1. TRI science addiction Implementing the IOM Report: The TRI-State Policy Program ACADEMY HEALTH Mady Chalk, Ph.D. Treatment Research Institute June, 2006

2. TRI science addiction The Presentation 1.Implementing the IOM Report 2.Creating an Environment for Exchange of Information and Identification of Priority Policy Concerns in States 3.Developing a Mutual Assistance Effort 4.Identifying and Testing Solutions That “Work” 5.Carrying Out Practical, Real World Evaluations

3. TRI science addiction The IOM Report Health Care Focus, e.g., mainstream medicine Linking Funding to Quality Patient-centered Care, e.g., long- term management support, concurrent recovery monitoring Coordination of care Data accessibility

4. TRI science addiction State Level Policy and Substance Abuse Discrepancy between what is known and what is delivered Lack of incentives in public sector funding to drive quality improvement Disconnected delivery arrangements lead to ineffective treatment Workforce Data infrastructure

5. TRI science addiction State Priority Concerns Performance and Outcome Measurement in Collaboration with Treatment Providers Data Reporting and Management Collaborative Financing of All Types Integrating Substance Use and Health Care: SBIRT; PRISM (mainstream medicine); Concurrent Recovery Monitoring

6. TRI science addiction State Priority Concerns (Con’t) Use of Incentives in Purchasing For: Treatment of priority populations Implementation of administrative and clinical best practices to improve access and retention Becoming “co-occurring capable” Creating a “medication friendly” environment in treatment

7. TRI science addiction Creating the Environment In order for States to work together the environment must allow for: Continuity over time Unofficial deliberations Neutrality of sponsoring organization Moderating presence of some disinterested members

8. TRI science addiction Creating the Environment Access to expert consultation and background papers from research, other businesses with similar issues Structured opportunity for regular discussion Practical, real world evaluations

9. TRI science addiction Advantages of Mutual Assistance Practices, policies and procedures have a higher likelihood of success and practicality since they are derived from common experience rather than academic research; Findings of a consortium of states will have greater political traction than the same findings resulting from a single state’s efforts;

10. TRI science addiction Advantages of Mutual Assistance Multiple issues can be worked on simultaneously because more sources of potential “solutions” are identified; Documentation of comparative results will become part of the “evidence base” providing greater legitimacy for state policies.

11. TRI science addiction The TRI-State Policy Program TRI’s Role: Providing an Environment for Open Exchange of Information, Identification of Policy Concerns, and Problem-Solving Focusing on Specific Policy Areas That Will Reform the Treatment System

12. TRI science addiction The TRI State Policy Program TRI’s Role: Providing Strategic Information from Some Other Industries That Can Be Used By State SA Agencies Evaluating Implementation Experiments Hosting Long-Term Working Groups to Develop Approaches to Knotty Policy Problems

13. TRI science addiction How Will States Work Together? Prioritize a common set of two or three policy, performance, business, administrative and/or financing issues; Describe and circulate promising approaches that may have already been tried by member states;

14. TRI science addiction How Will States Work Together? From the promising practices and group discussion create a practical evaluation of an improvement protocol to implement within member states; Analyze data from the evaluation and produce “evidence” of effective policies and practices that can be disseminated widely.

15. TRI science addiction Some of the Issues States Face Data Issues: Collecting and Using Data to Support Policy Objectives: –Cost Offset Data to Support Re-Allocation of State Dollars Implementing WEB-Based Data Systems to: –Support Accurate Reporting by and Immediate Feedback to Providers incl., Encounter Data

16. TRI science addiction Some of the Issues States Face Working with Governors and Legislatures To: Remove Regulatory Barriers That Impede Implementation of Cross-Agency Financing Approaches Remove Barriers to Medication-Assisted Treatment of All Types Implement Performance-Based Purchasing

17. TRI science addiction Necessary, but Not Sufficient A Continuum of Care from Primary Care, to Specialty Health Care, to Specialty Treatment for Substance Use Disorders and Mental Illnesses A Bridge Between Research and Tx –So, Is Research Part of the Bridge or Is It Part of the Gap? –Can the Infrastructure Meet the Public’s Demands?

18. TRI science addiction Some Thoughts About Quality Improvement Making the Case for Change Costs, Cost-offsets, Access Health Care and Substance Use Consumer Choice and the Continuum of Care