Securing Collateral Support for Whole Systems Change: Seeking Resources and Key Stakeholder Support Victor Capoccia, Program Director, Open Society Institute John O’Brien, Legal Action Center Associate

What Do We Know About the Treatment Gap? Addiction to drugs and alcohol is a chronic health condition affecting 22 million Americans Proven treatments for this health condition exist Ninety percent of those who need addiction treatment are unable to get it.

Towards A National Campaign Campaign’s Focus Increase awareness of this problem Make treatment as available for addiction disorders as it is for any other chronic health condition

The Barriers to Success It’s a personal, moral or social problem, not a health condition There is nothing that can be done, treatment doesn’t help The economic, legal, and social side effects of addiction are more compelling than the condition itself

Campaign Strategy Communication: Shape message to policy makers and public Change Policy and Practice: Insurance—Addiction is a chronic health condition and should be covered like diabetes by specific benefits in all existing and future public, semi-public and private health plans. Appropriations— Where insurance is unavailable, government at all levels has a role to pay for treatment until universal health plan coverage reduces the need for special categorical funding. Efficiency—Expediting the engagement, integration and retention of individuals into treatment is critical to using existing resources more effectively. Advocacy: Drive policy message and policy change

Change Principles It’s a Health Issue Leadership, Champion Clear and Persistent Public Presence Payor Engagement Change Leader Access to and Facility with Datac

Towards A National Campaign What Are the Goals?  Increased number of consumers receiving high quality care  Increased resources available to pay for treatment  Effective practices or models for change created by grantees that are applicable in other jurisdictions

What Are the Models? Baltimore  Developed a broad-based advocacy and communications to increase appropriations  Developed a new city-wide administrative entity to purchase and monitor treatment services.  Used data to track performance aggressively and improve the efficiency and to effectiveness of individual programs. The results:  Funding for the treatment system increased from $20.3 million in 1997 to $52.9 million in 2005,  Number of people receiving drug treatment in publicly funded programs increased from 18,449 in 1997 to 28,672 in 2005.

What Are the Models? Florida  No clearly defined Medicaid SA benefit (> $10 million annually—redefined mental health coverage to include SA and created intensive TA for providers  Service gaps—initiated several new covered services for Medicaid recipients  Little new state funding—partnered with counties to identify local dollars and leverage federal funds

What Are The Models Connecticut—Department of Mental Health and Addiction Services:  Three state agencies had different contractual requirements for similar SA services—created one contract  Had multiple and different monitoring processes for same SA providers—create a single monitoring process  Paid vastly different amounts for the same services to the same providers—reviewing opportunities for developing a consistent reimbursement methodology

Future Directions—Closing the Addiction Treatment Gap (CATG) Seeks to expand treatment by increasing public funding, broadening insurance coverage and achieving greater program efficiency. A $10 million national program of the Open Society Institute (OSI). Demonstration sites across country National communication initiative Learning Collaborative and technical Assistance Evaluation

CATG Summary 35 Applications were submitted in April 8 sites recommended for participation:  Arkansas  Milwaukee  New Hampshire  New Jersey  New York  Puerto Rico  Rhode Island  Tarrant County

Help Us with CATG Financing, How do you:  Increase the scope of benefits covered by public payers (e.g. Medicaid, Medicaid contracted health plans and other state agencies)?  Shift expenditures from inpatient, emergency departments and corrections to community services?  Finance across systems and create purchasing efficiencies?

Proposed Strategies Increase state appropriations for AODA treatment services—several different strategies proposed (general request for increased spending) Add AODA community services to the state’s Medicaid plan Shifting spending from inpatient services to more effective community treatment approaches Review and retool the purchasing practices among state agencies that purchase substance abuse services. Increase the insurance coverage (through state’s Medicaid program) for low-income uninsured individuals Increase the use of evidenced based and promising practices offered by treatment providers and increase access and retention to addiction treatment services.

Help Us with CATG Efficiency, How do you: Expand the use of proven interventions to improve outcomes and reduce relapse? Develop recovery support systems? Use established system redesign and improvement strategies to expand treatment access?

Help Us with CATG Advocacy and Communication What is the message that you would use to publicize the costs and consequences of the treatment gap? Who would you involve in delivering the message? Who would you target to receive the message? What data and analysis would you want to make the case?

Thank you for your thoughts! Track the CATG