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July 13, 2017

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

Report:  Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-2012

This report from the Bureau of Justice Statistics presents prevalence estimates of mental health indicators among state and federal prisoners and jail inmates by different time periods, demographics, criminal justice history, most serious offense, mental health treatment received while incarcerated, and rule violations. Indicators were defined as serious psychological distress (SPD) in the 30 days prior to the interview or having a history of a mental health problem. Data are from BJS's 2011-2012 National Inmate Survey. Findings include that more people incarcerated in prisons (14%) and in jails (26%) met the threshold for SPD in the past 30 days than in the standardized general population (5%).
Psychiatry Hospitalist Model Allows for More Patient, Family Time

During the last several years, hospital
inpatient wards nationwide have undergone  significant changes with the initiation of "hospitalist" programs, using dedicated inpatient physicians who work exclusively in a hospital.1 Although these models were initiated with internal medicine, hospitalist programs have expanded into other disciplines, are now are prevalent in such specialties as obstetrics and gynecology, and have moved into inpatient psychiatry as well. Psychiatrists are currently being hired by hospitals and physician provider organizations across the United States to participate in psychiatric hospitalist divisions.

In the early 2000s, very few programs were using the hospitalist model, with the exception of academic centers and some hospital systems.2 Even now, many psychiatric hospitals and inpatient units still use psychiatrists who intersperse visits for inpatient responsibilities amidst the maintenance of an outpatient office practice.   In recent years, hospitals have started taking a closer look at metrics, patient satisfaction, and experience.  Read more here.
NAM Report:  Effective Care for High-Need Patients

To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016 and summarizing the presentations, discussions, and the relevant literature. The resulting special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, reports and reflects on the following issues: 
  1. Key characteristics of high-need patients
  2. Use of a patient categorization scheme-or a taxonomy-as a tool to inform and target care
  3. Promising care models and attributes to better serve this patient population, as well as insights on "matching" these models to specific patient groups
  4. Areas of opportunity for policy-level action to support the spread and scale of evidence-based programs. The publication concludes by exploring common themes and opportunities for action in the field. 
Click here to read the report.

July 27, 2 - 3 pm, SAMHSA

August 8, 2:30 - 3:30 pm, National Council for Behavioral Health

HEDIS® Behavioral Health Measures: An Update From NCQA©
August 15, 12 - 1 pm, National Committee for Quality Assurance (NCQA)

August 16, 3 - 4:30 pm, Rural Behavioral Health

September 12, 2:30 - 3:30 pm, National Council for Behavioral Health


JULY 2017

Children & Families Committee Meeting
July 18:  11:30 am - 1 pm, GTM

Directors & Executive Committee Meeting
July 19:  9:30 am - 12:30 pm, GTM

CSPOA / DOH / OMH Monthly Call
July 20:  3 - 4 pm, GTM


Officers, Chairs & Regional Reps Call
August 2:  8 - 9 am

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 

Tough Question for Hospitals: Who's too Risky to Release?

Four days before Alexander Bonds ambushed and killed a New York City police officer, he was in a hospital emergency room getting a psychiatric evaluation. The hospital released him the same day.

Now the hospital's actions are under a state review ordered by the governor. St. Barnabas Hospital says it handled Bonds appropriately and welcomes the inquiry.

The decision was one psychiatrists across the country make regularly: whether patients pose enough danger to themselves or others to require hospitalization. Practitioners say that it's often a difficult call to make and that even an experienced evaluator can't predict someone's behavior.

"Most of the time, it's very complicated. You're trying to make an assessment: Is the person going to a home? Is there family? Are they reliable? What was the specific reason they were brought in? Is that likely to occur again?" said Bea Grause, president of the statewide hospital and health system association HANYS and a former emergency room nurse.  Read more here.
Desperate for Addiction Treatment, Patients are Pawns in Lucrative Insurance Fraud Scheme

Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by STAT and the Boston Globe has found.

They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses.

Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs.

The fraud is now so commonplace that brokers use a simple play on words to describe how it works: "Do you want to Blue Cross the country?"

Patients from across the United States have been taken in by these profiteers capitalizing on the surge in opioid addiction. For Peter SanAngelo, hopeless and homeless after a decade of heroin use, the promise of free insurance and luxury rehab in another state was a lifeline. A patient broker used a phony address to enroll the Massachusetts man in a Pennsylvania Blue Cross plan and bought him a plane ticket to Florida. He was even promised money for cigarettes.  Three months later, the 33-year-old died of a drug overdose.  Read more here.
The Messenger Also Matters: Value-Based Payment Can Support Outreach To Vulnerable Populations

With the proliferation of value-based payment initiatives and implementation of the Affordable Care Act's (ACA's) coverage expansions, states have had many opportunities in recent years to improve the health of vulnerable populations through health promotion, prevention, and care coordination. It is vital that value-based payment models can and must support accountable health care delivery systems in partnering with community-based "messengers" to engage vulnerable individuals in health education and promotion. 

One such messenger program,  ACCESS, a Brooklyn-based project of the  Arthur Ashe Institute for Urban Health, trains barbers and hairstylists to help formerly incarcerated men learn to recognize and act upon their own health risk factors. Value-based payment offers an opportunity to support programs such as this.  Read more here.
If Your Goal Is To Share Savings, You Need To Measure It

We've all heard the expression, "What gets measured is what gets done." But at The 2017 OPEN MINDS Strategy & Innovation Institute, I learned a new one. If it isn't measured, it's like it didn't exist. That was the takeaway from the comments of Carl Clark, M.D., President & Chief Executive Officer, Mental Health Center of Denver, during his session,  Preparing Specialty Provider Organizations For Value-Based Reimbursement: An Overview Of Competencies Required For Success . His comments were made in the context of value-based reimbursement and the need for provider organization executives to not only understand how they provide "value" but to be able to measure that.

Dr. Clark's organization, the Mental Health Center of Denver, has a value-based capitated behavioral health contract with Colorado Access, a Regional Care Collaborative Organization (RCCO). RCCOs are the current Colorado version of a Medicaid accountable care organization. Read more here.
A What-Works Approach to the Opioid Crisis

States recently got important help to address the opioid epidemic: a billion dollars over two years from the 21st Century Cures Act, passed by Congress late last year. States are now deciding how to use that funding. A critical question - a truly life and death issue - is how states can save the most lives with it.

To put the opioid epidemic in perspective, about 34,000 Americans die in car accidents each year, and about the same number die from gun violence. Opioids, including prescription medications and heroin, kill almost as many: over 33,000 in 2015, more than any year on record. Moreover, in 2015 there were an estimated 2.7 million Americans who suffered from opioid dependence or addiction, with only about a quarter of them in treatment. Closing this treatment gap is a key goal of the Cures Act.

Simply increasing access to treatment, however, is not enough. If states focus only on increasing its availability without building in ways to learn which treatment and engagement strategies are most effective for this diverse population, it will be a huge missed opportunity that will cost lives down the road.  Read more here.
Uberizing Health Care Transportation

Its become abundantly clear over the past few years that transportation network companies, like Uber and Lyft, are reshaping our workforce and economy - putting taxi services out of business; turning employees into "microentrepreneurs"; and now, potentially shaping how we purchase cars. But the most fascinating market development we've seen recently are forays by Uber and Lyft into the health care market.

Social determinants of health - such as poverty, lack of education, racism, discrimination, environment, and community conditions - have been on the front burner of many of the health care strategy sessions and policy discussions I've been in this year. While we've seen many new programs and innovative projects to address food insecurity, housing, and education issues, I haven't seen as much movement on the transportation side - though it remains a big barrier to care for many consumers. About 25% of consumers in the suburbs miss medical appointments due to the lack of transportation.

Recent market developments show that the transportation networks of Uber and Lyft are converging with the needs of the health care system to provide non-emergency
transportation for consumers.  Read more here.
HEDIS Scores Next Year To Include Telehealth Treatment for Substance Abuse

The National Committee for Quality Assurance is updating its Healthcare Effectiveness Data and Information Set or HEDIS scores for 2018 to include telehealth and to combat addiction risks associated with opioid use.

One new measure assesses the use of opioids at high dosage - an average morphine equivalent of more than 120 mg - for adults who receive long-term treatment.
Another addresses the rate of adult health plan members who receive opioids from multiple providers and pharmacies.

"High dosage, multiple prescribers and pharmacies are all risk factors for dangerous overdose and death," the NCQA said. "These measures add health plans to the group of stakeholders currently addressing the opioid epidemic."  Read more here.
Healthify Raises $6.5 Million to Transform How Healthcare Addresses Social Needs

Healthify, a leading community referral and social determinants management platform, announced the close of a $6.5 million Series-A round led by  BlueCross BlueShield Venture Partners (BCBSVP). To date, Healthify has raised over $9.5 million through investments, grants and awards. 
Healthify works with managed care plans and healthcare providers in 30 states, helping more than 15,000 healthcare staff coordinate the care of nearly five million Medicare Advantage and Medicaid beneficiaries. Healthify will use the funds from the financing to expand its care coordination product suite and grow its network of customers and social service partners. 
The Centers for Medicare & Medicaid Services (CMS), the federal agency that supports the admini stration of Medicaid and Medicare, has made managing the social determinants of health a priority through 1115 waivers and the Accountable Health Communities Model. Unaddressed social needs, which include access to healthy food and stable housing, are strongly linked to poor health outcomes and high health costs. Read more here .
EHR Use Cases, Not Certification, Should Drive EHR Selection

EHR certification is useful in signaling when certain technology meets industry standards in a test environment. In particular, 2015 edition ONC health IT certification informs providers when a  certain technology can be used to earn payments under federal incentive programs such as the EHR Incentive Program and the Quality Payment Program.   However, the recent  $155-million  lawsuit to settle EHR certification allegations against eClinicalWorks has raised questions about the significance of EHR testing versus performance in the real world.

Providers relying on word of mouth and health IT certifications when making EHR purchasing decisions now have less assurance these stamps of approval mean much.   While the certification process itself has strict and specific criteria, the possibility that vendors could illegally obtain certification by hiding certain inefficiencies or inadequacies of its technology from the certification body raises concerns.   Read more here .
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.