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Addiction Treatment in Healthcare Reform Tom McLellan, Jan 21, 2010
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Substance Abuse Specialty Treatment ~ 2,300,000 Abuse/Dependent – 25,000,000 “Harmful Users” – ??,000,000 Little or No Use
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~ 12,000 specialty programs in US 77% government funded Primarily Block Grant - $2B Private insurance <12% No parity – Many inequities
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~ 12,000 specialty programs in US + 8,000 FQHCs ( 27 million patients ) Block Grant + Medicaid ($70 B) ~ 60% of those not covered 100% Federal – No State Match Parity Requires = Coverage
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1. National Prevention System 2. Engage Primary Care 3. Treat Addiction as a Disease 4. Emphasis on Offenders 5. Performance Monitoring
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Evidence Based Interventions Delivered Within Communities Investment in Infrastructure
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Intervention
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A Continuing Care Model Primary Continuing Care Primary Care Specialty Care
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Continuing Care In Addiction Recovery Support Services Primary Care Specialty Care Screen Intervene Monitor Refer Re-Intervene Monitor/Support Stabilize Motivate/Medicate Train Self-Mgmnt Refer
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4. Expand SBIRT Code and Financing 5. Train/Motivate Generalist Physicians 6. Coordinate & Expand Prescription Drug Monitoring Programs
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Treatment
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7.Integrate Addiction Treatment into Federal Healthcare Systems 8. Performance Contracting in State Treatment Systems 9. Consumer Choice Through Vouchers for Recovery Services
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Recovery “A voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship” J. Substance Abuse Trt, 2008
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Community Corrections
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Pre-Arrest Pre-Trial Prosecution Sentencing In Jail/Prison Re-Entry ~5 Million Offenders In Community 700,000 /yr Released
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10. Drug Treatment Alternatives to Prison Continued Emphasis on Drug Courts 11. Offender Re-Entry Programs 12. Screening and Brief Treatments of Juvenile Offenders with MH and SA Problems
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1. National Prevention System 2. Engage Primary Care 3. Close the Addiction Tx Gap 4. Special Care for Offenders 5. Improved Data Systems
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