Health Care Reform

1. Health Care Reform What does it mean for you? Philadelphia Department of Behavioral Health & Mental Retardation Services

2. What is HCR? • The “Patient Protection and Affordable Care Act” was signed into law in March of 2010 • A governmental policy that changes the delivery of health care services in a given place Major Changes: • All Americans must have health insurance by 2014 (just as every car owner must buy insurance) • More emphasis on community-based services and less reliance on institutional care • Disease prevention and wellness are major themes

3. Health care reform typically attempts to: • Broaden the population that receives health care coverage through employment, or public sector insurance companies (example department of public welfare, or DPW). • Increase the number of health care providers people may choose from. • Improve the referral process and the right to be seen by a specialist. • Mandate health insurance by reducing the cost and making it affordable for everyone.

4. Challenges in the Field • Outcomes matched the national experience • Unmet Need: < 10 % who need Tx. seek treatment or if they do, arrive under coercive influences • Low Pre-Treatment Initiation Rates • Low Retention: > 50 % do not successfully complete treatment • Inadequate Service Dose: significant % do not receive optimum dose of Tx. as recommended by NIDA. • Lack of Continuing Care: only 1 in 5 receive post-discharge planning • Recovery Outcomes: most resume using within 1 year and most do so within the first 90 days of discharge from Tx. • Revolving Door: > 60% one or more Tx. episodes, 24% 3 or more – 50% readmitted within 1 year.

5. Healthcare Reform andBehavioral Health

6. The new law expands the range of covered behavioral health services: • Substance use disorder/mental health (behavioral health) coverage • Behavioral Health is included in chronic disease prevention initiatives • All plans must treat Behavioral Health services the same as all other covered medical and surgical benefits (parity)* • Allows adults without children to receive health coverage, including Behavioral Healthcoverage • Increases the grant eligibility for more Behavioral Healthprograms LEGAL ACTION CENTER http://lac.org/index.php/lac/378

7. Insurance Plans : Health Insurance For Everyone!

8. Medicaid Expansion Medicaid will cover more people by changing the minimum income necessary to qualify: • Meaning… one individual can now earn up to $14,400 and qualify • A family of four can earn up to $30,000 and qualify • Potentially an additional 32 Million individuals eligible for Medicaid

9. Health Information Technology

10. What is it? the use of computers as a means of exchanging medical information from doctor to doctor, or provider to provider Health IT allows doctors to: reduce paperwork by eliminating the need for handwritten medical records reduce medical errors by transmitting accurate information electronically and eliminating mistakes due to misreading of your doctor’s handwriting Health Information Technology

11. Health Information Technology Health IT allows providers to… • reduce health care costs by decreasing the need for repeat medical tests by different doctors and eliminating storages space and staff time to maintain medical records • improve patients quality of care by decreasing medical errors and assuring that all patient health care providers have accurate and timely information

12. Accountable Collaborative Care vs. Quantity Quality

13. Accountable Collaborative Care • An Accountable Care Organization (ACO) is an organization of health care providers that agrees to be responsible for the quality, cost and overall care of Medicare [persons] who are enrolled in a fee-for-service program. Medicare: Accountable Care Organizations

14. Accountable Collaborative Care • The purpose of Collaborative Care and ACC is to provide [person] first treatment, that is properly managed, while using aligned incentives to measure outcomes. • Reduce avoidable health care cost. • ACC is part of Medicaid reform effort, and was developed to consist of statewide information.

15. “Collaborative care organizes information, expertise, and resources around the “whole [individual]” for better decisions and optimal outcomes, starting with primary care.”

16. What does HCR mean to “average every day” people? • Choice of doctors • Improved medical treatment • Choice of insurance plans • Employee insurance coverage • Decreased cost sharing (lower co-pays on prescriptions and medical visits). • Better quality services for people in recovery

17. How does HCR impact providers? • Training/ Education on new system/technology and policies • Employer mandated health insurance(depending on size of agency) • Increased communication and coordination across disciplines and levels of care • Measurable outcomes • Prevention/ Early intervention Strategies • Recovery and wellness supports and services

18. Benefits of HCR for Providers • Moving from hand written medical records to electronic medical records may provide better organization for providers, and better professional care to patients (Health IT) • Makes significant improvements to Medicaid including expanding the number of people who can qualify for the extensive behavioral health services Medicaid covers • Enhanced coordination and quality from primary care doctors and behavioral health providers, for anyone using public behavioral health services.

19. Recovery Oriented (Transformative) Systems are well-placed for Healthcare Reform

20. Connecting the Dots: The Philadelphia Model and Health Care Reform System Management

21. Connecting the Dots: The Philadelphia Model and Health Care ReformService Delivery

22. Connecting the Dots: The Philadelphia Model and Health Care ReformService Delivery

23. What policies will be implemented in the near future? September 2010 • Youth up to age 26 will be able to remain on their parents’ insurance policies. • New restrictions will be placed on insurers’ ability to impose annual limits: the allowable level of annual limits will be phased down until they are eliminated in 2014. • Lifetime limits will be prohibited. • Insurance plans will be required to cover certain preventive services, including depression screening and regular behavioral assessments for children. 

24. October 2010 Medicaid home- and community-based services (HCBS) These provisions took effect on Friday, October 1, 2010: • Individuals no longer have to meet an institutional level of care requirement in order to qualify for HCBS. • States may provide a broadly defined range of community-based services to persons with chronic mental illnesses and/or substance use disorders. • States may provide these community-based services to persons whose incomes are 300% of the SSI income benefit. • Benefits can be targeted to specific population groups or specific functional needs groups without violating Medicaid’s comparability requirements – this means a state could target persons with chronic mental illnesses, for example.

25. For more information on Health Care Reform, visit the following websites: • The National Council www.thenationalcouncil.org • Healthcare.gov www.healthcare.gov • Medicare Care Transitions Program Act of 2009 www.opencongress.org/bill/111-s1009/show

26. QUESTIONS ???