HEALTH POLICY In 2018: Emerging Challenges and Opportunities January 23, 2018 Greater Kansas City Chapter of HIMSS

I aM KARI BRUFFETT Director of Policy You can connect with me at: kbruffett@khi.org

One of these things is not like the otherS

ABOUT KHI Nonprofit, nonpartisan educational organization focusing on health policy and research. Established in 1995 with a multi-year grant by the Kansas Health Foundation and located directly across from Kansas Statehouse in downtown Topeka. Committed to convening meaningful conversations around tough topics related to health.

Key THEMES Policymakers want to understand how data and technology can: Help them understand and address factors that influence health. Allow partners along the continuum of care to understand each other and the populations they serve. Better integrate medical and behavioral health care.

“Population Health” The health outcomes of a group of individuals, including the distribution of such outcomes within the group. Kindig, Stoddart 2003

WHOSE Population? Employer Health system Insurer Community State Nation

Determinants of health Social Environmental Behavioral Medical Care Genetic

1. HEALTH Access to food Poor physical environment Smoking Stress Poor housing Air Pollution

Opportunities Policymakers are interested in new models that link medical care and the factors that influence health. Examples: More than 20 states require managed care organizations to screen Medicaid beneficiaries for social needs In Kansas, KanCare 2.0 proposes coordination of “social determinants of health and independence” Accountable Health Communities Managed Service Networks

Challenges Incomplete information Disconnect between social service and health care systems Includes disparities in size and sophistication of providers Requires process and culture change Billing complexity Example: Medicare chronic care management codes when initially rolled out

Integrating medical and behavioral health care Source: SAMHSA-HRSA Center for Integrated Health Solutions

Co-Occurring Conditions Source: SAMHSA-HRSA Center for Integrated Health Solutions

Opportunities Heightened interest from policymakers in behavioral health system reform Integrating medical and behavioral health care Models in Missouri and Kansas Interventions can work Example: Per SAMHSA, community-based addiction treatment can reduce ER costs 39 percent, inpatient costs 35 percent, and total medical costs 26 percent.

challenges Inpatient capacity Funding for community systems Billing restrictions (codes, provider types) Workforce Impact of opioid addiction Regulation limiting access to information related to substance use (42 C.F.R. Part 2) Rule revised in 2017

You can connect with me at: kbruffett@khi.org