"meeting challenges: trying to stay one step ahead" steve hanson associate commissioner...
TRANSCRIPT
"Meeting Challenges: Trying to Stay One Step Ahead"
Steve HansonAssociate Commissioner
Treatment & Practice Innovation
“ The times, they are a-changing” - Bob
Dylan
What’s Changing in Treatment?
Almost Everything!• Substances being used• Models for Treatment• Managing Care• Insurance Coverage• Payment Mechanisms• Performance Measures
Substances Being Used
• Alcohol, Cocaine, Marijuana,• Opiates – Heroin & Prescription• Designer Drugs
2011 National Survey on Drug Use and Health (NSDUH),
2011 National Survey on Drug Use and Health (NSDUH),
2011 National Survey on Drug Use and Health (NSDUH),
OASAS - 2011 Treatment System Fast Facts
2011 National Survey on Drug Use and Health (NSDUH),
2011 National Survey on Drug Use and Health (NSDUH),
2011 National Survey on Drug Use and Health (NSDUH),
2011 National Survey on Drug Use and Health (NSDUH),
Designer Drugs• Round 1 – ’60’s and ’70’s -
hallucinogens• Round 2 – ’80’s and ‘90’s – synthetic
opiates and MDMA (ecstasy) variations
• Round 3 – Now – synthetic cannabinoids and the “Bath Salt” family.
• www.Erowid.org
Designer Drugs• Take advantage of drug laws to
make a “new” drug that is legal• Make a drug that is “better” than
current• Avoid detection• Landscape changes quickly
Lab-Based Drug Testing (2010):
Lab Testing 2012
Analog Prevalence 2010
Analog Prevalence - 2012
Managed Care
Historic System• Fee for Service Medicaid – Patients frequently
use Emergency Rooms as primary provider. No one responsible for well being of patient.
• Uninsured – State funding (including Federal Block Grant dollars) for people without insurance or services not covered by Medicaid (e.g. Intensive Residential)
• Programs covered by “net deficit” reimbursement.
• Historic system consisted of high cost, frequently ineffective care for many.
2010 Detox Top 1000 Users
$159 million76%
$11 million5%
$39 million19%
Top 1000.3%
Next 9003.1%
Remaining27,81296.5%
21
One Person in 201073 Detox Admissions
291 Detox Days
15 Detox Providers
Over $300,000 Cost
It is Time to ChangeOh, DarnWas thatToday?
BHO Phase II• All Medicaid Covered Lives have managed
behavioral healthcare.• Offices (OASAS, OMH, DOH, NYC DOHMH)
working to develop model for Medicaid management.
• Implementation 2014• Working with Mercer consulting firm
– Design questions– Population/actuarials– Rate setting– Network Designs
24
It’s ComplicatedIssues:• Structures/Models• NYC and ROS• Waivers• CMS requirements• Eligibility• Enrollment• Actuarials• Benefits• Adults and Kids• Etc., Etc….
State Funded Care• Coverage of uninsured individuals • Coverage for non-Medicaid Reimbursable Care• “Net-Deficit” Funding• SAMHSA – Federal Block grant dollars should be
“managed”• Commissioner’s priority that a Pay for
Performance system of reimbursement be instituted.
• Hold providers accountable for outcomes.• In development.
Impact on Criminal Justice System
• Increased focus on treatment outcomes should improve CJ system outcomes for individuals receiving CD treatment services.
• OASAS working on LOCADTR-3. Level of care determination tool. What level of care is appropriate.
• Concern about CJ clients being placed in higher level treatment programs for “Public Safety” issues rather than clinical necessity.
Inpatient
Rehab
OutpatientRehab
IntensiveResidential
PROVIDERS IN THE MIDDLE
Medicaid Managed Care
• “Medical Necessity” Standard• Risk factors based on Substance
– High – Opiates – Overdose Risk Substantial
– Medium – Alcohol/Cocaine – Some OD risk
– Low – Marijuana- No OD Risk
Appropriate Levels of Care• Money is tight – Federal/State
budgets• Federal Block Grant changes• Expectations on Performance and
Outcomes• Level of Care must be determined by
Treatment, not CJ, using accepted standards – ASAM, LOCADTR-3
Improving Performance
• Governor/Commissioner’s Goals of Improving outcomes for patients
• Federal goals of performance improvement for Block Grant
• Identifying good outcome measures
61.3% 54.7%
46.3%
26.9%
Adverse Discharges
Pay for Performance
• Current “Net Deficit” funding mechanism does not address program outcomes.
• System to “pay for performance” under development
Treatment Models
• NY has utilized treatment models that are somewhat different than the rest of the country.
• US Median IR LOS for Treatment Complete – 90 days
• NY Median IR LOS for Treatment Complete – 189 days (221 with Transfers)
OASAS Goals
• Review Treatment models to ensure:– Best Outcomes– Appropriate Care– Reasonable Length of Stay– Program Accountability