1. 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

2. 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?

3. 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

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

5. 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

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

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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. “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

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

17. 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

18. 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

19. 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

20. Resources National Quality Forum http://www.qualityforum.org/ National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. http://www.qualityforum.org/Publications/2007/09/National_Voluntary_Con sensus_Standards_for_the_Treatment_of_Substance_Use_Conditions__Ev idence-Based_Treatment_Practices.aspx http://www.qualityforum.org/Publications/2005/10/Evidence- Based_Treatment_Practices_for_Substance_Use_Disorders.aspx

21. NIATx – Network for the Improvement of Addiction Treatment www.NIATx.org NREPP – National Registry of Evidence-based Programs and Practices http://www.nrepp.samhsa.gov/ CSAT Inventory of Effective Substance Abuse Treatment Practices http://csat.samhsa.gov/treatment.aspx Dennis McCarty The Realities of Evidence-Based Practices for Addiction Treatment http://www.attcnetwork.org/find/news/attcnews/epubs/v1i2_article04.asp

22. Institute of Medicine of the National Academies Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series http://www.iom.edu 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. http://www.iom.edu/Reports/2005/Improving-the-Quality-of-Health-Care- for-Mental-and-Substance-Use-Conditions-Quality-Chasm-Series.aspx

23. Bridging the Gap Between Practice and Research http://www.iom.edu Institute of Medicine (1998). Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: National http://www.iom.edu/Reports/2003/Bridging-the-Gap-Between-Practice-and- Research-Forging-Partnerships-with-Community-Based-Drug-and-Alcohol- Treatment.aspx

24. Contact Info Arthur SchutDick Dillon Arapahoe HouseInnovaision, LLC 8801 Lipan Street7558 York Drive Thornton, CO 80260St. Louis, MO 63105 aschut@ahinc.orgdickd@innovaision.com