Carol Coussons de Reyes Administrator of the Office of Consumer Affairs

1. 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

2. View from Nebraska’s OCA • 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

3. Who are the major voices in healthcare changes? • You • SAMHSA • HHS • Legislators

4. What is SAMHSA • 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

5. Pam Hyde 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.

6. Nebraska Joins the Pledge of the 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.

7. Eight Dimensions of Wellness • 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)

8. Sign Up for the Next 10x10 Campaign Teleconference 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/

9. Smoking Cessation Stats & Upcoming Peer Training • 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

10. SAMHSA’s 8 Strategic Initiatives • 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

11. What is HHS? 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)

12. SPEAKERS ON HEALTHCARE CHANGES • 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

13. HHS Website: Healthcare.gov What is HEALTHCARE.GOV? -A website with updates on healthcare insurance changes.

14. 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)

15. Pre-existing Condition Insurance • 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.

16. Insurance Language: 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.

17. Insurance Language: 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

18. Insurance Language: 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

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

20. Spending on People with Behavioral Health Challenges • 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)

21. Peer Areas of Focus: 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?

22. A Public Health Approach • 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

23. 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)

24. What is National HHS thinking? • 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)

25. National Quality Strategy • 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)

26. Principles Guiding the National Quality Strategy • 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)

27. Framework for the National 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)

28. Goals of the National Quality Strategy • 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)

29. Questions from Prior Slide • 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)

30. Measures of Progress to Priorities & 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)

31. Other Recommendations? • 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)

32. Nebraska’s OCA Statement • 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?

33. Places to Answer these US HHS Questions by October 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)

34. Websites on Healthcare Changes 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/