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Mental Illness and Treatment

Serious Mental Illness: 
—Adults:  ...
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Substance Abuse

* Substance Use Conditions: 
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Triple Aim:  Care,  Health,  and Cost

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Policies Reflected in the ACA

1. Universal Insurance Coverage and
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Implications of the ACA

Goa|  Changes Needed: 

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Implications of Wellness Model

Provision of primary care is essential. 
Provision of behavioral health care is essential....
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5 Core ACA Reforms

1. Insurance Reform — expansion of State
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5 Core ACA Reforms

3. Quality Reform — Health Homes,  Accountable

Care Organizations,  Quality Measures
(outcomes)

4. P...
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Affordable Care Act Repercussions for Psychologists

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Affordable Care Act Repercussions for Psychologists

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- APA Divisions 18 & 22

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The Affordable Care Act (ACA): Telemental Health Perspectives -- Marlene Maheu

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The Affordable Care Act (ACA): Telemental Health Perspectives
American Psychological Association Annual Convention, August 8, 2014

To invite Dr. Maheu to speak to your group about these issues, please send an inquiry at www.telehealth.org/contact

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The Affordable Care Act (ACA): Telemental Health Perspectives -- Marlene Maheu

  1. 1. ((6 ; _:_q: -,r: _.tII. 3,fn= ;e| :: ‘: lH"_Mfim_, " — — rfl Q up A ¢ fl ’ Q C ‘T fie ,5 5- ll C ‘ . u. a I- , . ‘MI. 23¢. ‘.4. xi . a ya. . a I- at ; I-. a’. I E s, «% ¢‘= rev» 9' yew» as _, r«*= a_» at-1 MP4-x * it «= *=*> at-1 AMERICAN PSYCHOLOGICAL ASSOCIATION 2014 Marlene M. Maheu Ph. D. TeleMenta| Health Institute www. Te| ehea| th. Org
  2. 2. /C G“ "l. :l‘: ".‘. E ': m‘. ,m 1'-"—ll'. —!Al“li. ull3 Mental Illness and Treatment Serious Mental Illness: —Adults: Approximately 13 million (5.8%) — Children: Approximately 8 million (10%) Overall Mental Illness — Adults: Approximately 55 million (25%) — Children : Approximately 16 million (20%) Treatment 1/3 of adults and 2/3 of children with SMI receive no services 2/3 of others with mental health conditions receive no care
  3. 3. /| _:l‘: 4Il. =.ll7.‘_§ iI1;VT| :[ ‘__lH'V. _H““l”" Substance Abuse * Substance Use Conditions: Approximately 24 million potential cases/ year ° Substance Use Care: Approximately 2.4 million people receive care/ year — More than 90% of people with substance abuse do not receive care — Care that is received comes principally from grants rather than personal insurance
  4. 4. F‘: 'l| .=| “": ‘_E iI1;lT| :( ‘__"’m_M““l. ”! Triple Aim: Care, Health, and Cost . ..we call those goals the Triple Aim: 9 improving the individual experience of care; ° improving the health of populations; and e reducing the per capita costs of care for populations. ” The remaining barriers to integrated care are not technical; they are political. Berwick, D. M., Nolan, T. W. & Whittington, J. (2008). Health Affairs, 27(3), p. 759-769.
  5. 5. 'I_: I.= '.. =.‘ir. ;: »=4;uu: z NH Hmhnu Policies Reflected in the ACA 1. Universal Insurance Coverage and Extension of Parity 2. No Pre-Existing Condition Exclusions 3. Fostering Medical and Health Homes 4. Disease Prevention and Health Promotion 5. Achieving ”Recovery” and ”Resi| ience”
  6. 6. ' H ‘WIW 1‘-ll—lI'. -IAll3I; .'ll! Implications of the ACA Goa| Changes Needed: 1. Person-Centered Care 1- Listen to Patiem 2. Person Care behavior & 3. Shared Decision Making 3- Teams of professionals 4_ gt, -,-V, -ng Toward 4. Resilience training to Recovery & replace “Illness” Models 5. Encourage consumers to 5. Significant Increases in U59 Self-help t00'5 and Self-Help & Social 5003' SUI’->P0Ft Support
  7. 7. Implications of Wellness Model Provision of primary care is essential. Provision of behavioral health care is essential. Facilitation of WELLNESS and RECOVERY approaches are essential. Integrated care is an obvious mechanism to achieve these goals. — Ron Manderschied, CIMH, 2014
  8. 8. ‘WIW 1'-ll—ll'. —lAl“l; .'ll! 5 Core ACA Reforms 1. Insurance Reform — expansion of State Health Insurance Marketplaces (20M) and Medicaid (19M). — Driven by essential health benefits (essential care categories). 2. Coverage Reform — Guaranteed enrollment, Young adult coverage to age 26, No annual or lifetime limits, Prevention/ promotion — no copay for some prevention
  9. 9. 5 Core ACA Reforms 3. Quality Reform — Health Homes, Accountable Care Organizations, Quality Measures (outcomes) 4. Payment Reform — providers will self-manage insurance benefits (case rates & capitation rates) 5. IT Reform (Electronic Health Records)
  10. 10. /(/ -Fl‘: "l. :l‘. "". E ': m‘. .': [ 1'-"—lll-lAlLali. uIl! Affordable Care Act Repercussions for Psychologists ~ Funding for private agencies will be shifted to the expanding Medicaid programs to support Health Care Reform ° Referrals to for ACA patients will come from primary care physician's offices to large groups of practitioners — Integrated care — Patient—centered homes ~ Small group and private practices likely to be squeezed out — Large groups can contain costs across practitioners and clients * Success of private pay model will decrease in long term — Everyone will have insurance / most people will want to use that insurance * Practitioners will be held accountable for outcomes and paid accordingly
  11. 11. /(6 "F": "L_: '|"""£ m“_m‘ 1‘-ll—lll—lAlL3l; .'ll! Affordable Care Act Repercussions for Psychologists ' Shorter sessions / more clients/ patients s More specific documentation — Documentation will require proof of interventions being tied to the evidence-base (’’treat-to-target’’) * Increased reliance on master's level practitioners II Increased reliance on technology — Required use of electronic health records (to measure outcomes) - Decreased reimbursement for free—f| owing sessions and non—specific note—taking — Apps and other self help tools will proliferate * Increased need for vision / graduate education and professional education
  12. 12. /(6 "F": "L_: '|"""E mflrgy‘ 1‘-ll—ll'. —lAll3l; .'ll! - APA Divisions 18 & 22 - American Counseling Association - American Psychiatric Association - American Bar Association - American Telemedicine Association 1. Competencies Task Force is exploring ways to validate competency in various technologies related to Behavioral Health practice (telehealth, mHea| th etc). 2. HL7 & Psychotherapy Note Task Force is working to help standardize interoperability between Electronic Health Records. An additional focus is the defining of the Psychotherapy Progress Note for EHRs. 3. Journal Task Force is forming an exciting new journal devoted to research and articles related to technology in the behavioral sciences. It is now forming an Editorial Board. If interested in participating in any initiatives, please apply by visiting website: www. ctibs. org[

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