FADAA Health Care Reform How Will Medicaid Reform Impact Substance Abuse and Mental Health August 19, 2010

Impact of Medicaid Reform ?

Impact of Medicaid Reform? Mental Health services will likely be delivered by HMOs or PSNs Inpatient treatment will probably be covered by these plans and they may be motivated to reduce ER and Inpatient costs Managed Care Plans may incorporate more disease management capacity to reduce costs and improve quality

Impact of Medicaid Reform? Marketing opportunities exist to: demonstrate cost savings from coordinating substance abuse services be prepared to work with Health care Plans to provide co-occurring services through FFS

Impact of Medicaid Reform The Faces of Medicaid III – October 2009 showed for the frequency of co-morbid conditions of the most expensive 5%: Psychiatric and Cardiovascular 40.4 % Psychiatric and Central Nervous System 39.8 % Psychiatric and Gastrointestinal 24 %

Impact of Medicaid Reform Psychiatric conditions were included 8 times in 20 conditions for co-morbidity in the highest 5% costs Psychiatric conditions are included in the top 5 of the highest cost group. Co-morbidity with Substance Use Disorders is very high

Impact of Medicaid Reform What substance abuse services could reduce the overall cost of care? HMOs have flexibility in what services they provide Physicians can bill for screenings Screening, Brief Intervention, and Referral to Treatment is effective

Impact of Medicaid Reform Providing substance abuse treatment saves medical costs Washington State showed a $2,500 reduction per recipient A study on methadone detoxification showed that for every dollar of treatment there was an offset of $4.87 in medical costs

Impact of Medicaid Reform Health Care Utilization Savings: California Treated patients have shown reduced: ER visits by 39% Hospital stays by 35% Total medical by 26% (when compared to a control group)

Impact of Medicaid Reform John Hopkins HealthCare Return on Investment study – 2006 Showed a $3.65 savings for every dollar spent Used integrated case management to coordinate substance abuse services and medical care Increased rate in treatment Decreased hospital admissions and length of stay

Impact of Medicaid Reform Outreach with primary care physicians can increase the number of persons entering treatment. Treatment of substance abuse can reduce overall medical costs including inpatient and ER use.

Impact of Medicaid Reform Substance Abuse providers must be prepared to bill Medicaid and work with Health Plans in an integrated market Medicaid billings for substance abuse diagnoses have been steadily increasing Opportunities exist to increase service provision through outreach and collaboration

Impact of Medicaid Reform The current Medicaid State Plan includes 10 services that can be billed to Medicaid for persons with SUD These are included under: Assessment services Behavioral Health Therapy Psychosocial Rehabilitation Medical and psychiatric management

Impact of Medicaid Reform Behavioral Health Overlay Services is also available but provided only in: Juvenile Justice Residential Programs Child Welfare Residential Programs Currently not included in any Health Plan

Impact of Medicaid Reform Preparing for Medicaid Reform and Health Care Reform --- What can you do? Expand your billing of Medicaid Learn to use the existing services to meet the needs of the people you serve Establish means to determine your unit rates and negotiate accordingly

Impact of Medicaid Reform What can you do? Develop informal partnerships or Memorandums of Agreements to assist Health Plans in managing substance abuse with their enrollees Reach out to Federally Qualified Health Care centers to be a partner in their services Establish small pilots within your areas to demonstrated medical cost saving through substance abuse treatment

Impact of Medicaid Reform Assist hospitals and ER in screening their patients for Substance Abuse Establish referral linkages with hospitals and physicians both in specialty practices and in primary practices to encourage referrals for persons for early intervention. Work with OB/GYN to improve access to substance abuse services for pregnant women.

Impact of Medicaid Reform Why take these actions now while services are still paid fee-for-service? We don’t know how long Substance Abuse community services will remain out of the plans PSNs are already starting to manage mental health services

Impact of Medicaid Reform Demonstrate your value to health care systems now Take advantage of the system flexibility that currently exists Become part of the health care delivery system Be seen as an essential element in overall health care management

Impact of Medicaid Reform Demonstrate how the array of services that you provide are vital to health care service delivery Show that non-licensed staff provide essential services that can be incorporated into a health care system Work within your Managing Entity (if you have one) to begin to negotiate with health care systems for substance abuse services.

Impact of Medicaid Reform Capitalize on your current opportunities and value: You can provide services for Medicaid health plans at no cost to them You can help them provide care coordination through your collaboration Substance Abuse agencies are vital to health care service delivery.

Impact of Medicaid Reform Discussion: What have we accomplished ? How can we move forward ? What other opportunities are there ? How can we work together to be successful ? What do we need to know ?

Impact of Medicaid Reform Celeste Putnam Health Care Services and Systems Consultant Department of Children and Families Celeste_Putnam@dcf.state.fl.us 850-413-6666 850-228-5018