Health Care Reform Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA

Affordable Care Act Major Drivers – More people will have insurance coverage – Medicaid will play a bigger role in MH/SUD than ever before – Focus on primary care and coordination with specialty care – Major emphasis on home and community based services and less reliance on institutional care – Preventing diseases and promoting wellness is a huge theme

Person Served by SSAs/SMHAs 12 M visits annually to ERs by people with MH/SUD Individuals with schizophrenia have one of the highest rates of smoking (58%–88%) Cardiovascular mortality was 6.6 times higher among SMI clients than the general population 70% of SMI had at least 1 chronic health conditions, 45% have 2, and almost 30% have 3 or more.

Primary Care And Coordination Individuals with SMI die on average at the age of 53 years old Barriers include stigma, lack of cross-discipline training, and access to primary care services Have elevated (and often undiagnosed) rates of: – hypertension, – diabetes, – obesity – cardiovascular disease Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers

Primary Care And Coordination Readmissions – 20% of Medicare patients are readmitted within 30 days after a hospital discharge – Lack of coordination in “handoffs” from hospital is a particular problem – More than half of these readmitted patients have not seen their physician between discharge and readmission

Affordable Care Act Opportunities Grants for mental Illness with co-occurring primary care conditions (SAMHSA) Health Homes (CMS and SAMHSA) Prevention Trust Fund and Primary care and Behavioral Health Integration (SAMHSA) Community health teams (CMS/Medicare)

SAMHSA Grant Program To improve the physical health status of people with serious mental illnesses (SMI) by supporting community-based efforts to coordinate and integrate primary health care with mental health services in community- based behavioral health care settings

SAMHSA Grant Program To better coordinate and integrate primary and behavioral health care resulting in: – improved access to primary care services – improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease – increased availability of integrated, holistic care for physical and behavioral disorders – better overall health status of clients

SAMHSA Grant Program FY 2010 $28 million to help 56 community behavioral health agencies $5.3 million national resource center (co- funded by SAMHSA/HRSA/HHS)

11 Facilitate screening and referral for primary care prevention and treatment needs Provide and/or ensure that primary care screening/assessment/ treatment and referral be provided in a community-based behavioral health agency Develop a registry/tracking system for all primary care needs and outcomes Offer prevention and wellness support services (>10% of grant funding) Build processes for referral and follow-up for needed treatments that are not appropriately provided in a primary care setting PBHCI: Services Delivery

12 Baseline Descriptive Information Personal/family history of: diabetes, hypertension, cardiovascular disease; substance use; tobacco use Medication history/current medication list, with dosages Social supports Health Outcome Indicators (by individual) Weight/Height/Body Mass Index Blood pressure Blood glucose or HbAiC Lipid profile PBHCI: Data Collection and Performance Outcomes (<20% of grant funds)

13 Services Outcome Indicators The number of mental health consumers receiving primary care services The number of mental health consumers screened for: hypertension; obesity; diabetes; co-occurring substance use disorders; and Tobacco product use PBHCI: Data Collection and Performance Outcomes (<20% of grant funds )

Training and Technical Assistance Center In partnership with HHS/Health Resources and Services Administration Purpose – to serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development – provide technical assistance to PBHCI grantees and entities funded through HRSA

Training and Technical Assistance Center (TTA) TTA will: Increase the number of individuals trained in specific behavioral health related practices; Increase the number of organizations using integrated health care service delivery approaches; Increase the number of consumers credentialed to provide behavioral health related practices; Increase the number of model curriculums developed for bidirectional primary and behavioral health integrated practice; and, Increase the number of health providers trained in the concepts of wellness and behavioral health recovery.

Health Homes Section 2703 – Enhanced integration of primary and specialty care for individuals with: At least two chronic conditions One chronic condition and be at risk for another, or Serious and persistent mental illness – Chronic conditions include: mental health condition, substance use disorder, asthma, diabetes, heart disease, and being overweight, BMI < 25.

Health Homes Health homes (several new services): – Comprehensive Care Management – Care Coordination and Health Promotion – Patient and Family Support – Comprehensive Transitional Care – Referral to Community and Social Support Services Timing – States can submit plans for effective dates as early as 1/2011

18 More Information: