Behavioral Health Integration in Alaska Lessons Learned

1. Behavioral Health Integration in Alaska Lessons Learned Bill Hogan, Commissioner Alaska Department of Health and Social Services

2. Behavioral Health In Alaska • When and How Should Idaho Integrate Substance Abuse and Mental Health from a Structural Perspective? • When the Majority of Consumers (Clients, Patients) experience a Co-Occurring Disorder – Initial Data in Alaska indicated 65% of those Served in Separate Systems had “Both Problems” • Does Idaho have this Data? Or some way of determining the extent of the Problem?

3. Behavioral Health in Alaska • When Family Members and Advocates consistently talk about consumers “falling through the cracks” and being “shuffled between the Substance Abuse system and Mental Health system. • When Providers have already moved in this direction – In Alaska many of our frontier, rural, remote and Alaska Native providers had already moved in this direction out of necessity and based on the people they were serving.

4. Behavioral Health in Alaska • What Oversight Structure is Needed to Sustain Transformation? • Alaska created a Behavioral Health Integration Steering Committee designed to provide Executive Oversight – Membership included – the Governor’s Office; AK HSS / Division of Behavioral Health Director; Executive Directors of the AK Mental Health Trust Authority, the Mental Health Board and Advisory Board on Alcoholism and Drug Abuse – Started with a “Charter” Document

5. Behavioral Health in Alaska • Alaska created an “Internal” Planning Committee to integrate the Divisions of Mental Health and Alcohol and Drug Abuse, the Office of Fetal Alcohol Syndrome (FAS) and to bring the various Medicaid Management and Oversight Functions into the new Division • Alaska created an “External” Stakeholders Group to develop an “Integrated” Behavioral Health Service Delivery System – Members included: Consumers, Family Members, Advocates, Providers, the University, Alaska Native providers, Legislators, Community Health Centers, Hospitals, etc.

6. Behavioral Health in Alaska • Describe Logical Steps through System Re-Design • Create an “Integrated” Division of Behavioral Health – using Vision, Mission and Values process – and a “Functional” Organizational Structure – designed to support the “Integrated Behavioral Health Service System” you envision. • Focus on the Continuum of Services – Prevention, Early Intervention, Treatment and Recovery

7. Behavioral Health in Alaska • Behavioral Health Statute • Integrated Behavioral Health Regulations • Quality Standards – Focus on Competencies/Credentialing; Change Agent as Implementation Strategy • Identify the Population to be Served • Design the System – “From the Ground Up” • Financing – “Be Creative” – Grants, Fee for Service, Case Rate, Capitation, etc. • Information Exchange – AKAIMS • Outcomes and System Performance – Start with the Client – Client Status Review (CSR) – but also consider population measures – i.e. Suicide

8. Behavioral Health in Alaska • Need a Full Time Coordinator/Manager – Someone who gets up every morning focused on this Initiative • Develop a Work Plan • Establish Clear Goals and Benchmarks – Create Short Term “Successes” • Use Data and Measure what you are doing • Modify and Adjust • In other Words – Adopt a Continuous Quality Improvement (CQI) Philosophy • Communicate, communicate, communicate to: Legislators, stakeholders, the public.

9. Behavioral Health in Alaska • What Other Thoughts or Perspectives Might Alaska Have re: This Type of Initiative? • Integration occurs Locally at both the Clinical and Administrative Level • Adopt a “No Wrong Door” Philosophy – Consider “One Stop Shop” / Behavioral Health “Home” • Develop Standardized Screening • Everyone Should get a “Comprehensive Treatment Plan” – that addresses both problems • Services should be provided by the same agency where practical and feasible

10. Behavioral Health in Alaska • When Considering Administrative Integration – think about Creating Efficiencies, talk openly about “Consolidation and Mergers” • Stay Focused on the “End Goal” / Outcomes • Ensure you have Solid, Consistent Leadership • Perseverance – Addressing “Change Fatigue” • “Manage Expectations – “When will we be done?” • Identify and Work with “Legislators” who are “Champions”

11. Behavioral Health in Alaska • How Does Alaska Manage for Quality Assurance and Accountability? • Accreditation • Performance Based Contracting/Funding • Ongoing Technical Assistance • Audits • Modifying or Altering Regulations • Certification and Licensing

12. Behavioral Health in Alaska • What Systems and Structures Need to be in Place to Implement an Outcomes-Based/Managed Care System? • General Agreement and Understanding of what Outcomes Providers are Expected to Achieve – Client Outcomes – Productivity/Employment, Housing, Staying out of the Criminal Justice System, “Social Connectedness”, etc. • Beginning to discuss what Constitutes a “Healthy Community” and what role do Behavioral Health Providers play in creating a healthy community

13. Behavioral Health in Alaska • Need to be able to Receive and Send Data – Analyze the Data, etc. – AKAIMS • Re: Managed Care – there is Essentially “No” Managed Care in Alaska • Alaska has used various Managed Care Strategies – i.e. Prior Authorization, Limits on Services, Utilization Management/Review, etc. – but for the most part Alaska has been quite resistant. • One exception – SouthCentral Foundation – in Anchorage

14. Behavioral Health in Alaska • How does Alaska ensure People are being served Effectively and Efficiently? • Effectively – Based on Client Outcomes and reduced rates of Suicide, Fetal Alcohol Spectrum Disorder, Crimes and Accidents where Alcohol and Drugs were involved, etc. • Efficiently – Reviewing Cost Data, Provider Productivity Standards, Consolidating Administrative Functions, etc.

15. Behavioral Health in Alaska • Recommendations re: Draft Approach? • Vision, Goals, etc. • Oversight Structure – Need to “Institutionalize” it – Does the BHTWG/Board – serve as this Entity? • Continuum of Services / Core Services • Comprehensive Focus • Regional Authorities? • Provider Networks? • Workforce? • Primary Care / Behavioral Health Integration?

16. Behavioral Health in Alaska • Comments? • Questions? • Documents you would like to see? • People you would like to talk to? • Thanks • Bill Hogan, Commissioner, Alaska Dept. of Health and Social Services – William.Hogan@alaska.gov – 907-465-3030