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Health Care Changes & the Average Nebraska Utilizing Behavioral Health Services: What the OCA learned at Alternatives 2010: Understanding & Opportunity to be Heard~. Carol Coussons de Reyes Administrator of the Office of Consumer Affairs Division of Behavioral Health: DHHS Nebraska

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Health Care Changes & the Average Nebraska Utilizing Behavioral Health Services: What the OCA learned at Alternatives 2010: Understanding & Opportunity to be Heard~

Carol Coussons de Reyes

Administrator of the Office of Consumer Affairs

Division of Behavioral Health: DHHS Nebraska

Copresenter: Lisa Alexander

Consumer Advocate


View from nebraska s oca
View from Nebraska’s OCA Behavioral Health Services:

  • Consumer/Survivors/People in Recovery are being asked to talk to new people & planners.

  • Changes aren’t so easy for us

  • Many of us have challenges solving problems

  • This is meant as a guide to share what the OCA learned at Alternatives about Healthcare Changes


Who are the major voices in healthcare changes
Who are the major voices in healthcare changes? Behavioral Health Services:

  • You

  • SAMHSA

  • HHS

  • Legislators


What is samhsa
What is SAMHSA Behavioral Health Services:

  • SAMHSA:

    Substance Abuse Mental Health Service Administration

    The Substance Abuse and Mental Health Services Administration's (SAMHSA) mission is to reduce the impact of substance abuse and mental illness on America's communities.

Administrator: Pam Hyde

Deputy Administrator & Acting Director of Policy, Planning, & Innovation:

Eric Broderick


Pam hyde on affordable care act
Pam Hyde Behavioral Health Services: on Affordable Care Act

  • 25% of Hospital Admissions related to Behavioral Health

  • 66% of Antidepressants prescribed by primary care doc

  • 83% of People with Serious Mental Health Conditions are Overweight

  • People with Serious Mental Health Conditions die on average at Age 53

    SAMHSA 10x10 Wellness Campaign:

    The Campaign emphasizes the importance of addressing all parts of a person's life. The goal is to extend the life expectancy of persons with mental health problems by 10 years within the next 10 years.


Nebraska joins the pledge of the 10 x 10 wellness campaign
Nebraska Joins the Pledge of the Behavioral Health Services: 10 x 10 Wellness Campaign

We envision:

A future in which people with mental health problems pursue optimal health, happiness, recovery, and a full and satisfying life in the community via access to a range of effective services, supports, and resources.

We pledge:

To promote wellness for people with mental health problems by taking action to prevent and reduce early mortality by 10 years over the next 10 year time period.


Eight dimensions of wellness
Eight Dimensions of Wellness Behavioral Health Services:

  • Social

  • Physical

  • Emotional

  • Spiritual

  • Occupational

  • Intellectual

  • Environmental

  • Financial

    (Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29,(4) 311- 314.- extracted from the internet on 10x10 Website: http://www.promoteacceptance.samhsa.gov/10by10/default.aspx)


Sign up for the next 10x10 campaign teleconference
Sign Up for the Next 10x10 Campaign Teleconference Behavioral Health Services:

Training Teleconference: Tracking Wellness Measures to Increase Life Expectancy Among People with Mental Health Problems

October 26, 20103:00 p.m.–4:30 p.m., Eastern Time (ET) http://www.esi-bethesda.com/10x10teleconference/


Smoking cessation stats upcoming peer training
Smoking Cessation Stats & Upcoming Peer Training Behavioral Health Services:

  • 75% of individuals with behavioral health problems smoke cigarettes

  • 44.3% of the U.S. tobacco market are people living with mental health conditions

  • Half of all deaths from smoking occur among patients with mental health problems

    (Extracted from the internet at: http://www.promoteacceptance.samhsa.gov/10by10/wellness_tools.aspx)

    It’s Your Life, Don’t Let It Go Up

    in Smoke Training

    October 26th & 27th , 2010 from Office of

    Consumer Affairs & Public Health: DHHS Nebraska


Samhsa s 8 strategic initiatives
SAMHSA’s 8 Strategic Initiatives Behavioral Health Services:

  • 1: Prevention of Substance Abuse and Mental Illness | http://go.usa.gov/xnh

  • 2: Trauma and Justice | http://go.usa.gov/xQi

  • 3: Military Families | http://go.usa.gov/xQ3

  • 4: Health Care Reform | http://go.usa.gov/xQO

  • 5: Housing and Homelessness | http://go.usa.gov/xQc

  • 6: Health Information Technology, Electronic Health Records and Behavioral Health | http://go.usa.gov/xQx

  • 7: Data, Outcomes, and Quality: Demonstrating Results| http://go.usa.gov/xQa

  • 8: Public Awareness and Support | http://go.usa.gov/xQC


What is hhs
What is HHS? Behavioral Health Services:

HHS:

US Department of Health and Human Services

Operating Divisions under Secretary Kathleen Sebelius: 

  • Administration for Children and Families (ACF)

  • Administration on Aging (AoA)

  • Agency for Healthcare Research and Quality (AHRQ)

  • Agency for Toxic Substances and Disease Registry (ATSDR)

  • Centers for Disease Control and Prevention (CDC)

  • Centers for Medicare and Medicaid Services

  • Food and Drug Administration (FDA)

  • Health Resources and Services Administration (HRSA)

  • Indian Health Service (IHS)

  • National Institutes of Health (NIH)

  • Office of the Inspector General (OIG)

  • Substance Abuse and Mental Health Services Administration (SAMHSA)


Speakers on healthcare changes
SPEAKERS ON HEALTHCARE CHANGES Behavioral Health Services:

  • Shawn Terrell

    Health Insurance Specialist: Office of Disability: HHS

  • John Obrien

    Healthcare Reform Specialist: SAMHSA

  • Barbara Coulter Edwards: Director in

    The Disabled and Elderly Health Programs Group in the Center for Medicaid


Hhs website healthcare gov
HHS Website: Healthcare.gov Behavioral Health Services:

What is HEALTHCARE.GOV?

-A website with updates on healthcare insurance changes.


What healthcare changes apply now for people with disabilities
What Healthcare Changes Apply Now for People with Disabilities:

  • New policies that make insurance more accessible related to enrolling & appealing decisions.

  • Job-based and new individual plans won’t be allowed to deny or exclude coverage to any child under age 19 based on a pre-existing condition, including a disability.

  • States will have the option to expand Medicaid coverage programs for adults and to include additional programs and services to help those who need long-term care at home and in the community.

    (extracted from the internet at: http://www.healthcare.gov/foryou/disabilities/soon/index.html)


Pre existing condition insurance
Pre-existing Condition Insurance Disabilities:

  • The law creates a new program – the Pre-Existing Condition Insurance Plan -- to make health coverage available to you if you have been denied health insurance by private insurance companies because of a pre-existing condition. 

  • In Nebraska these plans have a monthly premium and deductibles and co-pays.

    Extracted from the internet at: http://www.healthcare.gov/law/provisions/preexisting/states/ne.html

You will pay a $2,500 deductible for covered benefits (except for

preventive services preventive servicesRoutine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment copaymentA flat dollar amount you must pay for a covered service. For example, you may have to pay a copayment5 copayment for each covered visit to a primary care doctor.

for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.


Insurance language what is a monthly premium
Insurance Language: Disabilities:What is a Monthly Premium?

  • Monthly Premium:

    an amount of money determined by your insurance plan that a person pays each month to just have the benefit of having insurance.


Insurance language what is a copay
Insurance Language: Disabilities:What is a Copay?

  • Copay:

    an amount of money determined by your insurance plan that a person pays each time they see a doctor or facility


Insurance language what is a deductible
Insurance Language: Disabilities:What is a Deductible?

  • Deductible:

    a fixed amount of money a person must pay per year before your insurance plan starts paying for any of the services you purchase under the plan


Where is peer services
Where is Peer Services? Disabilities:

  • Where does Peer Support and Consumer Operated Services fit into all these new plans and changes?


Spending on people with behavioral health challenges
Spending on People with Behavioral Health Challenges Disabilities:

  • We represent significant benefit expenditures (or spending) even though we are a small portion of beneficiaries.

    “Social Security Administration disability programs are expensive,growing, and headed toward bankruptcy. People with psychiatricdisabilities now constitute the largest and most rapidly expandingsubgroup of program beneficiaries.”

    (Drake, Skinner, Bond, & Goldman, 2009)


Peer areas of focus wellness and prevention
Peer Areas of Focus: Disabilities:Wellness and Prevention

* Wellness:

New ideas: Emotional Health

* Prevention:

New ideas: Focus on Ages of Opportunity

  • If a person doesn’t abuse a substance by certain age, they are less likely to ever use it.

    What services and messages can reduce the expenditures for folks that utilize behavioral health services- because they are feeling well and are on the road to recovery?


A public health approach
A Public Health Approach Disabilities:

  • A continuum- prevention, Intervention, Treatment, and Maintenance

  • Levels of Risk/Protective Factors/Resilience

  • Web of Influence Model

  • Public Health Triangle (Agent/Environment/Host)

  • Prevention Planning Framework: Assess/Capacity/Planning/Implementation/Evaluation


Request made at alternatives 2010 for your input to designing us healthcare
Request Made at Alternatives 2010 for Your Input to Designing US Healthcare

  • What should our system look like?

  • What programs should we have?

  • What programs should we have more of?

  • What keeps you well?

  • What is it that is at the heart of supporting wellness and recovery?

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


What is national hhs thinking
What is National HHS thinking? Designing US Healthcare

  • Expand programs that assess & improve quality of care.

  • Promote better practice coordination & medical homes

  • Test Innovations & expand what works

  • Promote Electronic Healthcare Records

  • Prevention & Elimination of Healthcare Associated Conditions

  • Foster collaborations: Federal/State/Private

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


National quality strategy
National Quality Strategy Designing US Healthcare

  • Public/Private Partnerships for consistent, high quality, safe, affordable care

  • Sample Initiatives:

    Institute of Medicines: Crossing the Chasm of Quality Framework

    National Priority Partnership’s “National Priorities & Goals”

    HHS Healthy People 2020

    AHRQ National Healthcare Quality Report & National Healthcare Disparities Report

    White House Let’s Move Initiative

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Principles guiding the national quality strategy
Principles Guiding the National Quality Strategy Designing US Healthcare

  • Person Centered & Family Engagement

  • Strategies address all ages, populations, service locations, and sources of coverage

  • Eliminating health disparities

  • Design and Implementation will seek public/private collaborations

    Give Feedback: Appropriate? What would be better guide?

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Framework for the national quality strategy
Framework for the Designing US HealthcareNational Quality Strategy

  • Better Care- person centered that works for patients & providers. Address quality, safety, access, & reliability of how care is delivered and the experience of individuals receiving care

  • Affordable Care- lower costs for families, government, & private sector

  • Healthy People/Health Communities- Improve health and wellness at all levels thru partnerships of providers/individuals/community resources.

    Give Feedback: Understandable? Right Direction? What would be better?

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Goals of the national quality strategy
Goals of the National Quality Strategy Designing US Healthcare

  • Make healthcare safer, eliminating preventable events that injure folks

  • Increase Care Coordination with improved outcomes- reduced readmission/medication errors

  • Reduce occurrence of and improve management of chronic illnesses by strong partnerships & clear accountability across providers, patients, and communities

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Questions from prior slide
Questions from Prior Slide Designing US Healthcare

  • What goals are achievable in 5 years? Or should they think in a shorter time frame?

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Measures of progress to priorities goals
Measures of Progress to Designing US HealthcarePriorities & Goals

Looking at Goals and Priorities on Prior Slides:

What existing and widely used measures do you recommend to assess progress?

(Extracted from paper available on the internet at:

http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Other recommendations
Other Recommendations? Designing US Healthcare

  • How to engage stakeholders to drive progress?

  • Do the goals and framework meet the needs of our state’s vulnerable populations?

  • Are there priorities/goals that should be considered based on our state’s activities?

  • What are your recommendations to engage States to align with strategy?

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Nebraska s oca statement
Nebraska’s OCA Statement Designing US Healthcare

  • This document has been translated for you to assist in understanding, feel free to access the original document.

  • Tell people what you want.

  • If they didn’t ask you what you want in these questions, tell them anyways.

  • What keeps you well and/or working?


Places to answer these us hhs questions by october 15 2010
Places to Answer these US HHS Questions by Designing US HealthcareOctober 15, 2010:

  • Online:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html

  • In writing:

    Nancy Wilson

    Room 3216

    540 Gaither Road

    Rockville, MD 20850

  • By fax:

    Agency for Healthcare Research & Quality

    Attention: Nancy Wilson

    301-427-1210

    (Extracted from paper available on the internet at:

    http://www.hhs.gov/news/reports/quality/nhcqsap.html)


Websites on healthcare changes
Websites on Healthcare Changes Designing US Healthcare

National Health Care Quality Strategy & Plan: Online Form for Feedback

http://www.hhs.gov/news/reports/quality/nhcqsap.html

HealthCare.Gov

http://www.healthcare.gov/

HealthCare.Gov in Spanish

http://www.cuidadodesalud.gov/enes/

SAMSHA Strategic Initiatives:

http://www.samhsa.gov/about/strategy.aspx

Online Form for Feedback on Strategic Initiatives

http://feedback.samhsa.gov/forums/77283-samhsa-s-strategic-initiatives

10 x 10 Wellness Campaign: SAMHSA

http://www.promoteacceptance.samhsa.gov/archtelPDF/Mental_Illness_Awareness_Week_Guide.pdf

Kaiser Foundation Reform Site

http://healthreform.kff.org/

US Dept of Health and Human Services

http://www.hhs.gov/

National Council for Community Behavioral Health blog

http://mentalhealthcarereform.org/

Campaign for Mental Health Reform (17 Organizations)

http://www.mhreform.org/


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