A National Standard for Assessment/Placement

1. A National Standard for Assessment/Placement THE ASAM CRITERIA SOFTWARETM American Society of Addiction Medicine 44th Annual Medical-Scientific Conference: April 26, 2013, Chicago, Illinois

2. ASAM Disclosure of Relevant Financial Relationships Content of Activity: ASAM Medical –Scientific Conference 2013

3. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE AGENDA • Rationale & background for a new standard of assessment & treatment planning • Dr Gastfriend - 15 min • Hands-on experience at the computer • Mr Conrad & Dr Earley - 45 min • Interactive discussion • Drs Gastfriend & Earley & Mr Conrad - 25 min • ASAM’s plans: Dr Gastfriend - 10 min • Participants’ reaction: All - 25 min

4. A National Standard for Assessment/Placement: THE OPEN-SOURCE ASAM CRITERIA SOFTWARE • Rationale & background for a new standard of assessment and treatment planning • ASAM’s Goals • HBS’s Report Recommendations • SAMHSA’s Open Behavioral Health Information Technology Architecture Project

5. Stakeholders in an Information Technology Revolution Client Researcher Counselor Employer/Payer Supervisor Society Managed Care System Accreditation Body, Government

6. Corbel (Body) • National Treatment Center Study - 450 programs (U. of GA) • >70% of respondents using ASAM Criteria by 1996 • For-profits: 54% less likely to adopt (p=.02) • Single-level programs: 34% - 42% less likely than multi-levels (p<.01) • Dual diagnosis capable programs: 3.4 times more likely to adopt (p ≤.01) • Programs closing within 24 mos. were less likely to be ASAM adopters in 1996 (p<.05) • Programs closing within 6 mos. – even lower baseline adoption

7. HARVARD | BUSINESS | SCHOOL

8. Harvard Business School: Experts Contacted • Providers • Jerome Rhodes, President, Recovery Division, CRC Health Group • Nancy Paull MS, CEO, SSTAR of MA and RI • Ron Jackson MSW, Director, Evergreen Treatment Services, Seattle WA • Payers • Hyong Un MD, Chief Psychiatric Officer and Head of EAP, Aetna • Gary Henschen MD, Chief Medical Officer-Behavioral Health, Magellan • David Pating MD, Chief, Addiction Medicine, Kaiser Permanente SF Med Ctr • Tom Trabin PhD, Assoc Dir, Adult Care, Alameda County Behavioral Health, CA • Government/Non-Profit • Mady Chalk PhD, Dir, Center for Performance-Based Policy, TRI-U of PA • Daniel Kivlahan PhD, V.A. Assoc Nat’l MH Program Dir for Addictive Disorders • Andrew Saxon MD, Psychiatrist, VA Puget Sound • Eric Goplerud PhD, Research Professor, Geo Washington U/NORC • Carol McDaid, Principal, Capitol Decisions, Washington DC • Douglas Marlowe JD, PhD, Sr Investigator, TRI-U of PA; NADCP Science Advisor • Software Developers • Skip McGaughey, Executive Director, Open Health Tools • Simon Budman PhD, CEO, Inflexxion • Ken Tubman, CEO, Claricode HARVARD | BUSINESS | SCHOOL

9. Case Study: CRC Health • Operates 145 clinics treating 30,000 people • Largest behavioral health provider in U.S.   • Devotes significant resources to payer approval • Each center has 3-5 FTEs dedicated to UR • ~20% of cases are contested by payers • ~30% of MD time is lost interacting w/payers   • If this administrative time is reduced only slightly, the PPC software could yield substantial savings.   • Also, CRC recognizes the benefits that increased reliance on health IT could provide. HARVARD | BUSINESS | SCHOOL

10. ASAM Members’ Survey Results (N=95) • Leading concerns: • Cost 73% • Time 48% • 35% indicated that MDs earning $110,000 or more are conducting assessments; 46% indicated that the assessments take 60-90 min • Significant value if ASAM’s eCriteria can save time with payers: 31% are waiting ≥half a day for insurance authorizations • Treatment centers would find ASAM’s eCriteria a +value proposition if: • It improves treatment outcomes – 80% • It improves and standardizes assessments – 72% • It reduces time spent negotiating with insurance companies – 66% • It provides certification as “ASAM compliant” (42%) or CEU credits (39%) HARVARD | BUSINESS | SCHOOL

11. PPC Software Value Proposition • For Patients • Improves Patient Outcomes • For Payers • Improved Patient Outcomes > Lower Long-Term Costs • Standardizes approval process • IT can facilitate/automate approval process • Decreases expensive & unnecessary overtreatment • Improves inter-rater reliability • For Providers • Facilitates reimbursement process throughfewer disputes, decreased administrative burden, and faster turnaround on payment • Provides training to new counselors • Generates sophisticated reports & analyses HARVARD | BUSINESS | SCHOOL

12. The NEW ASAM CRITERIA Book&THE ASAM CRITERIA Software • Effective, reliable treatment planning requires that both be used together • The ASAM Criteria Software undergoing nationwide release by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) • The ASAM Criteria text is synchronized with the ASAM Criteria Software, such that definitions & specs in the text for the dimensions, levels of care & admission decision rules serve as the reference manual for the ASAM Criteria Software released by SAMHSA

13. ASAM’s Criteria Software – Commercial Plan • A full, patient-based, computer-driven, counselor tool • A comprehensive psychosocial, implements all PPC-2R decision rules • A quantitative, reliable & valid LOC recommendation & justification • Current Use: Norway (10 sites) • Goals: International standard & sustainability • Commercialization: Guided by Harvard Business School Business Plan – Stakeholder interviews, member surveys, & fiscal models • SAMHSA’s Open-Source project – nationwide behavioral EHR platform

14. Via SAMHSA’s OBHITA Open Behavioral Health IT Architecture Project • Meaningful Use Compliant Clinical Decision Support Software • Can integrate Primary & Behavioral Health Services • Eventually EHR Compliant: HL7, SNOMED, LOINC, ICD-10, etc. • Integrated with HIT Grants for Primary Behavioral Health

15. FEi Systems: Focused e-Health Innovations • Privately held, since 1999. 20-25% growth/yr. 2010 revenues ~$32 mm • 150 employees. Contracts with Avalon, Westat, Abt & others in projects at FDA, NIH, and in criminal justice parole & probation. • Contracted to rewrite the Block Grant process for SAMHSA. • HIPAA: Secure facility, encryption, security officer, & business associate agreements with all clients. Expert in data repository de-identification. • Access To Recovery: Serves 15 of 30 state grantees. • Commercially manages WITS for 28 states & counties, Supports 5,500 providers. FEi’s WITS team = 45 staff.

16. Text + Software = ASAM Criteria • The ASAM Criteria book & Softwareare companion text and application. The text delineates the dimensions, levels of care & decision rules that comprise TheASAM Criteria • The software provides approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care • The text provides background & instruction for proper use of software. The software enables comprehensive, standardized evaluation.

17. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE • Hands-on experience at the computer • Logging-on • Understanding the user-interface • Inputting mock data in selected dimensions • Reviewing the output reports

18. Intuitive User Interface Clean interface and presentation of data elements.

19. Intuitive User Interface Data visualization elements.

20. Enhanced Report Dynamically driven report with variable content regions.

21. Enhanced Report Improved readability and scanning of information.

22. Meaningful Documentation

23. Meaningful Documentation The black box barrier is removed, exposing the underlying algorithms.

24. Meaningful Documentation Enhances understanding of the ASAM algorithm by providing meaning and context.

25. Meaningful Documentation Facilitates updates and tweaking to the algorithm.

26. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE • Interactive discussion • Understanding the implementation process, including data privacy issues • Anticipating the learning curve • Measuring the ROI with • INSTRTM: INSTant Authorization for Reimbursement • Just-In-Time Supervision • Accreditation, Certification, Contracting, Grants, etc.

27. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE • ASAM’s plans • Releasing to the field, training & endorsement/certification • Research: optimizing patient care & recovery outcomes– The Central Data Repository • QI steps: ASAM’s Coordination & engaging stakeholders – The National Coalition on Placement Criteria

28. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE • Participants’ reaction • Fears: Concerns & obstacles • Hopes: Perceived benefits & needs • Likelihood of testing & adopting the software

29. A National Standard for Assessment/Placement: THE ASAM CRITERIA SOFTWARE • David R Gastfriend MD gastfriend@gmail.com