Behavioral Health and the HiTech Bill

1. Behavioral Health and the HiTech Bill Dennis Morrison, PhD Chief Executive Officer Centerstone Research Institute

2. Introduction to Centerstone

3. Original Corporate Structures

4. Final Corporate Structure

5. Final Corporate Structure

6. Our Footprint then: CBH Primary Service Area

7. Our Footprint now: Centerstone Primary Service Area

8. Counties where 100+ clients reside Counties where <100 clients reside Counties with Centerstone Facilities Centerstone Mobile Crisis Coverage ( 24-hour Crisis Intervention, toll-free – 800-681-7444 ) Our Footprint Now

9. Summary Stats

11. Centerstone Research Institute • Private, non-profit corporation • Formed as result of merger of four CMHCs • Combined all IT and Research assets • 80 employees • Research and IT Institution • Not a provider organization • $64M in Research Grants since 2003 • IT support for Centerstone companies • Behavioral Pathway Systems

12. When you think of a scientist…

13. We see it a little differently

14. The Ultimate Goal for Centerstone Prevent and Cure Mental Illness and Addiction CRI’s Job: Advance the Science of Care

15. Centerstone Mission Prevent and Cure Mental Illness and Addiction Prevent and Cure…

16. CRI Mission Advance the Science of Care Advance the Science of Care

17. Leading Sources Of Disease Burden in Middle Income Countries 2004 Surgeon General’s Report on Mental Health

18. Leading Sources Of Disease Burden in High Income Countries 2004 Surgeon General’s Report on Mental Health

19. Putting DALY’s in Perspective Major depression is equivalent in societal burden to blindness or paraplegia Active psychosis seen in schizophrenia is equal in societal burden to quadriplegia.

20. Remember three numbers 6-17-25 • 6 years - Half life of psychological knowledge • 17 years - Science to Service Gap • 25 years - Average loss in life expectancy for SMI

21. Integrated Primary and Behavioral Health Care

22. The Stats • 30% of family practice physician visits involve psychological counseling • 21% of patients seen by primary care physicians are depressed • only 1.2% self-report depression) • 51% of behavioral health care services are delivered by non-psychiatric physicians • Primary care physicians write 67% of all psychotropic prescriptions • psychiatrists wrote less than 18%. • 70% of all primary care physicians visits are for psychosocial problems • Psychologically distressed patients use 2 to 3 times more health care services than non-distressed patients.

23. Non-Psychiatric Physician Visits in Panic Disorder Salvador-Carulla, et al (1995). Costs and Offset Effect in Panic Disorders. British Journal of Psychiatry 166, (23-28).

24. Bottom Line Primary care is the “de facto” mental health service system for 70% of the population Regier et al., 1993

25. It goes both ways

26. USA Today May 3, 2007

27. If you have a serious mental illness Probability of death compared to general population: • Heart disease 3.4 • Diabetes 3.4 • Accidents 3.8 • Respiratory ailments 5 • Pneumonia, influenza 6.6 Joseph Parks, Missouri Department of Mental Health

28. René Descartes Descartes Was Wrong

29. Problems “For every complex problem there is a simple solution -and it is wrong.” • H.L Menken

30. Health Information Exchanges (HIE)

31. Interoperability We must become Operable before we become Interoperable

32. Physicians in the US(thousands) http://www.census.gov/compendia/statab/cats/health_nutrition/health_care_resources.html

33. Electronic health records in ambulatory care: a national survey of physicians. • 4% have fully implemented Electronic Health Records (EHR) • 13% reported having a basic system. • Implementation varied somewhat by region of the US • Physician perception was positive regarding quality of care effects of EHRs • Largest barrier to adoption is cost DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, Blumenthal D. New England Journal of Med. 2008 Jul 3;359(1):50-60. Epub 2008 Jun 18.

34. Hospitals in the US http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html

35. Use of electronic health records in U.S. hospitals. • 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), • An additional 7.6% have a basic system (i.e., present in at least one clinical unit). • Computerized provider-order entry (CPOE) implemented in only 17% of hospitals. • Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. • Cost was the primary barrier • Interestingly, hospitals with electronic-records systems less likely to cite cost as a barrier Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. New England Journal of Medicine. 2009 Apr 16;360(16):1628-38. Epub 2009 Mar 25

36. Outpatient Penetration(Medical) * Estimate www.amednews.com/2010/bil20201

37. Behavioral Healthcare

38. Problems Unique to Behavioral Health • Different diagnostic nomenclature • ICD9 vs. DSM-IV • Higher standards for confidentiality • Especially for substance use disorders • Poorer funding • Different Health IT vendors than medical

39. Percent of Behavioral Health Providers with Fully Implemented Components Behavioral Health/Human Services Information Systems Survey, May, 2009 Software and Technology Vendors Association.

40. Healthcare Reform

41. Three Distinct (but related) Federal Policies • Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (2008) • HITECH Act (2009) • Patient Protection and Affordable Care Act (2010)

42. Not a Moment Too Soon...

43. Parity and Addiction Equity Act (2008) A plan may not apply any financial requirementor treatment limitationto mental health or substance use disorder benefits in any classificationthat is more restrictive than the predominantfinancial requirement or treatment limitation for substantially allmedical/surgical benefits in the same classification • Plan years beginning July 1, 2010 • Collectively bargained plans have slightly different dates • General rule: parity applies if a plan offers medical/surgical and MH/SUD benefits (> 50 employees)

44. American Recovery and Reinvestment Act (ARRA)

45. $787 Billion, $50+ Billion for HIT

46. TITLE XIII of ARRA - HIT ‘‘Health Information Technology for Economic and Clinical Health Act’’ or the ‘‘HITECH” Act Health IT becomes a major Federal program – overnight! Fastest funding growth of any program since WW2 (except Homeland Security post 9/11)

47. Health IT and Transformed Health Care Vision: Significant and measurable improvements in population health through a transformed health care delivery system . • Key goals: • Improve quality, safety, & efficiency • Engage patients & their families • Improve care coordination • Improve population and public health; reduce disparities • Ensure privacy and security protections Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008

48. Conceptual Approach to Meaningful Use

49. Three Parts of the HITECH Act • Create standards, implementation specifications and certification criteria for HIT Infrastructure Interoperability • Implement the HIT Infrastructure and EHRs through grants, loans, and incentives for the Meaningful Use of Certified EHRs; • Encourage the use of the HIT Infrastructure by improving information privacy and security

50. Meaningful Use A Meaningful user is an eligible provider who: • Uses certified EHR technology • Includes the use of electronic prescribing • Provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination • Submits information on clinical quality measures selected by the Secretary