“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System AHCCCS Behavioral Health Medication Initiatives Kristin Frounfelker Behavioral Health Administrator September 19, 2012

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 2 Psychotropic Medication for Foster Care Children  Results of GAO December 2011 Report 1) FC children were prescribed psychotropic medications 4 times higher than non foster care children. 2) FC children were prescribed 5 or more psychotropic medications concomitantly 1.3% more than non FCC.(0.07%) 3) FC children were prescribed medications exceeding the FDA approved maximum dosage 3% more than non FCC. (0.16%) 4) FC children ages 0-1 were prescribed a psychotropic medication up to 2% more than non FCC.( %)

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 3 Arizona’s Foster Care Children  Arizona Study Results 1) FCC (0-18) were 4 times more likely to be prescribed psychotropic medications than non FCC. 2) FCC were 5 times more likely to be prescribed psychotropic medications exceeding the FDA maximum dosage than non FCC 3) FCC were 9 times more likely to be prescribed concomitant psychotropic medications non FCC. 4) Psychotropic medications for FCC ages 0-1 is an uncommon practice.

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 4 AACAP Guidelines  AACAP Consent Oversight Consultation Information Sharing

“Reaching across Arizona to provide comprehensive quality health care for those in need” Comparing Arizona’s Practice to AACAP Guidelines  ADHS/DBHS in partnership with DCYF and CMDP conducted a self assessment:  Consent  Oversight  Information Sharing  Consultation  Results on ADHS/DBHS website: medication-use-foster-care-az.pdf (19 indicators- 9/Fully Implemented, 9/Partially Implemented, 1/Not Implemented) Our first care is your health care Arizona Health Care Cost Containment System 5

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 6 August 2012 Summit  Because Minds Matter-ACYF State Medicaid, Child Welfare, State Mental Health brought together to discuss: Cross System Collaboration Data Sharing Screening and Assessment Care Coordination Increased Access to EBP Access to Accurate Info Informed Consents/ Assents Youth Engagement Medication Monitoring Clinical Consultation

“Reaching across Arizona to provide comprehensive quality health care for those in need” Arizona’s Next Steps  Priority Areas: 1) Strengthen Management of Medication Monitoring 2) Youth Engagement/Assent  Next Steps: DES/DCYF Lead Agency Develop Charter Determine Data Pull Discuss Strategies of Cross Collaboration January Multi Agency Work Plan Our first care is your health care Arizona Health Care Cost Containment System 7

“Reaching across Arizona to provide comprehensive quality health care for those in need” Reducing Antipsychotic Usage for Nursing Facility Residents with Dementia  2010 CMS data found estimated 40% of NF residents with signs of dementia were receiving antipsychotic medications without a diagnosis of psychosis.  17% were receiving doses exceeding the recommended levels.  There are no FDA approved medications for dementia.  CMS Initiative- 15% Reduction by 12/31/2012 Our first care is your health care Arizona Health Care Cost Containment System 8

“Reaching across Arizona to provide comprehensive quality health care for those in need” CMS Goals- July 2012  Develop Hand In Hand training series for NF staff- person centered planning, prevention of abuse  Provide training to State and Federal surveyors  Provide each NF antipsychotic drug use on Nursing Home Compare website  Emphasize non pharmacological interventions such as managing acute/chronic pain, staff consistency, increased exercise/outdoor time, person centered planning  State Coalitions Our first care is your health care Arizona Health Care Cost Containment System 9

“Reaching across Arizona to provide comprehensive quality health care for those in need” Arizona’s Approach  Coalition Lead-Health Services Advisory Group 1 st Meeting- August 28, 2012 Next Meeting: October 4, 2012 at HSAG Coalition Objectives: * Introduce the CMS Initiative * Discus how to collaboratively decrease inappropriate use of antipsychotic medications and improve dementia care in NFs * Establish actions plans * Establish frequency of meetings Our first care is your health care Arizona Health Care Cost Containment System 10

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Action Plan * July 30,2012- Letter to AHCCCS: CEO/CMO/Pharmacy/Directors/Compliance Officers * August 1, Met with ALTCS Case Managers * Developing a data collection tool for CM’s to use for top 30% of NFs identified by CMS- Nursing Home Compare * Collect data and identify strategies to reduce reliance on antipsychotic medication to manage dementia behaviors * Continuing Statewide monitoring Our first care is your health care Arizona Health Care Cost Containment System 11

“Reaching across Arizona to provide comprehensive quality health care for those in need” Promote Opportunities Use this initiative to:  Rethink dementia care  Reconnect with residents via person centered care strategies  Restore good health and quality of resident life Our first care is your health care Arizona Health Care Cost Containment System 12

“Reaching across Arizona to provide comprehensive quality health care for those in need” Questions/Comments For more information: Our first care is your health care Arizona Health Care Cost Containment System 13