John touched on this. There is — then this question
becomes what do we need to do to deal with the first problem, which
is the number of avoidable deaths, and the second problem, the
amount of money that is spent in the United States’ healthcare system. And folks, health policy leaders
have really focused on the fact that it’s really a small
percentage of people, those with chronic conditions
who account for a disproportionate amount of spending in
the US healthcare system. So people with chronic conditions
account — which is about forty percent of people, account for
eighty percent of the spending. And if we look within that cluster,
we also see that there are very high rates of mental disorder and
substance use in that population who also has a chronic illness. And certainly, there is some
relationship factors there that people living with chronic — with
heart disease or diabetes — tend to have high rates of depression, etc. And if this is a study looking
at data from Washington State, that if you look at the fact that all
of these illnesses terribly overlap. So the question becomes — there is an —
there is a link between these illnesses, that they tend to be co-occurring and
we need to do something holistically if we’re going to address the rate of
spending related to chronic illnesses. The next slide also just talks about
the need to address this holistically. Not only do people with chronic
health conditions have high rates of substance use and mental
illness but conversely, people with mental illness and
substance use in co-occurring disorders have high rates of chronic
— other chronic health conditions and that that combination of factors
is very deadly for this population. So the research prepared by the
National Association of State Mental Health Program Directors based on
data from eight public mental health systems showed an average life
span of fifty-three for people with serious mental illness. The State of Oregon did some further
research and they looked at what were the death rates for
people with serious mental illness, what were the death rates for people
with — being treated for substance use disorders and what was it for
people with co-occurring disorders. And in Oregon, they found that
people with co-occurring disorders actually have an average
age of death of forty-five. So if you kind of put that — that’s
comparable to life expectancy in sub-Saharan Africa. So obviously, there’s this huge
issue here of how do we improve the life trajectory for this population? If we think then, about the
relationship of these illnesses and why it’s important to think holistically, this data from California
is also interesting. And it shows that the — not only
is the overall cost of care in the mental health system higher than
other people who are enrolled in Medicaid but that the rate
of chronic illnesses is also substantially higher
for this population. So if you look at the Medicaid
— (medic) health fee for service population total and then you then
just look at the population that has serious mental illness, you see huge
disparities in the amount of monies spent on that population as well
as the rates of chronic illnesses. So I think — all of these
statistics have — point then, to a couple of conclusions. One, that there is a growing
awareness of the prevalence of mental health and substance
use disorders and the costs, the true costs of not providing
effective treatment and supports to address those disorders. Now obviously, those are costs
in terms of spending as well as loss of life. And that awareness is happening at
the same time that there is broad recognition that the
services we provide are essential, that prevention works,
that treatment is effective, people can recover. So, it’s kind of this interesting
confluence of understandings occurring. Those of you who follow the healthcare
reform debate have heard a phrase that was coined by the then director of
the Office of Management and Budget that one of the goals of healthcare
reform was to bend the cost curve. And of all of this data that
we have examined so far today, if we’re going to achieve that, if
we’re actually going to reduce the amount of money that is being
spent by the healthcare system, there is no way that we can
accomplish that without addressing adequately the healthcare needs of
persons with serious mental illness, the co-occurring disorders and
the mental health and substance use needs of the population
that has chronic illnesses. And we’ll come back to this
later in our presentation. So then as we entered into
the healthcare reform process, there were really kind of
several goals driving policymakers. If you would talk to
people in the White House, people on Capitol Hill that really
the goal here is two-fold: how do we improve quality of care
while managing costs. And there were a couple of
ideas that were then included in healthcare reform to
try to achieve that. The first is this notion of
moving from a sick care system to a healthcare system or another way
to say that how do we move further upstream with prevention and early
intervention services to prevent health conditions from
becoming chronic health conditions. If we think about to some of the
points that I made earlier about the amount of money that is spent by
our healthcare system on persons who have chronic health conditions, that
it makes a lot of sense that we want to try to avoid those chronic health
conditions from ever occurring. Secondly then, related to that is we
also wanted to dramatically improve the management of chronic health
conditions for Americans who have one or more of those conditions. So then, there are then particular
interventions and ways of organizing services to better manage care and
we’ll talk about and I think John talked about the fact that we are
going to talk about healthcare homes and accountable care
organizations today. Those are two of the ways that are
being talked about to try to improve that management of
chronic health conditions. And then a third goal always is, A: how do we reduce errors and waste in
the system and reduce incentives for high cost low value
procedure based care. So every system is perfectly
designed to achieve the result that it achieves. So the idea here is that if things
aren’t going right in our system it’s because it’s — has a
design flaw and part of then, what we are going to be talking
about are ways to re-engineer the system to produce different outputs. I’d also say that even before
healthcare reform legislation was being considered in Congress
that the President and the Congress realized that there was another
first step that they had to take in order to achieve this vision. And that was in the passage of the
High Tech Act which was part of the Recovery Act that was — were the
first pieces of legislation — one of the first pieces of legislation
passed in the hundred and tenth Congress and that really envisioned
a future where healthcare providers, hospitals could be connected to
each other electronically to share patient information to reduce
unnecessary and duplicative tests and to improve care quality. So a lot of what we’re going to be
talking about — a lot of the vision for how the healthcare system
will change is really built on that electronic infrastructure. That the ability of healthcare providers
to share information electronically about common patients becomes very
important as we go into the future. Whenever I describe the
Healthcare Reform Law, I really say that there are
four pillars underlying the law. There are four things that
it was trying to achieve. The first is insurance reform. Second, coverage expansion. Third, delivery system redesign
and fourth, payment reform. I think it would be fair to say that
the law did a lot more on the first two pillars, insurance
reform and coverage expansion. It laid important groundwork for
the second two but I think the difference is also reflected in —
is a product of what we’re being — kind of what’s envisioned here is
that things will have to change in order to achieve payment reform
and delivery system redesign. And I often reflect that the most
important thing I learned in social work school was the notion that all
organisms tend toward homeostasis. That none of us likes to change
and the prospect of change is scary. It conjures up images of winners
and losers and I think what we — in order for payment reform and
delivery system redesign to be effective we’ve got to be smart
going into that and not be afraid of what the future might hold. So the notion of insurance reform,
kind of why is that important? You think about it, every country
that has approached healthcare reform has done it from the
foundation in which it found itself. No country just took whatever
healthcare system they had, threw it out the window and started
from scratch as attractive an idea as that is to some people. So, in our country, private health —
since World War II, private health insurance offered by employers is
the primary source of coverage. So we wanted — Congress obviously,
then wanted to build on that foundation of private insurance
coverage yet there was broad recognition that the insurance
system might not be as a reliable partner as it needed to be
in order to make this work. So then there are quite a few
changes to the insurance system contained in healthcare reform to make
private health insurance a more stable, reliable partner and resource
for people who need healthcare. So there are a number of changes
to the healthcare system contained in the law. I’ll just mention a few that I think
are particularly important to people with substance use and mental
illness — substance use disorders and mental illness. The first is that insurance
companies can no longer deny coverage based on
pre-existing conditions. That all insurance policies have to
be offered and renewed regardless of the health conditions experienced
by people who have that coverage. There will also be prohibitions on
all annual and lifetime limits so your insurance company can’t pay
to a maximum in a year or in your lifetime, that the amount of
healthcare that you need is the healthcare that you need. Another interesting one is the notion
that young adults will have the option of re-staying on their parents’
insurance until the age of twenty-six. Now this will be particularly
interesting as this is a prime time for people to develop substance use
disorders and/or mental illnesses and — then it really begs the
question of how adequate are the services that people can
access through their private health insurance and — so I think that is going
to be something we’ll need to watch going into the future. Another component of healthcare reform
is this notion of coverage expansion. So we currently have fifty million
people it’s estimated in this country who don’t
have health insurance. What do we do to — what do
we do to cover those people, to give them some source of
health insurance coverage? And again, the approach that
Congress took was to build on what was already there and it
does that in two ways. The first is to build on
the foundation of Medicaid. That Medicaid is an entitlement
program for people — for poor people and people with disabilities and
it’s historically been categorical. That you qualify for Medicaid
through a combination of your income as well as you meeting certain
eligibility characteristics. So the Federal government has said
we’re going to expand Medicaid but we’re — but where it’s only going
to be based on — this new expansion of Medicaid will only be
based on your income level. So that for individuals and families
who make a hundred and thirty-three percent of poverty or less, that
they will be eligible to enroll in their state’s Medicaid program. Unfortunately, that Medicaid
expansion will allow states to offer a reduced benefit from traditional
Medicaid but it’s also something I think we need to think about but
nevertheless, six million people are expected to enroll in Medicaid
as result of this expansion. Going back to my previous thought
or comment about the role of private health insurance then what we’re —
the Healthcare Reform Law also then creates a new marketplace for
individuals and small employers to purchase insurance through these things
that are called health exchanges. So states — individual states or
groups of states will have the ability to create these health exchanges
and think about them in two ways. One is creating a kind of large
purchasing pool for insurance. So it’s all these people who either
individuals or families or small employers pooling together to
purchase insurance and if you think about the way this
works for employers, typically the more employees you
have the better rates you can get on your insurance coverage. So that’s — it’s creating this
pooling mechanism and in effect, the exchange will be a state
sponsored website that allows you to know which plans are available in
your state and to choose among them. So I’ve heard people refer to it
as Expedia for health insurance. And in order to make that work —
so this is for people between one hundred and thirty-three percent of
poverty — individuals and families between a hundred and thirty-three
percent of poverty and four hundred percent of poverty that the Federal
government will provide subsidies to help people purchase insurance. What’s important about both
the Medicaid expansions and the insurance that is going to be
available through these health exchanges is that in both cases,
mental health and substance use benefits are required and the
federal parity law cross-references — I’m sorry. The Healthcare Reform Law
cross-references the Pete Domenici, Paul Wellstone Mental Health
Parity and Addiction Equity Act. And that bill basically says that
you can’t — that everything has to be even, financial requirements,
limitations have to be even between medical surgical benefits and
mental health and substance use. So we have a situation here that all
plans offered through the exchange have to offer mental health and
substance use as part of their essential health benefits,
parity applies and then, this is also the case then in the
Medicaid expansion that mental health and substance use are mandatory
and parity applies there as well. So obviously, many think tanks,
others have been kind of writing and producing models
around, kind of changing the American healthcare system. I think one of the most influential
groups has been the Commonwealth Fund and the Commonwealth Fund,
really right as healthcare reform was taking off, issued a paper that
said that if there were ten things — if these ten things were
accomplished in healthcare reform, it would result in savings of about
three trillion dollars over ten years. And those ten things
fall into three buckets. One of them is near universal
coverage so the coverage expansion (inaudible) is very important
then towards achieving this goal of saving money. The others then, fall into these
categories of payment reforms and improving quality and
outcomes, which are also part of delivery system redesign. And that’s what brings us then to
these notions of healthcare homes and accountable care organizations. And kind of everyone is talking
about healthcare homes and kind of, “Why is that?” “Where do they come from?” “Why do they get that name?”
and “Why are they important?” Those are some of the
topics we’ll try to navigate. So the notion of healthcare homes
really was born — kind of came out of work done by the American Academy
of Pediatrics in the seventies. Trying to think about how to
redesign pediatric care to be more effective to produce
better outcomes for kids. Eventually, that notion was then
adopted by all of the large primary care specialty associations and kind
of this notion grew out of this idea that — and many of us
have experienced this right? That trying to navigate the
healthcare system is like trying to find your way
through a tangled maze. Those of us who have chronic health
conditions or if we have family members who have chronic
health conditions, understand that individuals could be forced to
— they might have a primary care physician as well as two or three
specialists that they are seeing. None of these doctors
talk to each other. They don’t
necessarily share information. So the idea here is
how do we improve that? How do we take the responsibility
off of the consumer to make that connection to manage their care,
that consumer or their family and how do we make it really
part of the healthcare system. So what healthcare homes are also
part of is a larger notion about how do we redesign care? And I think if you — to think about
this is really can we picture a world in which all of
us has a long term, ongoing relationship with
a primary care provider. That the primary care provider
stays with us over multiple years. That that primary care provider
has the support in their office, a care team who collectively takes
responsibility for ongoing care. That there is a team in that
healthcare practice that is making referrals, that is following up with
other — those providers that they made referrals to, that
they’re sharing information, that they are able then, to fit all
the pieces together and it’s not the individual or the family’s
responsibility to do that. We envision that each of these care
teams would have behavioral health capacity, a behavioral
health specialist on it. So the idea here then, is you would
have this practice that’s doing this and the — really the goals are
that as a result of having this relationship, this
care coordination, the quality and safety are the
hallmarks of what is happening, that medical homes are expected
to have enhanced access to care meaning that you have access to that
practice on evenings and weekends and that payment shifts from being
about how many people that I see that day to added value. If you think about right now, most
primary care — if you’ve seen your primary care doctor recently, right,
your appointment is probably about seven minutes and the reason it’s
about seven minutes is your primary care doctor has to get in a certain
number of — amount of volume in a day in order to make his
or her practice profitable. And the notion here with
healthcare homes is to say, that’s not what this is about. It’s not about seven minute
appointments in order to generate enough fee for service billing. It’s really about how do we improve
care for the individuals that we’re seeing in our practice. And we’ll hear about ways then,
that this has driven the redesign of care in certain places. So lots of — there are — the
last slide referenced these joint principles that were developed by
the (inaudible) medical specialty to kind of layout the groundwork for
kind of what are our expectations around medical homes and
then, individual states, of course, have to take
their own crack at it. What’s the other
interesting — is that Oregon, I think, what they tried to do is
they thought about how are they going to implement on the concept
of medical homes and their Medicaid program, they took these notions and
put them into people first language. So the idea here then, is that
healthcare homes are there when — that they will be
there when I need you, that they’re going to take
responsibility for making sure I receive the best
possible healthcare, the provider helped me get the
healthcare and services I need, they’ll be my partner over
time in caring for my health, that they’ll help me navigate the
healthcare system to get the care I need in a safe and timely way
and recognize that I am the most important member of my care team and
not that I am ultimately responsible for my overall health and wellness. So I think that the notion here
that’s being driven at is improved quality, patient centered,
kind of person-centered care. What’s a little confusing, as I
mentioned is that there are many different names right
now for healthcare homes. As we mentioned, these medical
specialties came together and then they developed standards for
patient centered medical homes. The National Council contributed to
this (confusion) in a paper that we developed and released in 2007
called Person Centered Healthcare Homes that we wanted the focus to be
broader than just the medical system to explicitly include the specialty
behavioral healthcare systems. Oregon has dubbed theirs
patient-centered primary care home. Sometimes there are
abbreviations of medical homes. In the Affordable Care Act
actually uses the term health homes. All of these terms however, refer
to the same goal of trying to convey the message that the primary care
clinic of the future isn’t going to look like the primary
care clinic of today. And Dale, I think I’m going
to turn it over to you now. Dale: Very good. Thank you, Chuck. Can you hear me? Chuck: Yes, we can. Dale: Great. Thank you. I’m going to pick up with the three
questions that Chuck was talking about related to
healthcare homes, what are they, why did they get that name and why
are they important by talking about why they’re important. I happen to live in Seattle and
(Group Health) story to tell about what they’ve done
with medical homes. Group Health was started after World
War II by a group of Quakers and they’ve always seen themselves
as being prevention and early intervention
oriented, patient oriented. They used to actually have — make
major decisions for the cooperative by having members and advisory
council literally sit around in a circle and decide whether to build a
new hospital or a new clinic or how to change the practices. In 2002, they realized that they
weren’t really doing enough in the primary care area so they made some
changes and they said we’re going to do three things different
with our primary care clinics. Everybody can email their doc. You can have online access to your
medical records and you can have — get into care to see a doc or nurse
practitioner same day, next day. And as you can imagine, this
increased patient satisfaction but we also saw provider burnout and
we saw decline in quality scores, which makes perfect sense because
if you look at those three bullets, everybody was being asked
to do more in the provider, but they weren’t
adding any more services. So they got really nervous about
the provider burnout and the quality score decreases and so they tried an
experiment on the East Side in Seattle in one of the clinics where there were
ninety-two hundred adult patients. They decided not to experiment on
the kids and what they did was they said we’re going to implement some
medical home idea closer to fidelity so if you think about what Chuck was
talking about with those principles, there were two key
interventions that they made. They added substantially more staff. If you look at the
numbers on the screen, you can see lots more docs, lots
more nurse practitioners, etc. And they shifted — they’ve
(inaudible) their appointment schedules for all the docs
and nurse practitioners. They basically said everybody
has a default of thirty minutes. And Chuck’s seven-minute example is
what I experienced in healthcare and so this is a radical departure
from what Group Health is trying. What they did was they — by adding
more staff and increasing the time the doc had with those patients, they
lowered what’s called the panel size so given doc or nurse practitioner
had fewer patients that they needed to manage. And their hypothesis was maybe in
a few years they could break even because think about how much more
money they’re spending by making these 2007 changes. Group Health has a
very good research arm. At the end of the year, they
realized — they were measuring this as they went along. The quality scores went back up. They indeed reduced burnout but what
sort of blew everybody away around the country is that they
broke even in the first year. For every extra dollar that
they spent on primary care, they saved a dollar on inpatient. This was really beyond their dreams. And in 2008, they continued the
pilot at this clinic and what they found in 2008 was that for every extra
dollar they spent in primary care, they saved four dollars on inpatient. And this was for an organization that
prides itself on good primary care, good prevention and early intervention. It just showed how much further they
had to go to helping do what Chuck had described earlier as moving
further upstream with prevention, early intervention and helping
folks better manage the chronic health conditions. I was talking to a colleague who
didn’t know about this research. In 2009, Group Health said
we’re going to this system-wide. All of our clinics are going to move
their and the colleague of mine had just been to the doctor the week
before and he had had a forty-five minute visit with his doc and the
doc just kept asking him questions and he was like — felt a little
bit nervous like maybe he should be leaving the room. And they went through five
different programs — I’m sorry. Five different conditions and came
up with treatment plans for how to deal with all five conditions. It was a totally life changing
experience for him in terms of his interactions with
the healthcare system. So what we know is that if
you do healthcare homes right, there is — the data is starting to
come out of the woodwork that you can actually improve
quality and save a ton of money. Why don’t we go to the next slide? The patient centered primary
care collaborative which Chuck was talking about that put together
those principles that we saw on a few slides ago has been
a leader in this work. And Paul Grundy who is one of the board
members is a doc who works for IBM and he’s been talking about health
care homes and why they’re important and there’s a couple of factoids that
I want to plant in your brains. Denmark has been working on this
for much longer than we have and as you see from the slide, there’s been
a radical change in how healthcare is delivered and what happens
when you do good primary care. You can see that the number of
hospitals have dropped from a hundred and fifty-five to twenty-one in the
country over the last couple of decades because of the work that they’ve
been doing with healthcare homes. I look at this number and I almost
fall over and faint but I — it really supports the idea that if
you actually help people manage — keep their — manage the care so that
their health conditions don’t become chronic health conditions. And for those of us do get
chronic health conditions, if you become a hospital prevention
organization really helping people manage those chronic
health conditions, you can make a major difference
in the number of surgeries, the number of specialty procedures
that need to be performed, the number of emergency room visits. It really has the potential
of being a radical change in the healthcare system. Chuck, if you push the next button,
we’ll see the other part of this. The Geisinger System in Pennsylvania has
also been working on healthcare homes. They’re one of the
leaders like Group Health, around the country and what they’ve
found is that — as you can see, they’ve been able to achieve
reductions in emergency room utilization, reductions in
hospitalizations and a rather dramatic reduction in
re-hospitalizations. What we know is that if you have
Medicare in this country and you go into the hospital and
you get discharged, eighteen percent of you are going
to be readmitted within thirty days because the handoffs aren’t working
because of the fragmentation and lack of coordination, which
takes us to our next slide. Now all this stuff is not
going to magically happen and I’m a CPA by training. It’s very clear to me that the
payment reform if you think about the four boxes that Chuck was
talking about is very critical to helping change the incentives in the
system so that we fund healthcare homes and we change the incentives
so that we actually — what we’re trying to do here is move from
having what I would describe as a sick care system in this country
where you basically don’t — once you get sick, there’s lots of care
available if you have insurance to a healthcare system where we are
incentivizing the provision of prevention, early intervention and
the management of chronic health conditions and
behavioral health disorders. There’s payment reform going on all
around the country in medical homes. And I believe that fee for service
is headed towards extinction. That removing what’s called
from paying for volume to a healthcare system where we’re paying for value. There’s the three layer funding
design that’s unfolding that you should plant away if you’re a
behavioral health provider because I’m expecting that these kinds
of models are going to come to a community behavioral health center
near you relatively soon as this gets further tested
in the medical homes. And what we’re seeing is that there
is a case rate that’s being paid for nurse care managers or behavioral
health specialists or nutritionists to do prevention, early intervention,
care management for chronic health conditions and behavioral
health disorders in primary care. We’re seeing that some of these
early models like in Maine are continuing to use fee for service
for the doc and nurse practitioner services but they’re paying a
higher rate and the most what I call radical payment reform is a
bonus layer that’s being added. So that’s — what we’re talking
about in healthcare is twenty to thirty percent of practice incomes
come in from bonuses in medical homes if the medical homes do a good
job getting their quality scores and managing the total health
expenditures of their patients. Basically, the idea is to
do sharing the savings. It costs so little really to provide
good primary care compared to what it costs for the kind of
hospitalizations and all the other complications related to chronic
health conditions that don’t get managed and folks end
up in the hospital. Let’s move on to the next slide. Many of you have probably heard this
term accountable care organization. They’re a critical
piece of the puzzle. The reasons why Group Health was able to — Bob: Dale, could you — would mind
— this is Bob (Inaudible). Would you speak
directly into the phone? We’ve got a few people who say
the sound is wavering a little bit. Dale: Yes, thank you. Bob: Okay. Thank you, Dale. Dale: Please holler if
there are any problems. Accountable care organizations are the
other part of integrated health systems. Integrated health systems like Group
Health and Kaiser and Intermountain Healthcare and Geisinger basically
are both an insurance company and a delivery system so the
payer pays a pot of money, a capitated payment to the health
plan and then that integrated health system provides and
organizes all the care. Well, that’s only ten percent of the
population in this country so the question that folks have been asking
for several years is what do we do about the other ninety percent
of folks that aren’t in these integrated health systems
where the incentives are lined up. And this idea of accountable care
organization which I would call an integrated health system (light)
is a model that is unfolding as an organizational structure to support
the coordination of care that Chuck was talking about and the
payments among healthcare homes, specialists and hospitals so
that we’re moving towards achieving better coordination of
care, better incentives, prevention, early intervention, a
lot more money spent on primary care and I predict then,
behavioral health. And it’s also a way for the small to
mid-size primary care practices to obtain the infrastructure that’s
going to be necessary to work inside this healthcare home world. So it’s really interesting as we see
by the next slide that’s coming up, I’m seeing that in predicting that
medical homes are going to become, if you will, the center of
the healthcare universe. This model shows that a health plan
will make a payment to this thing called the
accountable care organization, that the provider owned entity
— it’s owned by the docs and the specialists and the hospitals
and when I say specialists, I’m thinking about cardiologists and
I’m thinking about behavioral health clinicians and behavioral provider
organizations and being part of the accountable care organization
where they are working together to coordinate care for the
patients, to reduce duplication, to reduce medical errors. For these organizations,
working together to become hospital prevention organizations and if we
think about what happened in Denmark where there was a fairly major drop
in the number of hospitals in the country, it’s really about if you
have a healthcare system rather than a sick care system. You have to have an organizational
structure that’s the framework for getting all of these provider
organizations and individual providers working together
within a common IT system, a common set of performance measures, etc. Let’s go on to the next slide. So these are some of the ideas
that are being kicked around around service delivery,
design and payment reform. People say that there is about seven
hundred billion dollars a year that is spent that is
waste, that’s duplication, that’s treating people after they
fall off the cliff as opposed to putting fences up at the top. The question is will the current
Healthcare Reform Law and the accompanying payment reform and
delivery system tools really be enough to make a
difference before we go bankrupt. Our prediction which is not in the
last — here is where I sort of go out on a limb saying it’s not going
to work unless the healthcare system addresses the needs of individuals
with mental health and co-occurring disorders which takes us on to
chapter two in the next slide. If you remember — the question is how
will the answer to this first question — let’s pretend that these
healthcare homes and accountable care organizations and new
service delivery designs really work generally in healthcare, will
they work for folks with behavioral health disorders and will
organizations that serve folks with behavioral health disorders fit
into this new healthcare eco-system. Next side, please. Remember the slide about
the alignment of the stars? I think that there is a lot happening
and let’s go on to the next slide. I’ve been following the Accountable
Care Act and one of the questions that I’ve been contemplating is did
the authors of the Act understand these issues, the needs of
folks with behavioral health. And I would say that the short
answer is yes and I’d also say that I think that President Obama basically
pulled together a dream team around healthcare reform. If you think about Don
(Berwick) as the head of CMS, if you think about Richard (Crank)
(inaudible) in an important position and (Aspey) the planning and
evaluation arm of HHS and he being a medical economist from Harvard who
specializes in mental health medical economics and Pam Hyatt
is the head of SAMHSA. I mean truly this is what
I consider the dream team. Also, what we see is there are over
a hundred funding opportunities, pilot projects and demonstration
projects that are in the Accountable Care Act. I’ve got a few on the screen. Parity is embedded, is
required in healthcare reform. There is (inaudible)
national prevention, on the next slide, the National
Prevention Council that’s appointed to really think about
moving further upstream, workforce expansion, names,
behavioral healthcare workers as high priority in the bills,
workforce strategy and addiction and mental health providers are eligible
for community health team grants. These are just a few. I’ve counted no less than two dozen
items in the Healthcare Reform bill that allows behavioral health —
the behavioral health system to be included in healthcare
reform not excluded. Moving onto the next slide, I
want to think about what are the implications of these changes for
mental health and substance use and co-occurring disorder
provider organizations. And I think that there are two
critical ones that behavioral health providers — I’ll use that term so
that I — as a shortcut — need to get involved in healthcare homes
and we’re going to talk about what that looks like. And secondly, they need to be close
— much more closely linked to the rest of the healthcare system and
seen as high performing specialists that can support the management of
total healthcare expenditures and as it says on the side,
minimize the defect rate. What we’re talking about is if we
have a very large number of folks in this country with behavioral health
disorders and those folks as we saw from the California slides cross so
much not because their behavioral health conditions but
their healthcare conditions. I think it’s absolutely essential
that behavioral health clinicians be deeply embedded in the DNA of the
healthcare delivery system to help folks with
behavioral health disorders, be able to help better
manage their health conditions, have access to early intervention
and prevention services so that we can bring down the cost because of
their unmanaged health conditions. So let’s go on and talk a little
bit about the healthcare home. There’s a couple of slides
here I want to cover and explain. A number of you may have seen
or heard about the four quadrant clinical model of integration
that talks about folks with low to moderate physical health risks
and complexity and low to moderate mental health and substance use
disorder risk and complexity. And what this model postulates is
that folks with low to moderate behavioral health disorders ought
to get their care and primary — their behavioral health services in
primary care and folks with serious and severe behavioral health disorders
generally ought to get their primary care services in behavioral health
or at least that’s an option. But as I’m looking at this
slide, I’m going oh, my gosh. The print is too small so let’s
look at the next couple of slides. So quadrant one are folks with
low behavioral health and low physical health disorders. Those folks generally — what we’re
seeing in the models around the country — John was talking about
the number of integration projects that was mentioned that are going on
as everybody should have a primary care provider in a medical home. There should be a behavioral health
clinician working in that primary care clinic and there should be a
psychiatric — psychiatrist or a psychiatric nurse practitioner
supporting the team of the primary care provider and the behavioral
clinician in the mental health center helping folks who have
mild to moderate behavioral health disorders, wellness
programming and other interventions. For folks that have low to moderate
behavioral health disorders but chronic health conditions
like diabetes or hypertension, you add more medical specialists so that
you support their health conditions in the primary care clinic. Moving on to the next slide. For the folks that have more
serious and severe behavioral health disorders, what’s being tested
now in the SAMHSA grants are a very critical piece of this is embedding medical
clinics in behavioral health center. My neighborhood
mental health center, (Navos), here in Seattle has a
medical clinic embedded as do a number of other behavioral
health centers around the Northwest. And there’s — they’re working on
developing a clinical model based in this case, on the impact model which
uses a particular design working with tracking health conditions in the
behavioral health clinic, providing residential treatment if necessary,
really trying to help folks manage both their health and
behavioral health conditions in a setting that’s comfortable and
preferred by consumers who choose to get their medical care in
their mental health center. And folks that have both behavioral
health conditions and serious physical health conditions, they
also need to ramp up the medical care so that folks have a really
robust set of behavioral health and medical care for
quadrant four folks. Moving on to the next slide. What we’re talking about —
what I’m really describing is illustrated by this picture here. It’s called bi-directional care. The left hand box basically says
generally speaking we need to have folks with low to moderate
behavioral health disorders getting their primary care — their
behavioral health and the primary care in their primary
care clinic or medical home. And adults with moderate to
high behavioral health risk and complexity having the choice of going
to an embedded primary care clinic inside their mental health center or their
substance use provider organization. On to the next slide, thank you. Folks in California have spent a
great deal of time figuring out the who, how many, what and where and —
so they’ve been thinking about how many people that live in California
that are members of the safety net population fit in to the mild,
moderate, serious and severe categories in term of the risk
and complexity and need. And they’ve also
been saying well, okay. Let’s think about mental
health and primary care, substance use and primary care,
behavioral health services having medical clinics embedded. And what’ they’ve concluded is that
folks with mild behavioral disorders generally ought to get their behavioral
health care in primary care. Folks with serious disorders
often have their medical care in behavioral health and
folks who are in between, if you will, in terms of the risk
and complexity that they have at a given point in time,
is a local decision. The community mental health center,
the community substance use provider needs to be working with the local
primary care practice whether it’s an FQHC or a private practice to
work together to say what’s the best way to do bi-directional care based
on the skills and abilities of the folks in our respective clinic. So this stuff is being worked out. All healthcare is local. This stuff is being
worked out state by state, community by community. Next slide, please. And I’ve been thinking a lot about
accountable care organizations for persons with co-occurring disorders
is a sort of quicker way to (inaudible) folks with mental health
substance use (blowing) it but if you think about folks
with co-occurring disorders, it helps me wrap my
brain around this easier. Good medical care
alone isn’t the answer. We need to expand the available
services in medical homes so that we have a focus on not just
behavioral health but housing, social and personal supports needed
to achieve and maintain health. So this picture envisions an
accountable care organization with specialty clinics including
behavioral health clinics as members of the accountable
care organizations, are working very closely with the
person centered healthcare homes and connected, in many ways,
with social service agencies, schools, childcare and a whole
host of other systems that I would describe as the safety net system. That it’s not just about medical
care and what we’re really pushing is a safety net healthcare system
that takes into account all of these pieces of the puzzle that are
needed to support folks with behavioral health disorders. Next slide, please. I’d like to leave you with
the question so — we’ve — our time has been short. We’ve raced through a number of
the concepts but the question I’m continuing to ruminate on will
all these great ideas really work? And I guess I have to say the short
answer is we don’t know but the longer answer is we have a once in a
generation opportunity to reform the healthcare system and to make sure
that folks with mental health and substance use disorders aren’t left out. We have the knowledge, the technology
to move from what I, again, call a secure system to a healthcare
system and include persons with mental health and substance
use and co-occurring disorders. But I believe that the
general healthcare system, the folks that work there generally
don’t understand the complexities or the population that
we’re talking about today. It’s going to take strong advocacy, a lot
of education on the part of consumers and advocates to make sure that we’re
included in healthcare reform. And it’s also going to take a lot of
hard work by provider organizations to prepare for what I
think is the brave new world. I think the Pandora’s box is opened. Healthcare reform is happening. The Accountable Care
Act is an accelerant. It’s not mission — healthcare
reform will — would have occurred without the Accountable Care Act
but the Accountable Care Act makes a huge difference in terms of
helping move this forward. So with those comments, I’d like
to turn it back to the organizers for questions and answers. Rebecca: At this time, we’ll
take questions from the audience. You can recall that you can submit a
question using the questions pane on the control panel of your screen. Just type your question in the
box and send it to the organizer. Our first question is about the
mental health and substance use coverage changes
under healthcare reform. Chuck: So the — as both I and Dale
mentioned that in both the expansion of Medicaid as well as in the
private health insurance that will be offered through the exchanges,
the legislation is very clear that in both instances, both services for
mental health conditions as well as substance use disorders must be
offered and that the Mental Health Parity and Addiction Equity Act
standards need to be applied. Now the question is going to be how
does that actually translate that into — through the regulatory and/or
guidance process that will unfold? So the first thing that is going to
have to happen is the Department of Health and Human Services will be
creating regulations related to then what’s (going to) be
essential health benefits. So what we’ll be monitoring then is
any opportunity to provide comment about the scope of those
benefits offered by health plans participating in the exchange. And secondarily, also looking
for regulatory or guidance — regulations or guidance coming
from the centers for Medicare and Medicaid services regarding the
Medicaid expansion and the benefit that has to be offered there. I would note, however, I think that work
in this area has already begun by SAMHSA. SAMHSA recently released a paper in
which they expound on what is a good and modern mental
health and addiction system. And then, it contains within it a
chart of the kinds of services from prevention — starting off at
prevention and going all the way to inpatient of the kinds of services
that a good system would have to adequately treat substance use
conditions as well as mental illnesses. So then I think that SAMHSA has
put us in a good position then with other federal agencies
as we go down this road. So the short answer is we’re not
sure exactly what it will look like. We know that it is mandated and
we’ll have opportunities to provide comment to shape
that into the future. Rebecca: Our next
question is for Dale. Dale, could you please provide a
little bit of clarification on how the pay for performance or
bonus payment system will work for individuals with co-occurring,
chronic disorders like serious and persistent mental illness
or substance use disorders? Dale: Yes. I think that what’s going
to happen is we’re going to see some of these pay for performance models
roll out first in general healthcare especially in medical homes and
hospitals that are already under way. And for me, the key question is
how do we in the behavioral health community use that same model so
we’re not creating a completely different model to support the needs
of folks with behavioral health disorders especially folks that have
serious disorders and I think that there is two things
that are going to happen. One is because there is such a
high — there are so many folks with serious mental illness and substance
use disorders that have chronic health conditions, the performance
measures and bonuses related to helping folks manage their chronic
health conditions will apply to those folks as well. And what’s really clear to me is
that if somebody has let’s just say major depression and diabetes,
there’s no way that a healthcare provider who is at risk
— their bonus is at risk, is going to be able to ignore a
person’s major depression as they try and earn the bonus off
their diabetes treatment. So it’s really kind of cool because
primary care providers are basically going to have to do a much better
job helping folks manage their major depression because there is no way
they are going to be able to manage the diabetes — help them
manage their diabetes otherwise. So we’re going to see a sort of a
naturalistic unfolding of folks getting a lot
better coordinated care, a lot better attention to their
behavioral health disorders in order for primary care docs, if
you will, earn their bonuses. The second thing we need to do is
start designing the performance measures and the pay for performance
models in behavioral health so that we basically mirror that. I think it’s very important to think
about what it means for folks to be able to get their lives back who
have serious mental illness and serious substance use disorders. How we measure that, how we put in
place systems to track — for me, it’s all about if we can help
people get their lives back, that’s where the bonuses come in and
we can help people manage who have serious conditions. We have (inaudible) conditions
managed their health disorders without helping them move
towards recovery and wellness. So we have to do both pieces,
figuring out the measures on the behavioral health side get
embedded in the healthcare piece. Rebecca: Thank you, Dale. Our next
question is for Chuck and Dale. We have a few folks on the line
who are asking about collaborations between behavioral health
centers and primary care providers. Do we have any good resources on
how these collaborations can best be structured and what would your advice
be to organizations seeking to have a more collaborative relationship
with their primary care provider? Chuck: Dale, do you want to
take a crack at it first? Dale: Sure. What’s really
fascinating to me is my partner, Barbara (Mauer) started working
on thinking about primary care behavioral health integration
eight years and at that time, there were just a few places around
the country that we could look to: Cherokee in Tennessee and the
Washtenaw County Health System in Ann Arbor, Michigan to sort of
figure out what’s going on and how folks are working together. Today, if you go to Colorado, they
actually have a website that has a Google map of the state and
there’s over a hundred collaboration projects between the behavioral
health providers and folks in the healthcare system. The thing that we need to do is to
— I think do a better job getting information out into the field about
who to actually talk to to have person to person conversations
about how you’re doing it. There’s also a number
of things on the Web, the Council’s website that talks about
the different collaboration pilots that they have been running and
information that’s written on that. I think it’s both about reading
about how this is being done and talking to folks that
are actually doing it. Chuck? John: And this is John. I
don’t want to interrupt you. I think that’s a really important
point and I want to say that SAMHSA through the National
Technical Assistance Center on primary care behavioral health
integration will (offer) those once we get that off the ground. Dale: Thanks, John. Chuck: The — I think — Dale, I
think your answer is right on. And I know that for many
organizations it’s daunting to try to make those connections. I think it’s really valuable to focus on
what are our areas of common interest. You’re — typically, community health
centers are safety net providers. Behavioral health organizations are
safety net providers in their own right. Can you identify common patients
and work on protocols about where people will be served? In one of our
collaboration projects, a community mental health center
had an obscene waiting list for individuals to see their
psychiatrist and in collaboration with their health (inaudible)
identified that a large majority of those people were already being seen
at the health center and they were able to — by providing psychiatric
consultation to the primary care docs, get people into
access much more quickly. So I think, try to think
about it in very practical terms. What are things that you can bring
to the table that would be of help to your primary care — local
primary care organization and vice versa what are some of the
practical things that you need that they might be able to provide. I think it’s always helpful to have
something concrete as you look to have those conversations. Rebecca: Our next
question is for Chuck. We know that having access to
health information technology and electronic health records is an
important part of integration. In the Economic Stimulus Act, there
were incentive payments enacted for the adoption of
electronic health records. Our question is how is this going to be
applied to behavioral health centers? Chuck: So the High Tech Act
basically creates Medicare and Medicaid incentive payments to
particular — in two ways to particular types of facilities, at
this point limited to certain types of hospitals and then to certain
types of eligible professionals. And the eligible professional
payment is agnostic about the place of employment of that
eligible professional. So that right now, if you were a
physician or a nurse practitioner and you meet the meaningful use
criteria, you are eligible for the Medicaid incentive — Medicaid
or Medicare incentive payment and then you can turn that
payment over to your employer. So behavioral healthcare
organizations that have doctors or nurses on staff will still be eligible
to get the payment that way. And for the Medicaid incentive
payment over a course of four years per eligible professional,
it’s $63,750. There are efforts under way
in Congress to expand that. I’ll just mention that
there are two bills. HR5040 in the House of
Representatives introduced cooperatively by Patrick Kennedy
and Tim Murphy now has seventy-eight co-sponsors in the
House of Representatives. And then there is the
Senate Companion bill, Senate 3709 that was introduced by
Senator Sheldon Whitehouse of Rhode Island and it currently
has seven co-sponsors. That legislation would expand the types
of organizations that are eligible for facility payments to better
reflect mental health and substance use treatment organizations
as well increase the types of eligible professionals that would be available
to receive incentive payments. Rebecca: Our next
question is for Chuck and Dale. As healthcare reform rolls out over
the coming years, what are the next developments and the next steps
that we need to be aware of? Chuck: Well, I think
already this year, we’ve see HHS release a
number of regulations. There are a bunch of provisions of the
affordable care act that actually go into effect this week related to the
oversight private health insurance. The next wave then, there are a
number of provisions that come online over the next few
years and into next year. The National Council on our website, on our blog… Rebecca: On our blog, we’re keeping
track of all the federal regulations that are being issued in
regards to healthcare reform. So if you visit our blog, and search for federal regulations,
you’ll be able to find a comprehensive list not only of the
regulations and what they mean for behavioral healthcare providers but also
of the National Council’s comments. Chuck: And what we’ll try to do is keep
people apprised as regulations come out and then, if time allows, we’ll also
share draft comments for your feedback. So I think John, at the beginning at
the top of the Webinar mentioned a particular section 2703, which creates
a new health home state plan option. That goes live January 1 so we
would expect guidance from CMS sometime before then. Obviously, then, we’ll be looking
for regulations that come out related to the essential health
benefits, the Medicaid expansion. There are a number of areas where
there will be guidance forthcoming as well as additional
grant opportunities, which will be coming online. So check out our — the blog and the
White House also has a really good health reform website
where all of this is posted. Rebecca: Unfortunately, I think
we’re out of time for more questions at this point. We want to thank everyone in our audience
again for your time and interest in healthcare reform and its implications
for behavioral health providers. We’d like to thank
Charlene (LaFove), (Najay Saleem), Deborah (Stone) and
John O’Brien from SAMHSA once again for sponsoring this Webinar. And of course, to our presenters,
Chuck Ingoglia and Dale Jarvis for their valuable contributions today. As we mentioned earlier, the
Webinar will be archived on the National Council website. You can see the link
there on your screen: And it will also be archived on
the CODI website which is currently under development at All participants on the
Webinar today are going to receive a follow-up email with a
link to an evaluation form. We very much appreciate everyone’s
feedback and will be using it in our development of future Webinars. Thank you again and this
concludes our call for today.

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