Health Care Reform  Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA
  Affordable Care Act  <ul><li>Major Drivers </li></ul><ul><ul><li>More people will have insurance coverage </li></ul></ul...
Person Served by SSAs/SMHAs <ul><li>12 M visits annually to ERs by people with MH/SUD </li></ul><ul><li>Individuals with s...
Primary Care And Coordination <ul><li>Individuals with SMI die on average at the age of 53 years old </li></ul><ul><li>Bar...
Primary Care And Coordination <ul><li>Readmissions </li></ul><ul><ul><li>20% of Medicare patients are readmitted within 30...
Affordable Care Act Opportunities <ul><li>Grants for mental Illness with co-occurring primary care conditions (SAMHSA) </l...
SAMHSA Grant Program <ul><li>To improve the physical health status of people with serious mental illnesses (SMI) by suppor...
SAMHSA Grant Program <ul><li>To better coordinate and integrate primary and behavioral health care resulting in: </li></ul...
SAMHSA Grant Program <ul><li>FY 2010 </li></ul><ul><li>$28 million to help 56 community behavioral health agencies  </li><...
<ul><li>Facilitate screening and referral for primary care prevention and treatment needs  </li></ul><ul><li>Provide and/o...
<ul><li>Baseline Descriptive Information </li></ul><ul><li>Personal/family history of: diabetes, hypertension, cardiovascu...
<ul><li>Services Outcome Indicators  </li></ul><ul><li>The number of mental health consumers receiving primary care servic...
Training and Technical Assistance Center  <ul><li>In partnership with HHS/Health Resources and Services Administration  </...
Training and Technical Assistance Center (TTA) <ul><li>TTA will:  </li></ul><ul><li>Increase the number of individuals tra...
Health Homes  <ul><li>Section 2703 </li></ul><ul><ul><li>Enhanced integration of primary and specialty care for individual...
Health Homes <ul><li>Health homes (several new services): </li></ul><ul><ul><li>Comprehensive Care Management </li></ul></...
More Information: http://www.samhsa.gov
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Health Care Reform: Primary Care and Behavioral Health Integration

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  • Consistent with the President’s prevention and wellness initiatives, we feel this multi-layered response not only meets the emerging needs of States, communities, and individuals; but also prepares HHS in moving toward a National response and recovery system that truly mitigates the prolonged effects of disasters. In closing, we would like to thank you for your time and attention. We look forward to a discussion about what was presented here today and we are particularly interested in your ideas and feedback. Thank you.
  • Health Care Reform: Primary Care and Behavioral Health Integration

    1. 2. Health Care Reform Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA
    2. 3. Affordable Care Act <ul><li>Major Drivers </li></ul><ul><ul><li>More people will have insurance coverage </li></ul></ul><ul><ul><li>Medicaid will play a bigger role in MH/SUD than ever before </li></ul></ul><ul><ul><li>Focus on primary care and coordination with specialty care </li></ul></ul><ul><ul><li>Major emphasis on home and community based services and less reliance on institutional care </li></ul></ul><ul><ul><li>Preventing diseases and promoting wellness is a huge theme </li></ul></ul>
    3. 4. Person Served by SSAs/SMHAs <ul><li>12 M visits annually to ERs by people with MH/SUD </li></ul><ul><li>Individuals with schizophrenia have one of the highest rates of smoking (58%–88%) </li></ul><ul><li>Cardiovascular mortality was 6.6 times higher among SMI clients than the general population </li></ul><ul><li>70% of SMI had at least 1 chronic health conditions, 45% have 2, and almost 30% have 3 or more. </li></ul>
    4. 5. Primary Care And Coordination <ul><li>Individuals with SMI die on average at the age of 53 years old </li></ul><ul><li>Barriers include stigma, lack of cross-discipline training, and access to primary care services </li></ul><ul><li>Have elevated (and often undiagnosed) rates of: </li></ul><ul><ul><li>hypertension, </li></ul></ul><ul><ul><li>diabetes, </li></ul></ul><ul><ul><li>obesity </li></ul></ul><ul><ul><li>cardiovascular disease </li></ul></ul><ul><li>Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers </li></ul>
    5. 6. Primary Care And Coordination <ul><li>Readmissions </li></ul><ul><ul><li>20% of Medicare patients are readmitted within 30 days after a hospital discharge </li></ul></ul><ul><ul><li>Lack of coordination in “handoffs” from hospital is a particular problem </li></ul></ul><ul><ul><li>More than half of these readmitted patients have not seen their physician between discharge and readmission </li></ul></ul>
    6. 7. Affordable Care Act Opportunities <ul><li>Grants for mental Illness with co-occurring primary care conditions (SAMHSA) </li></ul><ul><li>Health Homes (CMS and SAMHSA) </li></ul><ul><li>Prevention Trust Fund and Primary care and Behavioral Health Integration (SAMHSA) </li></ul><ul><li>Community health teams (CMS/Medicare) </li></ul>
    7. 8. SAMHSA Grant Program <ul><li>To improve the physical health status of people with serious mental illnesses (SMI) by supporting community-based efforts to coordinate and integrate primary health care with mental health services in community-based behavioral health care settings </li></ul>
    8. 9. SAMHSA Grant Program <ul><li>To better coordinate and integrate primary and behavioral health care resulting in: </li></ul><ul><ul><li>improved access to primary care services </li></ul></ul><ul><ul><li>improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease </li></ul></ul><ul><ul><li>increased availability of integrated, holistic care for physical and behavioral disorders </li></ul></ul><ul><ul><li>better overall health status of clients </li></ul></ul>
    9. 10. SAMHSA Grant Program <ul><li>FY 2010 </li></ul><ul><li>$28 million to help 56 community behavioral health agencies </li></ul><ul><li>$5.3 million national resource center (co-funded by SAMHSA/HRSA/HHS) </li></ul>
    10. 11. <ul><li>Facilitate screening and referral for primary care prevention and treatment needs </li></ul><ul><li>Provide and/or ensure that primary care screening/assessment/ treatment and referral be provided in a community-based behavioral health agency </li></ul><ul><li>Develop a registry/tracking system for all primary care needs and outcomes </li></ul><ul><li>Offer prevention and wellness support services (>10% of grant funding) </li></ul><ul><li>Build processes for referral and follow-up for needed treatments that are not appropriately provided in a primary care setting </li></ul>PBHCI: Services Delivery
    11. 12. <ul><li>Baseline Descriptive Information </li></ul><ul><li>Personal/family history of: diabetes, hypertension, cardiovascular disease; substance use; tobacco use </li></ul><ul><li>Medication history/current medication list, with dosages </li></ul><ul><li>Social supports </li></ul><ul><li>Health Outcome Indicators (by individual) </li></ul><ul><li>Weight/Height/Body Mass Index Blood pressure </li></ul><ul><li>Blood glucose or HbAiC Lipid profile </li></ul>PBHCI: Data Collection and Performance Outcomes (<20% of grant funds)
    12. 13. <ul><li>Services Outcome Indicators </li></ul><ul><li>The number of mental health consumers receiving primary care services </li></ul><ul><li>The number of mental health consumers screened for: </li></ul><ul><ul><li>hypertension; </li></ul></ul><ul><ul><li>obesity; </li></ul></ul><ul><ul><li>diabetes; </li></ul></ul><ul><ul><li>co-occurring substance use disorders; and </li></ul></ul><ul><ul><li>Tobacco product use </li></ul></ul>PBHCI: Data Collection and Performance Outcomes (<20% of grant funds )
    13. 14. Training and Technical Assistance Center <ul><li>In partnership with HHS/Health Resources and Services Administration </li></ul><ul><li>Purpose </li></ul><ul><ul><li>to serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development </li></ul></ul><ul><ul><li>provide technical assistance to PBHCI grantees and entities funded through HRSA </li></ul></ul>
    14. 15. Training and Technical Assistance Center (TTA) <ul><li>TTA will: </li></ul><ul><li>Increase the number of individuals trained in specific behavioral health related practices; </li></ul><ul><li>Increase the number of organizations using integrated health care service delivery approaches; </li></ul><ul><li>Increase the number of consumers credentialed to provide behavioral health related practices; </li></ul><ul><li>Increase the number of model curriculums developed for bidirectional primary and behavioral health integrated practice; and, </li></ul><ul><li>Increase the number of health providers trained in the concepts of wellness and behavioral health recovery. </li></ul>
    15. 16. Health Homes <ul><li>Section 2703 </li></ul><ul><ul><li>Enhanced integration of primary and specialty care for individuals with: </li></ul></ul><ul><ul><ul><li>At least two chronic conditions </li></ul></ul></ul><ul><ul><ul><li>One chronic condition and be at risk for another, or </li></ul></ul></ul><ul><ul><ul><li>Serious and persistent mental illness </li></ul></ul></ul><ul><ul><li>Chronic conditions include: </li></ul></ul><ul><ul><ul><li>mental health condition, </li></ul></ul></ul><ul><ul><ul><li>substance use disorder, </li></ul></ul></ul><ul><ul><ul><li>asthma, </li></ul></ul></ul><ul><ul><ul><li>diabetes, </li></ul></ul></ul><ul><ul><ul><li>heart disease, and </li></ul></ul></ul><ul><ul><ul><li>being overweight, BMI < 25. </li></ul></ul></ul>
    16. 17. Health Homes <ul><li>Health homes (several new services): </li></ul><ul><ul><li>Comprehensive Care Management </li></ul></ul><ul><ul><li>Care Coordination and Health Promotion </li></ul></ul><ul><ul><li>Patient and Family Support </li></ul></ul><ul><ul><li>Comprehensive Transitional Care </li></ul></ul><ul><ul><li>Referral to Community and Social Support Services </li></ul></ul><ul><li>Timing </li></ul><ul><ul><li>States can submit plans for effective dates as early as 1/2011 </li></ul></ul>
    17. 18. More Information: http://www.samhsa.gov

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