Moving the Addictions Treatment Field Forward Dick Dillon Innovaision, LLC St. Louis, Missouri Arthur Schut Arapahoe House, Inc Colorado 39 th Advanced International Winter Symposium January 2013

Moving Forward Advocating for addictions to be regarded as an illness Be careful about that for which you advocate We have caught the car, now what?

Significant changes include… o Moving back into the medical system o Some of us will be the substance-use illness specialty providers for the transformed system o Think of your programs as oncology or orthopedic clinics Moving Forward

Significant changes include… o Electronic Medical Records o Health Information Exchanges o Health status and health outcomes o Blended treatment approaches Moving Forward

Enhance Handoffs to and from “the health system/primary care” Organize services around episodes and a full continuum of care, rather than discrete levels of care or locations Increase diversity of professional staff to address major co-occurring conditions and deliver adjunctive services Challenges

Experience vs. education - No longer a “real” separate choice Brief interventions and case management alone are treatment Treatment and safe, drug free housing Challenges

Credentialing with third party payers Coding services delivered – need to be correct to result in payment Electronic claims processing Finance

IT is part of the essential foundation for service delivery. Sophisticated does not have to be complicated. Develop business processes anticipating Electronic Health Record (EHR). Information Technology

Effective, timely information sharing between clinicians, systems of care, and different provider organizations. Single entry data (efficient & reduces errors) Customer friendly information collection (unduplicated is efficient) Information Technology

Integrated with physical location services Target is to ultimately provide patient electronic access integrated with all clinical services e-Treatment

Smart phone, text messages, access to part of client’s clinical record, etc. Online support tools which can be used with and separate from formal treatment Innovative approaches including wearable medical devices, avatar therapy, etc. Secure login where clients can interact with providers e-Treatment

Success stories are great but “a lot of stories is not data” Reliable & accurate data are more important than lots of data Benchmarking – where is the thermometer by which we compare our organization’s performance – what is normal? Metrics

Evidence-Based Practices (EBP) need to be implemented with reportable fidelity measurement Results driven service delivery – what does the customer want as deliverables? What job is your customer hiring you to do? Health outcomes Metrics

Who are our health system customers? Where can we add value in the places we “touch”? What do we do that creates value for primary care and health systems? Is there a thorn in the paw that we can remove? Health Partnership Opportunities

“Fast Forward” – skip ahead to primary care integration Connecting our specialty care clients to primary care o At admission o Coordinate care o Before discharge o Arrange for a primary care “home” Improved Partnership with Primary Care

Provide consultation to primary care health professionals (need immediate access) Brief patient consult - 15 to 20 minutes sessions Improved Partnership with Primary Care

Intervening to help patients participate in the management of their illness to shorten hospital stays and improve health Partner around shared challenges – healthy babies, outreach, over-utilization, disruptive behavior, prescription medication addiction (pain management challenges), chronic illness management, improved health outcomes Health Partnership Opportunities

We are experts at dealing with difficult to reach patients We are experts at engaging patients that are seen as disruptive in other systems We are experts at de-escalation We have affection and tolerance for people who are addicted, when they are not at their best Strengths = New and Diverse Opportunities

We know how to manage a complex illness over a lifetime. We know recovery We understand what’s going on with the family in relation to the illness We understand how a range of external systems impact and can support a patient and family e.g., child welfare, employment, law enforcement, corrections, etc Strengths = New and Diverse Opportunities

Resources National Quality Forum National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. sensus_Standards_for_the_Treatment_of_Substance_Use_Conditions__Ev idence-Based_Treatment_Practices.aspx Based_Treatment_Practices_for_Substance_Use_Disorders.aspx

NIATx – Network for the Improvement of Addiction Treatment NREPP – National Registry of Evidence-based Programs and Practices CSAT Inventory of Effective Substance Abuse Treatment Practices Dennis McCarty The Realities of Evidence-Based Practices for Addiction Treatment

Institute of Medicine of the National Academies Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press. Institute of Medicine (2006). Improving the Quality of Health Care for Mental and Substance-Use Disorders: Quality Chasm Series. Washington, DC: National Academy Press. for-Mental-and-Substance-Use-Conditions-Quality-Chasm-Series.aspx

Bridging the Gap Between Practice and Research Institute of Medicine (1998). Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: National Research-Forging-Partnerships-with-Community-Based-Drug-and-Alcohol- Treatment.aspx

Contact Info Arthur SchutDick Dillon Arapahoe HouseInnovaision, LLC 8801 Lipan Street7558 York Drive Thornton, CO 80260St. Louis, MO