Wisconsin Department of Health Services SBIRT Ad Hoc Committee Report Presentation to the State Council on Alcohol and Other Drug Abuse June 7, 2013

Wisconsin Department of Health Services Thank you… Duncan Shrout, Chair Pamela Bean Steven Dakai Michael Davis Nina Emerson Jay Ford Tom Fuchs Shel Gross Carol Hanneman-Garuz Claudia Roska Larry Miller Kevin Moore Rich Brown Joyce O’Donnell and the Planning & Funding Committee Ashleah Bennett

Wisconsin Department of Health Services Wisconsin has an alcohol problem: 70% prevalence of monthly drinking 23% - 30% prevalence of binge drinking 1 million meet criteria for risky drinking 384,000 meet criteria for Alc Use Disorder 1 out of 20 in need of treatment receive it $6.8 billion annual cost from alcohol

Wisconsin Department of Health Services SBIRT can provide needed prevention, early identification, intervention, and referral resources.

Wisconsin Department of Health Services The SBIRT model: Screening  brief assessment Brief Intervention (protocol-guided, ~15 minutes) Referral to Treatment

Wisconsin Department of Health Services & Population Health Normative Drinking Risky Drinking Problem Drinking Likely Dependent

Wisconsin Department of Health Services Wisconsin SBIRT ( ) 113,642 screens ~ 3% of the primary care population 16,950 brief interventions 1,101 referral conversations

Wisconsin Department of Health Services Wisconsin SBIRT (Outcome Study, N = 675) 20% reduction of risky drinking 18% reduction of marijuana use High patient satisfaction

Wisconsin Department of Health Services 20% risky drinking is linked to… 20%emergency visits 33% injuries 37%hospital admissions 46%arrests 50% automobile crashes

Wisconsin Department of Health Services SBIRT saves costs Medicaid ~ $170 million Businesses ~ $895 per employee ETF ~ $52 million

Wisconsin Department of Health Services If SBIRT is so great, why aren’t health care providers delivering it? Not enough time Too many other initiatives - low priority Lack of recognition that addressing patient AOD use is important Not a big money maker

Wisconsin Department of Health Services What would need to happen if SBIRT were to achieve large-scale implementation? Implementation factors Focus of services Workforce Financing

Wisconsin Department of Health Services Implementation factors Integrating SBIRT into clinic flow takes strategic planning Robust quality improvement process Implement quality and outcome measures Develop linkages with treatment providers

Wisconsin Department of Health Services Focus of SBIRT Alcohol* Illicit Drugs* Tobacco* Depression* Diet Exercise * Reimbursable service

Wisconsin Department of Health Services A workforce is needed Current health care professionals don’t have time Employing paraprofessional “health educators” can be highly effective Expanding the healthcare team Training, education, and on-going professional development

Wisconsin Department of Health Services Financing SBIRT Medicaid – “effective reimbursement” Commercial Insurance - ??? Health care reform codifies SBIRT Financial incentives may be needed (e.g., pay-for-performance)

Wisconsin Department of Health Services Recommendations of the SBIRT Ad Hoc Committee relate to… Coordination Providers Purchasers Payers Dissemination

Wisconsin Department of Health Services Motions 1)SCAODA accept the SBIRT Ad Hoc Committee Report dated May 1, 2013; 2)SCAODA forward the accepted Report to the Wisconsin Council on Mental Health and the Wisconsin Council on Public Health for their information and further action; 3)SCAODA forward the accepted Report to the Majority and Minority Leadership of the Wisconsin State Senate and Assembly for their information and further action; and 4)SCAODA forward the accepted Report to Governor Scott Walker for his information and further action.