/ en Sat, 26 Apr 2025 05:09:21 -0500 Wed, 08 Jan 25 14:25:57 -0600 /news/headline/2025-01-08-samhsa-awards-1-million-grants-15-participants-medicaid-behavioral-health-program <p>The Substance Abuse and Mental Health Services Administration Jan. 7 <a href="https://www.samhsa.gov/newsroom/press-announcements/20250107/biden-harris-administration-awards-fourteen-states-washington-dc-ccbhc-medicaid-demonstration-planning-grants-expanding-access-mental-health-substance-use-disorder-services">announced</a> it will award $1 million grants to 14 states and Washington, D.C., to take part in the Certified Community Behavioral Health Clinic Medicaid Demonstration Program. The program provides states with sustainable funding to help them expand access to mental health and substance use services.  <br><br>The latest states selected are Alaska, Colorado, Connecticut, Delaware, Hawaii, Louisiana, Maryland, Montana, North Carolina, North Dakota, South Dakota, Utah, Washington and West Virginia. Participants must ensure patients have access to a comprehensive range of services that provide care coordination, incorporate evidence-based practices and give support based on a community needs assessment — including crisis services that are available 24/7.</p> Wed, 08 Jan 2025 14:25:57 -0600 Substance Use Disorder /news/headline/2024-12-18-cms-announces-state-participants-innovative-behavioral-health-model <p>The Centers for Medicare & Medicaid Services today <a href="https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model" title="ibh model">announced</a> Michigan, New York, Oklahoma and South Carolina state Medicaid agencies were selected to participate in its state-based Innovation in Behavioral Health Model. The eight-year IBH Model is intended to improve care quality and behavioral and physical health outcomes for Medicare- and Medicaid-enrolled adults with moderate to severe mental health conditions and substance use disorders. The pre-implementation period will begin Jan. 1, 2025, when states will begin to conduct outreach and recruit specialty behavioral health practices to participate in the model.</p> Wed, 18 Dec 2024 15:53:49 -0600 Substance Use Disorder /lettercomment/2024-11-20-aha-urges-congress-address-addiction-treatment-barriers <p>The Honorable Paul Tonko<br>U.S. House of Representatives<br>2369 Rayburn House Office Building<br>Washington, DC 20515</p><p>The Honorable Mike Turner<br>U.S. House of Representatives<br>2183 Rayburn House Office Building<br>Washington, DC 20515</p><p>Dear Representatives Tonko and Turner: </p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to respond to your questions about how hospitals and health systems across the country are working to expand access to addiction treatment and what additional steps Congress can take to eliminate the remaining barriers. We thank you for your bipartisan leadership in developing approaches to better meet the nation’s behavioral health care needs. </p><h2>AHA’S WORK ON ELIMINATING BARRIERS TO ADDICTION TREATMENT </h2><p>Physical and mental health care are inextricably linked, and everyone deserves access to high-quality behavioral health care, including medications for opioid use disorder (MOUD). The AHA has a long history of supporting hospitals and health systems across the country in their work to deliver behavioral health services to their patients and communities. In 2017 we released the first edition of our <a href="/opioids/stem-tide-addressing-opioid-epidemic-taking-action#Epidemic">Stem the Tide </a>toolkit to provide guidance and information to hospitals and health systems on partnering with patients, clinicians and the community to address the opioid epidemic.</p><p>In 2020 AHA released the next edition of this work, <a href="/opioids/stem-tide-addressing-opioid-epidemic-taking-action">The Opioid Stewardship Measurement Implementation Guide </a>— with ideas for driving improvements in opioid stewardship within hospitals and health systems and their communities — and <a href="https://soundcloud.com/advancinghealth/sets/the-power-of-prevention-and">The Power of Prevention and Treatment: An AHA Opioid Stewardship Podcast Series </a>to encourage discussion on how hospitals and health systems are improving access to opioid use disorder (OUD) care and what supports are needed to continue to improve care and access for patients and their communities. </p><p>Now, in 2024, we are encouraged by the progress to ease barriers to life-saving addiction medicine, but more work remains. AHA, through its affiliate Health Research & Education Trust, was recently awarded a <a href="/news/headline/2024-10-24-aha-receives-cdc-grant-address-opioid-stimulant-use-disorder-and-expand-infection-prevention-resources">grant </a>to support hospital and health system efforts to strengthen linkage to and retention in care for people with OUD and stimulant use disorder (StUD). Funded by the Centers for Disease Control and Prevention, this project aims to expand evidence-based and evidence-informed efforts to link people to care, treatment and recovery services for OUD and StUD. Specifically, the project seeks to develop resources that bolster cross-continuum collaboration and ultimately improve patient retention in and across three clinical settings: inpatient care, primary care and pharmacy. We will keep you updated on this project in the months to come. </p><p>AHA also has been working to reduce the stigma surrounding addiction and seeking treatment for substance use disorders (SUD) by partnering with behavioral health and language experts from member hospitals and partner organizations to release a series of downloadable posters — <a href="/people-matter-words-matter">People Matter, Words Matter </a>— to help create a culture of patient-centered, respectful language for addiction and SUD care. We have heard from our members that these posters have proved to be a valuable addition to their facilities to encourage more respectful dialogue among health care professionals and visitors alike. </p><h3>AHA Member Case Studies </h3><p>Nationwide, hospitals and health systems are engaged in extraordinary work to improve access to effective and high-quality treatment for SUDs. We felt it would be helpful to answer your questions by sharing a few examples from our members, in their own words, about what is going well and what challenges remain. Because each program is ongoing, it may have evolved or experienced changes in personnel since publication. We encourage you to take a look at our <a href="/advocacy/access-and-health-coverage/access-behavioral-health">website </a>for additional podcasts and resources. </p><ul><li><strong>Hospital Team Sets Patients Up for Successful Treatment and Recovery (</strong><a href="/advancing-health-podcast/2020-08-18-changing-way-we-approach-opioid-use-disorder"><strong>Case Study)</strong></a>. The Buprenorphine Team — or B team — was formed at Dell Seton Medical Center in Austin, Texas, in collaboration with Dell Medical School at the University of Texas at Austin. The B team consists of physicians, nurses, pharmacists, social workers, chaplains and other health care professionals who provide information about buprenorphine and the best care for those with SUD.</li><li><strong>Small Rural Hospital Helps Build ‘Bridge’ to Addiction Services with New Mobile Clinic (</strong><a href="/system/files/media/file/2023/03/Behavioral-Health-Case-Study-Phys-Integration-Baystate.pdf"><strong>Case Study)</strong></a><strong>.</strong> With several key community partners, Greenfield, Mass.-based Baystate Franklin Medical Center established a mobile, home-based treatment service for its rural community located about 100 miles northwest of Boston. Fueled by a $1 million grant from the Health Resources and Services Administration’s (HRSA) Rural Communities Opioid Response Program, the Franklin County and North Quabbin Bridge Clinic aims to help meet patients where they are — be it a recovery center, library, a home or the Salvation Army.<em> </em></li><li><strong>Partnerships to Address Substance Use Disorders (</strong><a href="https://soundcloud.com/advancinghealth/presbyterian/s-QbTMA"><strong>Podcast)</strong></a><strong>.</strong> Presbyterian Healthcare Services is a not-for-profit integrated health system in New Mexico with nine hospitals, a medical group and a health plan. In this podcast, Daniel Duhigg, D.O., medical director for addiction services at Presbyterian Healthcare Services, discusses how their Integrated Substance Use Disorder and Community Collaborative Initiative uses a holistic approach to strengthen and improve outcomes for patients, families and health plan members affected by SUDs.<em> </em></li></ul><h2>REMAINING POLICY AND REGULATORY BARRIERS<strong> </strong></h2><h3>Bolster Reimbursements for Behavioral Health Providers </h3><p>Traditional fee-for-service payment systems, including Medicare, inadequately reimburse providers across the behavioral health service continuum. Fee-for-service payment structures rarely reimburse for important time-based (as opposed to procedure-based) elements of behavioral health care, such as coordinating care across providers and settings or for care management that does not occur face-to-face, including referrals and case management. Current reimbursement levels also reflect an undervaluing of behavioral health services, which may require more evaluation, clinical expertise and time than certain medical services. For example, unlike anemia, schizophrenia cannot be identified with a blood test; similarly, diagnostic imaging can reveal broken bones but not depression. Because identification, diagnosis and treatment of behavioral health disorders often involve using multiple tools and therapies, a simple fee-for-service payment structure cannot capture the wide span of costs incurred by behavioral health specialists. In addition, separate funding streams and benefit structures for psychiatric and SUDs create barriers and limit the integration of behavioral health care with other medical and surgical services. This is particularly true for the Medicaid program, the largest payer of behavioral health care. </p><p>In addition to underpaying for care and thus limiting providers’ ability to take on new patients, it is important to consider how low reimbursement rates may discourage the recruitment and retention of the next generation of behavioral health professionals required to serve the growing need for behavioral health care. </p><h3>Repeal the Institution for Mental Diseases Exclusion </h3><p>As Congress continues to look for ways to improve access to needed SUD treatment services for Americans and to reduce the stigma associated with these health conditions, we encourage you to permanently repeal the Institution for Mental Diseases (IMD) exclusion of federal Medicaid funding to pay for inpatient behavioral health treatment (including SUD and mental health services) in certain inpatient facilities. SUD treatment requires access to the full continuum of care, including inpatient care, partial hospitalization, residential treatment and outpatient services. Different types of patients require different clinical services across the care continuum, and the IMD exclusion currently blocks critical elements of that care. These patient populations include adolescents, pregnant women, individuals with unstable housing, people with high relapse potential, and individuals who have OUD or other SUDs with co-occurring alcohol or benzodiazepine addictions. Investing only in outpatient or community-based care and failing to provide states with relief from the IMD exclusion would continue to deny many of these patients access to the most clinically appropriate care. To alleviate the dire shortage of inpatient psychiatric beds, <strong>Congress should permanently repeal the IMD exclusion to allow federal Medicaid dollars to pay for clinically appropriate inpatient care.</strong> </p><h3>Remove the 190-day Lifetime Limit </h3><p>As we work to better address the nation’s health needs by further integrating physical and behavioral health, the 190-day lifetime limit on coverage under Medicare is another remaining antiquated obstacle. Medicare currently covers only 190 days of inpatient care in a psychiatric hospital in a person’s lifetime. No other Medicare specialty inpatient hospital service has this type of arbitrary cap on benefits. For many patients, chronic mental illness will be a lifelong journey and could far exceed 190 days of inpatient treatment, leaving them to rely on other sources of financing (including Medicaid and Social Security) to pay for long-term services in non-psychiatric settings that may be inadequate for their care. </p><p>With the nation’s population aging and an increasing number of seniors and people with disabilities seeking inpatient care to address their behavioral health needs, now is the time to repeal this outdated and discriminatory policy and ensure that Medicare beneficiaries can receive necessary inpatient psychiatric care. <strong>The AHA supports bipartisan legislation such as the Medicare Mental Health Inpatient Equity Act of 2023 (H.R. 4946) to remedy this discriminatory policy.</strong></p><h3>Repeal In-person Telehealth Requirement for Behavioral Health </h3><p>Behavioral health is one specialty that has seen sustained growth in telehealth utilization. In fact, prior to the pandemic, telehealth visits accounted for less than 1% of behavioral health visits. During the pandemic, they peaked at about 40% of all behavioral health visits and have been sustained at around 36%.<sup>1</sup> There continues to be an increasing demand for behavioral health services, but additional flexibilities are required to ensure the people who need them most can access these services. </p><p>The Consolidated Appropriations Act of 2021 requires that a patient must receive an inperson evaluation six months before they can initiate behavioral telehealth treatment, plus an annual in-person visit. From an access perspective, requiring an in-person visit six months before and annually after may serve as an additional barrier to receiving care, particularly for patients in rural or underserved areas. </p><p>The progression to a permanent pathway for waiving in-person visits has been delayed due to concerns about diversion risk. We recognize and appreciate the important role the Drug Enforcement Agency (DEA) plays in mitigating the diversion risk. However, significant data demonstrates that increased access to MOUD is only associated with improved outcomes, not increased misuse risks, and any diversion risks can be mitigated with efforts already in place.<sup>2</sup> The DEA relies on a general assumption that because controlled substances <em>can</em> be misused, an increase in access results in increased risk. This assumption not only overstates the risk of diversion but also fails to consider the millions of Americans who may be harmed by an inability to access medically necessary medication through virtual prescribing. <strong>In many cases, seeing a provider in person is simply not an option for some patients, whether due to physician shortages, mobility issues or transportation challenges.</strong> For example, there is a national shortage of psychiatrists and other behavioral health providers; indeed, according to HRSA, 123 million people live in a mental health provider shortage area, and the American Psychiatric Association projects a shortage of over 12,000 psychiatrists by 2030.<sup>3,4</sup> Therefore, remote services are becoming increasingly important to link geographically dispersed patients to prescribers for medications like buprenorphine. </p><h3>Establish DEA Special Registration Process for Telemedicine for Administration of Controlled Substances </h3><p>The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 outlined specific requirements for in-person evaluations prior to prescribing controlled substances. In conjunction with these requirements, this law also outlined seven categories where telemedicine could be utilized, including but not limited to public health emergencies (PHEs) (the basis for the waiver during COVID-19), a special registration obtained from the attorney general, and other circumstances to be defined by regulation. The Ryan Haight Act went on in Sec. 311(h)(2) to specify that the attorney general shall promulgate regulations specifying circumstances in which a special registration for telemedicine prescribing may be issued and the procedures for obtaining such a special registration. In other words, it was never the intention of Congress to permanently and unilaterally restrict access to telemedicine prescriptions of controlled substances issued by legitimate prescribers for clinically appropriate purposes. </p><p>The SUPPORT Act of 2018 again mandated that the DEA, in coordination with the Department of Health and Human Services, promulgate special registration final regulations specifying: (1) the circumstances in which a special registration for telemedicine may be issued that authorizes prescribing of controlled substances without an in-person evaluation; and (2) the procedure for obtaining a special registration. The COVID-19 pandemic provided an opportunity for the DEA to learn from the broad utilization of telemedicine prescribing and set forth policies and pathways for providers to continue to safely administer prescriptions virtually, even after the PHE period ended. <strong>Unfortunately, despite the Ryan Haight Act requirement that the DEA establish a special registration process </strong><em><strong>nearly 16 years ago</strong></em><strong>, and subsequent reinforcement of this requirement over five years ago in the SUPPORT Act, the agency still has not created one.</strong> </p><p><strong>We ask Congress to consider the following: </strong></p><ul><li>Continue to urge the DEA to require proposed and final rulemaking from agencies for the special registration for telemedicine regulation.</li><li>Grant a permanent exception for separate registrations for practitioners in states with medical licensing reciprocity requirements.</li><li>Require agencies to provide a proposed interim plan if there is ever a gap in PHE waivers and rulemaking. </li></ul><h3>Medication-assisted Treatment in Emergency Departments </h3><p>To help prevent SUD relapses, Congress can also provide additional support for programs that fund hospital efforts to initiate medication-assisted treatment (MAT) in emergency departments (EDs). The SUPPORT Act requires Medicaid programs to cover MAT from October 2020 through September 2025, and it expands certain providers’ ability to treat up to 100 patients in the first year of receiving a waiver. However, access to these programs remains limited. The AHA supports making this change permanent, as well as expanding grant funding for hospitals and other entities to enable the development of protocols for discharging patients from the ED who have overdosed on opioids, which may include providing MAT, connecting patients with peer support specialists, and supporting referrals to community-based treatment.   </p><h3>Eliminate Prior Authorization for MOUD  </h3><p>Millions of Americans rely on commercial insurers for their health care coverage, including Medicare Advantage (MA) plans through the Medicare program. Unfortunately, practices such as prior authorization can result in inappropriate denials, additional burdens on providers and ultimately delays in a patient’s access to needed care. </p><p>The AHA remains particularly concerned with current prior authorization practices for MAT that are not evidence-based and lack uniformity with insurers. Because many mental health services are more time-based than physical health services, with fewer quantitative ways to measure outcomes, these processes take a disproportionate toll on behavioral health services. Studies have shown that, compared with patients whose insurance did not impose prior authorization restrictions on their medication, odds of treatment effectiveness were 19-29% lower due to lack of medication adherence.<sup>5</sup> Payer practices that restrict access to care include overly broad use of prior authorization, automatic denials (most of which are overturned upon appeal), inappropriate delays of approvals, and insufficient provider networks. </p><p>To address these practices within MAT, Congress should: </p><ul><li><strong>Require</strong> a list of drugs subject to prior authorization that is uniform across insurers to provide consistent information to patients and providers.</li><li><strong>Make clear</strong> that coverage across the entire treatment spectrum is necessary (rather than requiring prior authorization each time the prescription is filled).</li><li><strong>Pass</strong> comprehensive legislation to streamline prior authorization requirements such as the Improving Seniors’ Timely Access to Care Act. </li></ul><h3>Strengthen the Health Care Workforce </h3><p>The chronic underfunding for behavioral health services has hampered hospitals’ and health systems’ ability to retain critical staff, especially as the financial pressures of the past several years further eroded hospitals’ ability to subsidize these services. As the need for behavioral health services continues to rise, the nation is ill-prepared to respond to these needs due to severe shortages in the behavioral health workforce. A key action needed to support and expand the behavioral health workforce is the elimination of policies that make it harder for existing providers to treat patients. </p><p>Reducing barriers to licensure can help maximize limited provider capacity, particularly in areas with shortages of practitioners. <strong>The AHA supports efforts to ensure that licensure processes are streamlined for providers employed by hospitals and health systems operating across state lines and encourages additional research on the feasibility, infrastructure, cost and secondary effects of licensure.</strong> </p><p>We are committed to working with the health care field, Congress and the Administration to address long-term workforce. The AHA recommends the following suggestions to support the behavioral health workforce: </p><ul><li><strong>Reauthorize</strong> the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program.</li><li><strong>Invest</strong> in graduate medical education and increase slots for behavioral health in underserved areas.</li><li><strong>Streamline</strong> and simplify licensure application and processing by reducing the variability of scope-of-practice laws and support changes that drive integration of care teams. </li></ul><h2>CONCLUSION </h2><p>We thank you for your leadership and dedication to finding bipartisan solutions to address these important issues. As you know, there is still more work to be done to reduce barriers to receiving and administering behavioral health services, and we look forward to working with you on these future efforts. </p><p>Sincerely, </p><p>/s/ </p><p>Lisa Kidder Hrobsky<br>Senior Vice President, Legislative and Political Affairs </p><p>__________<br><sup>1</sup> Centers for Disease Control and Prevention. "Increased Use of Telehealth for Opioid Use Disorder Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose." CDC Online Newsroom, August 31, 2022. <a class="ck-anchor" href="https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html" id="https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html">https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html</a><br><sup>2</sup> Gary Qian, Keith Humphreys, Jeremy D. Goldhaber-Fiebert, Margaret L. Brandeau. "Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis." Drug and Alcohol Dependence 256 (2024). <a class="ck-anchor" href="https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub" id="https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub">https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub</a> <br><sup>3 </sup><a href="https://data.hrsa.gov/topics/health-workforce/shortage-areas">https://data.hrsa.gov/topics/health-workforce/shortage-areas</a>  <br><sup>4</sup> <a href="https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/workforce-development">https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/workforce-development</a>  <br><sup>5 </sup>Boytsov, N., Zhang, X., Evans, K.A. <em>et al.</em> Impact of Plan-Level Access Restrictions on Effectiveness of Biologics Among Patients with Rheumatoid or Psoriatic Arthritis. <em>PharmacoEconomics Open</em>4, 105–117 (2020). <a href="https://doi.org/10.1007/s41669-019-0152-1">https://doi.org/10.1007/s41669-019-0152-1 </a> </p> Wed, 20 Nov 2024 13:25:30 -0600 Substance Use Disorder /advancing-health-podcast/2024-09-27-saving-peoples-lives-access-mental-health-and-addiction-services-rural-communities <p>Accessing mental health and addiction services can be especially difficult in rural communities, and solutions can be scarce. In this conversation, Brenda Romero, administrator at Presbyterian Española Hospital, discusses the methods for accessing treatment and the importance of the hospital's innovative and community-focused work.</p><hr><div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br>   </h2> </summary> <p> 00:00:00:09 - 00:00:21:21<br> Tom Haederle<br> Distance and lack of transportation. Obtaining a prescription and then paying for it. These are just some of the challenges that make accessing mental health and addiction services especially difficult in rural communities. </p> <p> 00:00:21:24 - 00:00:43:01<br> Tom Haederle<br> Welcome to Advancing Health, a podcast from the ���������� Association. I'm Tom Haederle with AHA Communications. Access to quality care in rural communities often presents problems that defy easy solutions. Still, there are workarounds, as we learn in this podcast hosted by Rebecca Chickey, the AHA's senior director for clinical affairs and workforce. </p> <p> 00:00:43:04 - 00:01:06:17<br> Rebecca Chickey<br> Indeed, it's an honor to be here today with Brenda Romero. I have known her for over a decade now. She is a past member of AHA's Committee on Behavioral Health, our national advisory committee that helps us with our advocacy and policy, as well as resource work. And that's why Brenda is here today as a CEO of a small rural hospital in New Mexico. </p> <p> 00:01:06:19 - 00:01:31:21<br> Rebecca Chickey<br> She has a great deal of experience, some of which she's going to share with you here today about improving access to mental health and addiction services in a small rural community. So, Brenda, welcome. Thank you for sharing your time and expertise. My first question to you is, what are a couple of the biggest challenges to accessing behavioral health in a rural community? </p> <p> 00:01:31:25 - 00:01:37:09<br> Rebecca Chickey<br> For those many, many listeners who live in an urban, metropolitan area, help them understand. </p> <p> 00:01:37:11 - 00:02:09:20<br> Brenda Romero<br> The first issue is access to the care in that rural communities don't usually have taxis. Transportation is an issue. And for people who are suffering from this illness, they're usually couch surfing or living out in the streets. And so finding them and getting them to the care is usually the first issue that we encounter. And the second is getting them the medication. The cost </p> <p> 00:02:09:20 - 00:02:38:15<br> Brenda Romero<br> of the medication can be up to $500 a month. And getting them the prescriptions is one thing, but then getting them the medications is another. Usually people with that presentation don't have a payor source, and so then it would require somebody giving them that money and willing to support that every single month. In order to increase compliance with medication treatment </p> <p> 00:02:38:20 - 00:03:03:26<br> Brenda Romero<br> we have started using some medications, like Brixadi, that we can give in the ER or in our infusion center, and it'll last a whole month. And we're using that type of medication for pregnant women that present and that we're not sure if we're going to see again for some time. And so that's been helpful. </p> <p> 00:03:03:28 - 00:03:27:15<br> Rebecca Chickey<br> So I'm going to hit home with a couple of things that you said for people who live in Chicago or New York or even Nashville, Tennessee, where I lived for a number of years. The fact that there's not a taxi is really sort of like, what? And I suppose that same lack of transportation services, you don't have an abundance of Uber drivers or Lyft drivers in your community either, right? </p> <p> 00:03:27:16 - 00:03:53:11<br> Brenda Romero<br> No, it's not available. And when you're talking about where these patients need to come from, we are in Espanola and there's about, there's less than 10,000 people that actually live in the city. And then there's Rio Arriba county, and it can be 100 miles to one of the borders. So we're talking about they come from surrounding communities. So it's not like somebody can walk there. </p> <p> 00:03:53:13 - 00:03:55:13<br> Brenda Romero<br> They need to find a ride. </p> <p> 00:03:55:15 - 00:04:18:17<br> Rebecca Chickey<br> And so that means relying on family or friends who may or may not also have transportation services. So just that physical capability of getting to the hospital or the emergency room is a challenge that many of our listeners probably can't imagine, but I can. Having grown up in rural Alabama, when EMS tried to get to my father, they couldn't find the house because there was no GPS at that time. </p> <p> 00:04:18:19 - 00:04:49:26<br> Rebecca Chickey<br> The next thing that you mentioned is the cost of the medications. So that's not unique to mental health. There always seems to be an article in the news or a discussion somewhere about the cost of medications, but these medications are for our most fragile patient populations because they often, and please correct me if I'm wrong, but they often have physical comorbidities as a result of or perhaps one of the reasons that they may be self-medicating with substances. </p> <p> 00:04:50:03 - 00:04:56:29<br> Rebecca Chickey<br> So their physical health and their mental health are often fragile and being challenged. Is that an accurate statement? </p> <p> 00:04:57:01 - 00:04:58:09<br> Brenda Romero<br> Yes. </p> <p> 00:04:58:11 - 00:05:16:02<br> Rebecca Chickey<br> And so because of that, tell me why it's so important to be able to provide a medication that lasts for a month. Is that to know that you don't have to worry after that because of compliance issues, because the patients are actually going to, they don't have to worry about that then. </p> <p> 00:05:16:05 - 00:05:48:23<br> Brenda Romero<br> Yes, it's not only compliance, but it's actually getting the medication. And so usually they don't have a payor source so they don't have Medicaid. And if they have Medicare due to a disability, they usually haven't signed up for part D or any of the other parts that they need to get payment for the medications, for prescriptions. And so if they were to try to go get their medications and be compliant with that, most times they wouldn't even get the medications because they can't pay for them. </p> <p> 00:05:48:26 - 00:06:07:24<br> Brenda Romero<br> And if a family member is willing to start them on it, like pay for the first month, it's pretty hard to get somebody to commit to just continue to pay for that. In order to get them on Medicaid, they would have to then get all the paperwork in order to apply. And they can apply online. </p> <p> 00:06:07:24 - 00:06:28:24<br> Brenda Romero<br> But some of these older folks don't have the capacity to be able to do that. They don't have the phone. They don't have the experience with getting on a website and filling in all the information that they need. And some of that information that they might need is to upload a copy of the birth certificate, and they might not have the birth certificate. </p> <p> 00:06:28:26 - 00:06:37:12<br> Brenda Romero<br> So the barriers are huge for them. They can't get there. And so I think that... </p> <p> 00:06:37:15 - 00:06:40:28<br> Rebecca Chickey<br> So what's your solution? What have you been creating, what have you been innovating. </p> <p> 00:06:40:28 - 00:07:01:18<br> Brenda Romero<br> So what we've done is we've started the treatment in the emergency room and then following them up in the clinic. And if we can get them started on medication, then we can buy more time to work with peer counselors, to work with case managers to help them get what they need in place in order to continue the treatment. </p> <p> 00:07:01:21 - 00:07:29:00<br> Brenda Romero<br> We are also encouraging the homeless shelters to work with the homeless population and to get them to our E.R. if they can do that. Presbyterian Healthcare Services, organization I work for, is now also asking if our paramedics can start giving out some of the medication when they respond to a call, if the patient is willing to start the treatment at the time. </p> <p> 00:07:29:07 - 00:07:37:17<br> Brenda Romero<br> So we're trying to figure out how to get the medications to folks where we can, even if they can't afford to do it. </p> <p> 00:07:37:19 - 00:08:04:08<br> Rebecca Chickey<br> So it sounds like you're taking advantage of every opportunity where there's a touchpoint with a patient that has this need. Yes. That's phenomenal. It's, I think, a broader sense of patient-centered care. You're going to where the patients are and providing the services. So do you think this innovative idea is replicable? Can it be implemented by other organizations in a similar crisis situation? </p> <p> 00:08:04:08 - 00:08:11:23<br> Rebecca Chickey<br> I would say because the challenges that you described almost seem insurmountable. But do you think others could replicate it? </p> <p> 00:08:12:00 - 00:08:35:21<br> Brenda Romero<br> Yes. Also, keeping in mind that, especially at the beginning, they're not going to have a payor source, right? So we're going to have to start that and not be reimbursed for that. But it makes a huge difference, not only most importantly to that person's life. Right? Like, who wants to be suffering like that? And then it starts improving their participation in society </p> <p> 00:08:35:21 - 00:09:02:27<br> Brenda Romero<br> and with their family members. And in our area it's a very family-oriented area, and most people who don't have a place to live will have a place to live if they sober up. And so reuniting those patients with their families is just, it would be an amazing thing to do. And then their reentry into their communities would be another win for everybody, right? </p> <p> 00:09:03:00 - 00:09:25:08<br> Brenda Romero<br> And makes it a safer place for the patient and for the communities that they live in. And so I think it's very, very important. I think it's worth it to everybody. There's something in it for everyone. And I think that one way to start is to assess what the barriers are, what are the barriers that those patients in your community are experiencing. </p> <p> 00:09:25:08 - 00:09:37:07<br> Brenda Romero<br> Because as you said, bigger communities have transportation. They have other ways to get around. So the patients in their community might not have the same barriers that we have in ours. </p> <p> 00:09:37:14 - 00:09:59:26<br> Rebecca Chickey<br> Yeah. As you were describing the long-term impact of this, if an individual gets on a medication that helps them remain sober for a month, then that gives them hope, then they may be able to get traction to go back and live with their family. Then they may be able to get a job. And that is something that is priceless, right? </p> <p> 00:09:59:29 - 00:10:26:15<br> Rebecca Chickey<br> You can't really put a price on giving someone their humanity back. But at the same time, the reality is that often no margin, no mission. So I realized that this is a new innovative initiative that you undertake, and so you probably haven't, you don't have hard data on that. But I would assume that what you're hoping is that you're going to see fewer emergency room visits, which we all know are costly. </p> <p> 00:10:26:17 - 00:10:54:12<br> Rebecca Chickey<br> I assume that you're going to have less use of emergency services outside, sending someone out to rescue someone who is in a crisis from a substance use disorder. And perhaps even you will see a reduction long term in things like cirrhosis, in things like congestive heart failure, in wound care for individuals, depending upon what the substance is. Is that what you're hoping for in the long run? </p> <p> 00:10:54:15 - 00:11:21:19<br> Brenda Romero<br> Yes. But most importantly, saving people, saving people's lives, right? They are at risk of death every day, premature death every day. And there's a lot of violence that's, you know, associated with this diagnosis. And so not only the patient's life, but their family and friends and other community members walking around. I mean, it would improve all of that also. </p> <p> 00:11:21:21 - 00:11:33:08<br> Rebecca Chickey<br> So it's a population health approach, I agree. Thank you. So much, one, for the work that you're doing. Boots on the ground, making a difference in individuals' lives. And thank you for sharing that inspiration with us here today. </p> <p> 00:11:33:10 - 00:11:34:27<br> Brenda Romero<br> Thank you. </p> <p> 00:11:35:00 - 00:11:43:10<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details> </div> Thu, 26 Sep 2024 23:07:39 -0500 Substance Use Disorder /2024-09-26/transforming-behavioral-health-journey <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-09/Iris-Telehealth-banner-1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Transforming the Behavioral Health Journey</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Transforming the Behavioral Health Journey</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="/system/files/media/file/2024/09/IrisTelehealth-TransformingBehavioralHealth-ke-092624.pdf" target="_blank"><img src="/sites/default/files/2024-09/Iris-Telehealth-cover-910x1220.jpg" alt="AHA Knowledge Exchange | Transforming the Behavioral Health Journey" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Finding the path to a sustainable, service continuum</h2><p>An estimated one in four Americans will require behavioral health services by 2026 according to Trilliant Health research. Behavioral health disorders include both mental illness and substance use disorders. Health systems increasingly are seeking ways to drive innovative, transformative change around this service line to solve critical challenges affecting behavioral health care delivery. This Knowledge Exchange ebook explores how hospitals and health systems are investing and partnering in behavioral health, where they face challenges and opportunities for strategic alignment and financial sustainability, and how they aim to leverage behavioral health to support their communities.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="/system/files/media/file/2024/09/IrisTelehealth-TransformingBehavioralHealth-ke-092624.pdf" title="AHA Knowledge Exchange | Transforming the Behavioral Health Journey" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat"><strong>Sponsored by: </strong><a href="https://iristelehealth.com/" target="_blank" rel="noopener nofollow"><img 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sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>10 strategic initiatives and investments that health leaders can prioritize for sustainable behavioral health services in their communities</h3><div class="sp_CTA5_section"><ul><li><strong>Identify community behavioral health needs and gaps</strong> in care to develop a comprehensive, integrated strategy as part of health and the continuum of care.</li><li><strong>Integrate physical and behavioral care in primary care settings</strong>, including pediatrics and obstetrics, as a way to focus on early prevention, screening and treatment.</li><li><strong>Partner, collaborate and joint venture</strong> with other hospitals, providers, schools and community organizations to build and create sustainable and coordinated behavioral health services.</li><li><strong>Research new approaches to addressing psychiatric emergencies</strong>, such as EmPath units and behavioral health urgent care, to determine the best fit for the needs of your community.</li><li><strong>Establish a coordinated community response to crisis situations</strong>, working in partnership with other health care providers, EMS, and law enforcement to provide the patient with the appropriate level of treatment and stabilization.</li><li><strong>Consider alternative use of vacant space in facilities and malls</strong> as locations for pieces of the behavioral health care continuum.</li><li><strong>Examine the existing continuum of behavioral health services</strong>, matched against community needs, and research options to fill the gaps and enhance the continuum.</li><li><strong>Where needed, augment substance use disorder care</strong> with detox units, long term injectables, and support with health related social needs, such as housing and employment.</li><li><strong>Improve access to behavioral health care in a multitude of ways</strong>, including telehealth, transportation to in-person care, peer-delivered interventions, and prescription digital therapeutics.</li><li><strong>Address workforce shortages through a multi-pronged approach including expansion of telehealth services</strong> across the care continuum, provision of integrated physical and behavioral care, use of peers/individuals with lived experience, and supporting the mental well-being of the behavioral health workforce.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media (max-width:991px) { .people { margin: auto; } .people p { text-align: center } } .ci_profile { margin-bottom: 30px; display: block; text-align:center /* this is for the "Executive Dialogue" page */ } @media (max-width:991px) { .ci_profile { text-align: center } } .ci_profile p { margin: 0 0 7px 0 } .ci_profile_name { font-weight: 700; font-size: 20px; } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .ci_profile_title { font-style: italic; line-height: 1.3em } .ci_profile_company { font-size: 1em; } p.ci_profile_award { font-size: .8em; text-align:center; color:#55555599; font-weight: 700 } .ci_profile_social { width: auto; } .ci_profile_social i { padding-right: 25px; font-size: 20px } .ci_profile_social a:last-of-type i { padding-right: 0px; } #ci_footer-social { font-size: 1.5em; padding-top: 0px; width: 100%; text-align: right; } @media (max-width:991px) { .ci_logo { margin-top: 25px } .ci_social p { text-align: center !important; } #ci_footer-social { text-align: center } } @media (min-width:769px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 3; /* 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src="/sites/default/files/2024-09/Augsburger_Marc_300x300.png" alt="Marc Augsburger" width="300" height="300"><p class="ci_profile_name">Marc Augsburger, MBA, BSN, RHCEOC</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Edgerton Hospital and Health Services</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Flanagan_Andrew_300x300.png" alt="Andrew Flanagan" width="300" height="300"><p class="ci_profile_name">Andrew Flanagan</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Iris Telehealth</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Hodshire_Jeremiah_300x300.png" alt="Jeremiah Hodshire" width="300" height="300"><p class="ci_profile_name">Jeremiah Hodshire</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Hillsdale Hospital</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Kirby_Rudy_300x300.png" alt="Ruby Kirby" width="300" height="300"><p class="ci_profile_name">Ruby Kirby, R.N.</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">West Tennessee Healthcare (Bolivar and Camden hospitals)</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Koekkoek_Doug_300x300.png" alt="Doug Koekkoek" width="300" height="300"><p class="ci_profile_name">Doug Koekkoek, M.D., FACP, SFHM</p><p class="ci_profile_title">Chief physician and clinical executive</p><p class="ci_profile_company">PeaceHealth</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/LaFrance_Judy_300x300.png" alt="Judy LaFrance" width="300" height="300"><p class="ci_profile_name">Judy LaFrance, MSN, R.N., NE-BC</p><p class="ci_profile_title">Chief administrative officer</p><p class="ci_profile_company">Hendrick Medical Center South</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Moore_Ed_300x300.png" alt="Edward Moore" width="300" height="300"><p class="ci_profile_name">Edward Moore</p><p class="ci_profile_title">President</p><p class="ci_profile_company">UMass Memorial Health Harrington Hospital</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Muller_Melinda_300x300.png" alt="Melinda Muller" width="300" height="300"><p class="ci_profile_name">Melinda Muller, M.D.</p><p class="ci_profile_title">Chief medical officer</p><p class="ci_profile_company">Legacy Health</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Romero_Brenda_300x300.png" alt="Brenda Romero" width="300" height="300"><p class="ci_profile_name">Brenda Romero, R.N., MSN</p><p class="ci_profile_title">Hospital chief executive</p><p class="ci_profile_company">Presbyterian Española Hospital</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Trestman_Robert_300x300.png" alt="Robert Trestman" width="300" height="300"><p class="ci_profile_name">Robert Trestman, Ph.D., M.D.</p><p class="ci_profile_title">Professor and chair, department of psychiatry</p><p class="ci_profile_company">Carilion Clinic</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-04/Hoppszallern_Suzanna_300x300%20%281%29.png" alt="Suzanna Hoppszallern" width="300" height="300"><p class="ci_profile_name">Moderator:</p><p class="ci_profile_name">Suzanna Hoppszallern</p><p class="ci_profile_title">Senior Editor, Center for Health Innovation</p><p class="ci_profile_company">���������� Association</p></div></div></div>@media (min-width:768px){ .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc(33.3% - 2px) /*Safari Fix*/; } } .center_callout_3invert { background-color: #f6f6f6; text-align: center; 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class="col-md-3"> </div></div></div><div class="col-md-1"> </div></div><div class="row"><h2>Latest Knowledge Exchange</h2><div class="feedEmbedImg">.feedEmbedImg .views-element-container { background-color: #f6f6f6;; padding: 20px } .feedEmbedImg .views-element-container h2{ margin-top:0px; color: } .feedEmbedImg .views-element-container .views-field.views-field-created{ color: } .feedEmbedImg .views-element-container .views-field.views-field-title a{ font-size: 20px; color:#002855 } .feedEmbedImg .views-element-container .views-field.views-field-body{ font-size: 16px; color:; } .feedEmbedImg .views-element-container .article.views-row { display: inline-block; transition: 1s; } .feedEmbedImg .views-element-container img{ float: left; margin-right:15px; max-width: 200px ; transition: 2s; } .feedEmbedImg .resource-block .resource-view .views-row:hover{ transform: scale(1.02); } .feedEmbedImg .resource-block .resource-view .views-row:hover img{ opacity: .6; transition: 1.5s; } 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src="/sites/default/files/styles/small_200x200/public/2024-12/VED_Accenture_Governance_620x381.jpg?itok=viVBuq-l" width="200" height="123" alt="VED_Accenture_Governance_620x381-image" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-10T16:11:13-06:00">Dec 10, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en">The Resilient Health System Operating Model</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Health system leaders are building a robust governance and resilient operating model to transform health care delivery models for the future.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/KnowEx_RI_RevenueCycle_620x381_rev1.jpg?itok=42C41VMq" width="200" height="123" alt="KnowEx_RI_RevenueCycle_620x381_rev1" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-05T14:26:53-06:00">Dec 5, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" hreflang="en">Optimize Your Hospital’s Revenue Cycle for Efficient, Patient-Centered Operations</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Optimizing hospital’s revenue cycle for efficient, patient-centered operations and enhancing critical KPIs using AI and robotic process automation.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-11/VED_PatientPoint_Engagement_620x381.jpg?itok=dHKIfRK6" width="200" height="123" alt="PatientPoint_Engagement_620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-11-13T15:51:45-06:00">Nov 13, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en">Empowering Patient Engagement and Behavior Change to Improve Health and Reduce Disparities</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Empowering patient engagement and leveraging customized communication and education via digital technologies to improve health and reduce disparities.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-10/KnowEx_CorroHealthh_Medicaid_620x381.jpg?itok=HS9Y48c8" width="200" height="123" alt="KnowEx_CorroHealth_Medicaid" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-10-29T15:17:14-05:00">Oct 29, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en">Aligning Payers and Partners for Value-based Care</a></span> </div><div class="views-field views-field-body"> <div class="field-content">As value-based care models grow, hospitals, providers and payers need to align goals and incentives to improve patient outcomes and reduce costs.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-09/Iris-Telehealth-banner-620x381.jpg?itok=QQ9C-7Mp" width="200" height="123" alt="Iris-Telehealth-banner-620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Wed, 25 Sep 2024 14:49:38 -0500 Substance Use Disorder <div class="container"><div class="row"><div class="col-md-8"><p>The Departments of the Treasury, Labor, and Health and Human Services (the Departments) Sept. 9 issued a final rule on the enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. The rule amends existing standards for the application of non-quantitative treatment limitations (NQTLs) preventing insurance plans and issuers from placing greater limits on access to mental health and substance use disorder (SUD) benefits as compared to medical and surgical benefits.</p><div class="panel module-typeC"><div class="panel-heading"><h2 class="panel-title">Key Highlights</h2></div><div class="panel-body"><p>The final rule:</p><ul><li>Provides more specific examples of what plans and issuers may not do regarding prior authorization and medical management techniques for mental health and SUD benefits.</li><li>Sets standards for network composition of mental health and SUD providers.</li><li>Provides factors to determine out-of-network reimbursement rates for mental health and SUD services.</li><li>Requires plans to collect and evaluate outcomes data and take action to address disparities in access between mental health/SUD services and medical/surgical services.</li><li>Codifies standards for comparative analyses of the use of NQTLs.</li><li>Sunsets the ability of self-funded, non-Federal government plans to opt-out of providing mental health/SUD benefits at parity.</li></ul></div></div><h2>AHA Take</h2><p>“The AHA is pleased that the Biden-Harris Administration has taken decisive action to remove barriers to vital mental health and substance use disorder services,” said Ashley Thompson, AHA senior vice president of public policy, in a statement. “We are pleased the Administration is providing clear guidance on how health plans may and may not apply administrative restrictions to behavioral health services. Thus, patients are more likely to get the care they need and to which they are entitled under the law, and providers can spend less time on burdensome and unnecessary paperwork. We recognize the challenges that exist to establish networks of behavioral health providers considering the dire shortages but encourage the Administration to work with AHA and other stakeholders to alleviate those challenges without compromising on the goals of parity and access.”</p><h2>Background</h2><p>Despite the passage of MHPAEA 15 years ago, plan participants continue to face barriers to accessing care for mental health and SUDs; many of these barriers are due to group health plans and health insurance issuers offering group or individual health insurance coverage that is not operating in compliance with the law. The Departments have conducted investigations — both independently and as a result of complaints —that have demonstrated that nearly all plans or issuers audited for MHPAEA compliance could not demonstrate compliance with the law’s obligations, specifically with the prohibition of setting NQTLs discriminatorily on benefits for mental health/SUD services. NQTLs are generally non-numerical requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy, and standards for provider admission to participate in a network, including methodologies for determining reimbursement rates.</p><p>In their 2022 MHPAEA Report to Congress, the Departments found that plans could not comply with requirements to provide comparative analyses of their application of NQTLs as directed by the Consolidated Appropriations Act of 2021. In their <a href="https://www.dol.gov/sites/dolgov/files/EBSA/laws-and-regulations/laws/mental-health-parity/report-to-congress-2023-mhpaea-comparative-analysis.pdf" target="_blank">2023 MHPAEA Report to Congress</a>, released contemporaneously with the proposed rule in July of that year, the Departments found once again that nearly all of the comparative analyses reviewed contained insufficient information, lacking specific supporting evidence, detailed explanations, or sufficient detail to draw meaningful comparisons. These failures occurred despite a large volume of guidance documents and other resources provided by the Departments to plans to assist them with their statutory duties. In the last two years, the Departments have prioritized oversight and enforcement of MHPAE.</p><p>The final rule amends certain provisions of existing MHPAEA regulations to incorporate new and revised definitions of key terms and to specify additional steps plans and issuers must take to meet their obligations under MHPAEA. The rule also adds a new regulation establishing minimum standards for developing NQTL comparative analyses to demonstrate compliance with the law, as well as content elements of the analyses and the timeframe for plans and issuers to respond to a request from the Departments to submit them.</p><h2>Summary of Final Provisions</h2><p>The Departments finalized changes that add requirements for plans and issuers that apply NQTLs to prevent the imposition of a greater burden on beneficiaries accessing mental health and SUD benefits while preserving the ability of plans to impose NQTLs to the extent they are consistent with generally recognized independent professional medical or clinical standards or standards related to fraud, waste and abuse. Specifically, plans and issuers will not be permitted to impose an NQTL unless specific conditions, elaborated upon below, are met.</p><h3>“No More Restrictive” Requirement</h3><p>One criterion to determine compliance is that the NQTL is no more restrictive as applied to mental health and SUD benefits than it is when applied to medical/surgical benefits. The final rule provides a framework, modified from the proposed rule, to prevent plans and issuers from designing and applying NQTLs in a manner more burdensome for mental health or SUD benefits than for medical/surgical benefits. Specifically, the final rule states that, as a general rule consistent with the fundamental purpose of MHPAEA, a health insurance issuer may not impose any NQTL with respect to mental health or SUD benefits in any classification that is more restrictive, as written or in operation, than the predominant NQTL that applies to substantially all medical/surgical benefits in the same classification. The Departments did not finalize the proposed four-prong test to determine whether a NQTL meets this requirement. Instead, the Departments will require plans to satisfy other requirements finalized in this rule, including the Design and Application requirements and Impact Analysis requirements.</p><h3>Design and Application</h3><p>Another criterion for determining compliance is that the plan or issuer satisfies requirements related to the design and application of the NQTL. This includes a prohibition on plans relying upon any process, strategy, evidentiary standard or other factor that discriminates against mental health or SUD benefits as compared to medical/surgical benefits (such as historical plan data from a time when the coverage was not subject to MHPAEA). In the final rule, the Departments provide additional clarity and examples regarding what it means for information, evidence, sources or standards to be “biased or not objective.” In addition, the Departments did not finalize the exceptions to these requirements for independent professional medical or clinical standards and fraud, waste and abuse measures; in other words, rather than exempting NQTLs informed by independent professional medical standards or fraud, waste and abuse protections from requirements that they not be designed and applied in a manner more stringently for mental health or SUD benefits than for medical/surgical benefits, the Departments will require those NQTLs to also be established through unbiased and objective data.</p><h3>Impact Analysis</h3><p>The plan or issuer will also be required to collect, evaluate and consider the impact of relevant data on access to mental health and SUD benefits relative to access to medical/surgical benefits and subsequently take reasonable action as necessary to address any material differences in access. The Departments state that differences in access will be considered “a strong indicator” of MHPAEA violation and are intended to work together with other requirements in the rule.</p><p>Relevant data includes — but is not limited to — the number and percentage of relevant claims denials and any other data related to the NQTLs as required by state law or private accreditation standards. In addition, the Departments will require plans and issuers to collect and evaluate data specifically related to network composition, including in-network and out-of-network utilization rates (including data related to provider claim submissions), network adequacy metrics (including time and distance data, and data on providers accepting new patients) and provider reimbursement rates (including as compared to billed charges). In the final rule, the Departments clarify that plans are not required to exhaustively survey all available data; in addition, the Departments plan to issue future guidance and update the MHPAEA Self-Compliance Tool to provide a robust framework and roadmap for plans and issues to comply with this requirement.</p><p>The plan will also be required to document any such action that has been or is being taken by the plan to mitigate any material differences in access to services between mental health/SUD and medical/surgical services when the issuer knows or reasonably should know that NQTLs may be contributing to these discrepancies. This provision allows plans to explain why these differences should not result in a violation of the rules for NQTLs.</p><h3>Not Finalized: Network Composition</h3><p>While the Departments maintain that there is a growing disparity between in-network reimbursement rates for mental health/SUD providers and those for medical surgical providers and a significant disparity between how often beneficiaries are forced to utilize out-of-network mental health/SUD providers and facilities as compared to medical/surgical providers and facilities, they declined to finalize the proposed special rule that would treat network composition as an NQTL for the purposes of the regulation (as opposed to merely an outcome of other NQTLs). Instead, the Departments include language in the final rule to explain how plans and issuers are expected to comply with the previously described data evaluation and impact analysis requirements regarding network adequacy.</p><h3>Final Determination of Noncompliance</h3><p>When a plan or issuer receives a final determination from the Departments demonstrating that it is not in compliance with the comparative analysis requirements for an NQTL, the relevant department secretary may direct the plan or issuer not to impose the NQTL unless and until the plan or issuer demonstrates compliance or takes appropriate action to remedy the violation. In the final rule, the Departments clarify that states with enforcement authority concerning MHPAEA are also permitted to make this direction to plans or issuers.</p><h3>Examples</h3><p>The final rule provides a list of 13 examples that show how an NQTL would be analyzed under these provisions and instances in which a plan would be determined to violate one or more provisions. In accordance with the modifications to proposed provisions finalized in this rule, the Departments have adjusted some of the fact patterns used in the examples.</p><h3>Content of Comparative Analyses</h3><p>The Departments finalize specific information and data that plans and issuers will be required to incorporate in each comparative analysis of the application of an NQTL and the factors and evidentiary standards used to design or apply it. Specifically, a comparative analysis must include, at a minimum, for each NQTL on mental health or SUD benefits, six elements:</p><ol><li>A description of the NQTL.</li><li>The identification of the factors used to design or apply it.</li><li>A description of how factors are used in the design or application of it.</li><li>A demonstration of comparability of the NQTL and stringency with which it is applied between mental health/SUD benefits and medical/surgical benefits, as written.</li><li>A demonstration of comparability and stringency in operation.</li><li>Findings and conclusions.</li></ol><p>The Departments propose that the analyses would have to include the date of the analysis, the title and credentials of all persons who participated in the documentation, and a certification by one or more named fiduciaries who have reviewed it. The rule also sets forth details concerning when and how plans would be required to make those comparative analyses available upon request, either to the Departments or to a enrollee.</p><h3>Regulatory Text</h3><p>The Departments add and revise several sections and terms in existing regulations, including:</p><ul><li>A new purpose section to the implementing regulations specifying the underlying intent of MHPAEA and requirements for plans and issuers in regard to the law.</li><li>Amendments to the definitions of medical/surgical benefits and mental health and SUD benefits to more clearly delineate these categories to comply with MHPAEA and to ensure that the use of state laws does not prevent the application of MHPAEA’s protections concerning conditions that are recognized as mental health conditions and SUDs under generally recognized independent standards of current medical practice.</li><li>Several new definitions related to the application of NQTLs to provide clarity to plans and issuers, regulators and beneficiaries regarding compliance; terms with new definitions include “processes,” “strategies,” “evidentiary standards,” and “factors.”</li></ul><h3>Compliance Date</h3><p>The proposed rule would have required plans to comply with all requirements beginning Jan. 1, 2025. However, the Departments acknowledge the magnitude of the changes that plans and issuers will have to implement, and thus will delay the applicability date for some of the provisions until Jan. 1, 2026. These delayed provisions include:</p><ul><li>Meaningful benefits standard.</li><li>Prohibition on discriminatory factors and evidentiary standards.</li><li>Relevant data evaluation requirements.</li><li>Requirements for comparative analyses.</li></ul><p>Until then, plans and issuers must continue to comply with the 2013 final MHPAEA regulations.</p><h2>Parity Opt-out of Self-funded Non-federal Governmental Plans</h2><p>Under the Health Insurance Portability and Accountability Act of 1996, sponsors of self-funded, non-Federal governmental health plans may elect to exempt those plans from parity in the application of certain limits to mental health and SUD benefits (including requirements of MHPAEA). However, the Consolidated Appropriations Act of 2023 eliminated this opt-out.</p><p>In this final rule, the Department of Health and Human Services amends regulations to specify that a sponsor of a self-funded, non-Federal governmental plan may not elect to exempt its plan(s) from any of the MHPAEA requirements on or after Dec.29, 2022, the date of enactment of the Consolidated Appropriations Act.</p><h2>Further Questions</h2><p>Please contact Caitlin Gillooley, AHA’s director of behavioral health and quality policy, at <a href="mailto:cgillooley@aha.org?subject=RE: Special Bulletin: Administration Finalizes Enhanced Mental Health Parity Regulations">cgillooley@aha.org</a> or <a href="tel:1-202-626-2267">(202) 626-2267</a> with any questions.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/09/Special-Bulletin-Administration-Finalizes-Enhanced-Mental-Health-Parity-Regulations.pdf" target="_blank" title="Click here to download the Special Bulletin: Administration Finalizes Enhanced Mental Health Parity Regulations PDF."><img src="/sites/default/files/inline-images/Page-1-Special-Bulletin-Administration-Finalizes-Enhanced-Mental-Health-Parity-Regulations.png" data-entity-uuid="f6115861-da9d-4ef3-b42b-5c25222e23d6" data-entity-type="file" alt="Special Bulletin: Administration Finalizes Enhanced Mental Health Parity Regulations page 1." width="695" height="900"></a></p></div></div></div> Tue, 10 Sep 2024 11:03:32 -0500 Substance Use Disorder /role-hospitals-saline-health-introduces-stepone-battling-addiction <div class="container"><div class="row"><div class="col-md-9"><div class="row"><div class="col-md-5"><p><img src="/sites/default/files/2024-09/ths-saline-substance-recovery-700x532.jpg" data-entity-uuid data-entity-type="file" alt="Saline Memorial Hospital. Male Clinician sits bedside talking to a male patient in a hospital bed" width="700" height="532"></p></div><p>Benton, Ark.-based Saline Memorial Hospital, in collaboration with Evergreen Healthcare Partners, introduced the StepOne Service, a program designed to support individuals struggling with addiction. The program, launched at the start of 2024, serves as the initial phase in the recovery journey, providing hospital-based acute withdrawal management for adults in the early or impending stages of withdrawal from alcohol or opioids.</p><p>“During our bi-annual community needs assessments, addressing substance abuse disorder is nearly always identified as one of the most critical health care needs for this area,” said Saline Memorial Hospital CEO Michael Stewart. “We have been working diligently to address this need and believe this is in the first step toward providing hope and support for those battling addiction.”</p><p>The program begins with a pre-screening process, which can be initiated over the phone or online. Patients who meet the necessary criteria are then scheduled for admission to the hospital’s medical-surgical unit.</p><p>“This service is not for everyone,” said Bryan Jensen, cofounder and CEO of Evergreen Healthcare partners. “Patients seeking this treatment must meet medical criteria, be in the early stages of withdrawal and be properly motivated for their recovery.”</p><p>Once admitted, patients receive continuous medical care from the hospitalists and nurses at Saline Memorial Hospital. The treatment involves using protocol-specific medications to help ease withdrawal symptoms, with an average duration of about three days for opioid withdrawal and approximately five days for alcohol withdrawal.</p><p>“From admission to discharge, we have a clinical care team specially trained to work with withdrawal patients,” Stewart said. “Once we address their medical needs, these patients can focus on the next steps of their recovery.”</p><p>Following the initial treatment, the clinical team collaborates with patients to develop a long-term care plan, ensuring a smooth transition from the hospital to the next stage of their recovery at an appropriate facility or program. The care team continues to provide support for up to six months post-discharge.</p><p>“After withdrawal treatment, it is important for patients to continue on with some form of addiction treatment to learn coping strategies for maintaining sustained sobriety,” Jensen said. “StepOne Service will assist patients in finding the next appropriate treatment center so they can get the life skills and relapse prevention training they need.”</p><p><a class="btn btn-primary" href="https://www.salinememorial.org/stepone">LEARN MORE</a></p><p> </p></div></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/center/population-health">Improving Health and Wellness</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Thu, 05 Sep 2024 13:56:44 -0500 Substance Use Disorder /news/headline/2024-07-31-aha-blog-reducing-barriers-behavioral-health-and-substance-use-disorder-treatment <p>Mary Thompson — a member of AHA’s Committee on Behavioral Health and president of Trillium Place, a mental health and addiction recovery organization affiliated with Carle Health — explains how the Illinois-based organization works to integrate physical and behavioral health services to improve access to care among historically underrepresented communities and eliminate health disparities. <a href="https://ifdhe.aha.org/news/blog/2024-07-30-integration-care-reducing-barriers-behavioral-health-and-substance-use-disorder-treatment"><strong>READ NOW</strong></a></p> Wed, 31 Jul 2024 17:03:09 -0500 Substance Use Disorder /news/headline/2024-07-24-samhsa-awards-grants-supporting-behavioral-health-services-children-and-adults <p>The Substance Abuse and Mental Health Services Administration July 24 <a href="/">announced</a> it is awarding $45.1 million in grants toward various behavioral health initiatives. The funding includes $15.3 million specifically planned to support children through mental health services in schools, services for those who have experienced traumatic events, and services specific to those at risk for or with serious mental health conditions. </p> Wed, 24 Jul 2024 15:22:19 -0500 Substance Use Disorder /news/headline/2024-06-10-aha-podcast-new-approach-opioid-abuse-helps-mothers-and-babies <p>Chris DeRienzo, M.D., AHA senior vice president and chief physician executive, speaks with three experts about how the award-winning Women and Infant Substance Help (WISH) Center at SSM Health St. Mary's Hospital is helping mothers break their addiction to opioids and other substances. <a href="/advancing-health-podcast/2024-06-10-it-takes-village-new-approach-opioid-abuse-helps-mothers-and-babies-">LISTEN NOW</a></p> Mon, 10 Jun 2024 15:44:53 -0500 Substance Use Disorder