cover photo1 - smiling people
April 20, 2016

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

Connect With Us:
Like us on Facebook   Follow us on Twitter    View our profile on LinkedIn
Francine Sinkoff, Editor

First Long-Acting Buprenorphine Implant Shows Promise for Opioid Addiction

Braeburn Pharmaceuticals announced positive data from the Phase 3 study of Probuphine (buprenorphine subdermal implant) for the long-term maintenance treatment of opioid addiction. Findings were presented at the 47 th Annual American Society of Addiction Medicine (ASAM) Conference.

Probuphine, an opioid antagonist, is a long-acting, 6-month, subdermal implant utilizing Titan's platform technology ProNeura, which is designed to provide continuous, long- term steady state levels of medication in the blood. Currently, buprenorphine is only available as a once-daily oral formulation.

The Phase 3 study is a double-blind, double-dummy trial designed to evaluate the efficacy and safety of Probuphine as a maintenance treatment for  opioid addiction. The primary endpoint was to show non-inferiority to sublingual buprenorphine.

Study results demonstrated that patients who were clinically stable on sublingual buprenorphine maintained stability when transferred to Probuphine. In addition, patients in the Probuphine group were more likely to be abstinent from illicit opioid use for 6 months compared to patients who remained in the sublingual buprenorphine group. The responder rate for the Probuphine group was 96.4% vs. 87.6% in sublingual buprenorphine group, meeting the study's primary endpoint (P=0.034).

The FDA is expected to make a decision on the approval of Probuphine by May 27, 2016.  Read more here.
Report:   Integrating Behavioral Health into Medicaid Managed Care: Design and Implementation Lessons from State Innovators

Medicaid enrollees with behavioral health needs have a high prevalence of chronic conditions and are often frequent users of physical and behavioral health services. More and more states are pursuing managed care models that integrate behavioral and physical health services to enhance care coordination, improve outcomes, and control costs for this high-need population. As of January 2016, 16 states currently provide or are planning to offer behavioral health services through an integrated managed care benefit - up from just a handful a few years prior.

This brief, made possible by Kaiser Permanente Community Benefit, provides insights from Medicaid officials and health plan representatives in five states - Arizona, Florida, Kansas, New York, and Texas - that are integrating behavioral health services within a comprehensive managed care arrangement. It explores three emerging options for integration, including comprehensive managed care carve-in, specialty plans for individuals with serious mental illness, and hybrid models. Common strategies used by these states to facilitate integration include a focus on engaging key stakeholders, balancing oversight and collaboration in state-plan relationships, and advancing clinical integration and cross-system accountability.

A key takeaway from states profiled is the need to develop flexible integrated care approaches that leverage existing capacity and account for variations in managed care landscapes. Lessons from these five early innovators offer valuable guidance for other states pursuing similar initiatives.
DSRIP Year 1, Third Quarterly Results

The DSRIP Team recently announced that the Independent Assessor has completed its reviews of the Third Quarterly Reports of DSRIP Year 1, covering all PPS activity through December 31, 2015. Click here to access the Third Quarterly Report for each PPS.  Additionally, the  results of the Independent Assessor's reviews and the breakdown of performance payments earned for each PPS can be found in the Achievement Value (AV) Scorecards.

The AV Scorecards include a summary of the AVs earned by each PPS for the Third Quarterly Report and details for each project being implemented by the PPS. For PPS that have requested a reconsideration of the results of the Third Quarterly Report by the Independent Assessor, the AV Scorecard will be made available on the DSRIP website following the completion of the Independent Assessor's reconsideration.
The results of the Third Quarterly Report along with the results of the Fourth Quarterly Report, due to the Independent Assessor by April 30, 2016, will be used in the determination of the third payment the PPS may earn for DSRIP Year 1. PPS received their first payments of DSRIP Year 1 for the approval of the DSRIP Project Plan Application and PPS earned their second payment of DSRIP Year 1 following the Second Quarterly Report. 
January 2016 CMS Medicaid & CHIP Eligibility and Enrollment Report

According to CMS's monthly Medicaid/
CHIP eligibility and enrollment  report , 72.4 million individuals were enrolled in Medicaid and CHIP in January 2016. Nearly 121,958 additional individuals have enrolled in Medicaid and CHIP since December 2015. Click  here  for the report.

SAVE THE DATE:  Suicide Prevention Center of NYS Annual Conference & Awards
Click  here  for more information.


May 25, 12 - 1 pm
June 22, 12 - 1 pm

June 30, 12 - 1 pm

July 27, 12 - 1 pm
August 24, 12 - 1 pm
September 21, 12 - 1 pm
October 26, 12 - 1 pm

April 21, 1:30 - 2:30 pm, National Council for Behavioral Health

April 26, 1 - 2 pm,  American Academy of Addiction Psychiatry

April 27, 2 - 3:30 pm, SAMHSA-HRSA

May 4, 2:30 - 4 pm, SAMHSA-HRSA

May 12, 1 - 2 pm, National Council for Behavioral Health



MAY 2016
Spring Full Membership Meeting & CLMHD 40th Anniversary Dinner
May 2 - 3: The Desmond, Albany

Officers & Chairs - Call In
May 4:  8 am

Mental Hygiene Planning 
May 5:  11 am - 1 pm
GTM Only

Children & Families Committee
May 17:  11:30 am - 1 pm
GTM Only

OMH Agency Meeting
May 23:  10 am - 12 pm
44 Holland Ave., Albany

OASAS Agency Meeting
May 23:  1 - 3 pm
1450 Western Ave., Albany

CLMHD Mentoring Workshop
May 25:  10 am - 4 pm
DoubleTree by Hilton Hotel, Syracuse

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Planning Champion Playing Thru
Some of you will recall the bad old days when Local Services Planning required three different plans, three sets of rules and three different time frames.  Thanks to efforts by Jean Audet, Manager of the Planning Unit for the Office of Alcoholism and Substance Abuse Services, most of you only know the one annual Local Services Plan.  Jean built the County Planning System in 2006 to allow New York's 57 Local Governmental Units (LGUs) and the City of New York to complete and submit the annual Local Services Plan for mental hygiene services to the state directly via the Internet.   OMH and OPWDD followed OASAS's lead and today we have a single streamlined CPS. 
While we are sad to see Jean's departure, he has been a true champion for the LGUs and we will miss his tireless efforts to make planning make sense.  Best wishes to Jean and many thanks for all your advocacy on behalf of the LGUs.  Best wishes for moving on to greener fairways! 
NY Proposes Regulations for Psychiatry by Video Conference

New York authorities have proposed regulations for state-licensed psychiatry providers to treat clients via live video conference.  

Telepsychiatry can help deliver mental health care when patients can't be seen directly because of distance, timing or lack of clinicians nearby, the Office of Mental Health said last week.   According to the proposed regulations, email, faxes and phone calls aren't equivalent and wouldn't constitute reimbursable services under Medicaid.

Outpatient clinics operated or licensed by OMH can use telepsychiatry now. The agency also uses it in prisons.   The proposed regulations will be reissued in late April then subject to 45 days of public comment before the agency considers making them final.

"This is a regulatory action to reflect the desire of the public and providers to utilize this emerging technology to deliver mental health services to underserved and hard-to-reach areas," the agency said. Benefits can include improved access and more timely care, as well as better continuity, compliance and coordination, it said.

The regulations apply to licensed mental health professionals such as psychiatrists, nurse practitioners, psychologists, psychoanalysts, therapists, counselors, physicians, nurses, social workers and physician assistants.

Protocols would be required to maintain patient confidentiality and for psychiatric emergencies that may override those privacy rights.   Procedures for prescribing medications would have to be identified and follow existing regulations. It couldn't be used for ordering psychiatric medications, restraints or seclusion over patient objections.

6 Ways Health Care Organizations Can Improve the Value of Care Delivered To Patients

Over the past several years, there has been an increasing focus on improving the "value" of care delivered by the healthcare system. Among the strongest advocates for "value" have been my mentor Michael Porter and his collaborator Elizabeth Teisberg, who in their 2006 book  Redefining Health Care
powerfully defined value in healthcare as the ratio of clinical outcomes to the costs incurred to achieve them. U.S. Secretary of Health and Human Services Sylvia  Burwell
last year announced that a majority of healthcare payments in the Medicare and Medicaid programs will  transition  to value-based payments by 2018. And numerous health systems have reorganized with a goal of improving the value of care delivered.

But what does high value care look like in practice? When pressed, most health  system  analysts focus on improvements in quality of care or on reduction of wasteful spending. This system-level perspective can obscure much of the nuance of care delivery. What does value-based care look like to the doctors and nurses who deliver it? Or, more importantly, to the patients who receive it?

As more healthcare delivery systems begin to refocus on improving outcomes and reducing costs, six principles of what value-based care looks like in practice have emerged.

Common Sense Prevails
Most clinicians and patients frequently confront situations where the structure of healthcare financing gets in the way of delivering the most appropriate (and often cheaper) services. For example, a patient may be hospitalized at a cost of tens of thousands of dollars when a less intensive intervention-prescription medicine, a home visit, a remote monitoring device-would keep the patient out of the hospital and healthier.

In organizations focused on value, common sense often prevails. Rushika Fernandopulle of Iora Health, a rapidly expanding innovative primary care practice, tells the story of Mr. Edwin , a patient with kidney failure whose anxiety caused him to skip dialysis appointments. Routinely missing critical treatment landed him in the hospital 37 times in one year alone. After one of the physicians caring for Mr. Edwin learned that music calmed his anxiety, Iora purchased a $39 iPod Shuffle for him to use at the dialysis center. The experience of dialysis now less anxiety-inducing, Mr. Edwin kept his appointments more frequently, and spent more time out of the hospital.  Read more here .
EHRs May Be Inadequate in Capturing Mental Health Diagnosis, Study Finds

The diagnoses of 27.3 percent of patients with depression and 27.7 percent of patients with bipolar disorder were missing from their primary care electronic health records, a study published in the Journal of the American Medical Informatics Association has found.

These behavioral health patients had an average of three to eight visits during the year both at the EHR site and outside the site. But despite these high numbers, the data from the encounters were underreported.

In the study, researchers from the Department of Population Medicine at Harvard Medical School studied Harvard Pilgrim Health Care patients at Harvard Vanguard Medical Associates who in 2009, who had a depression or bipolar diagnosis. Researchers studied outpatient care visits and calculated the proportion of these visits not found in the EHR.

"In this research, we found the lack of integration, interoperability and exchange in US healthcare resulted in a major EHR missing roughly half of the clinical information," the authors wrote. "While behavioral healthcare is unique, it's important to emphasize our findings demonstrate the problem of incomplete clinical data in the EHR is not limited to behavioral care."
Read more
here .
New Obamacare Program May Make Medical Homes More Common

More than six years after the Affordable Care Act (ACA) was first signed into law, President Barack Obama last Monday announced plans to address what many had hoped the act would do all along: move the nation's health-care system away from a traditional fee-for-service model.

The newly announced Comprehensive Primary Care Plus program, which will be part of the ACA, will impact the way 20,000 doctors serve 25 million patients. The five-year program, which will launch in January 2017, will pay participating providers a fixed monthly fee, along with bonuses for meeting various health goals. Traditionally, those providers have been reimbursed based on the number of patient visits or procedures they log. That approach has long been lambasted by health-care experts as a big reason for rising costs.

The new move could incentivize states to adopt the "health-care home" model of care that's been shown not only to improve health outcomes but also to save billions of dollars. Despite the promising potential of that model, it hasn't been widely embraced by states.

One state that has become a model for health-care homes is Minnesota, which has saved more than $1 billion over the past five years by investing in that form of care, according to a study by the University of Minnesota earlier this year. These health-care homes embody precisely what advocates of a coordinated health-care system want: a one-stop shop for a patient to get all of her health needs met in as few visits as possible.

In 2008, before the Affordable Care Act had been introduced, then-Minnesota Gov. Tim Pawlenty formed a task force to study how to cut health-care costs across the board. The state had a maternal and child health-care coordination program, which parents had been happy with, so the state expanded that program to transform all primary care clinics into patient-centered health-care homes.

Eight years later, 54 percent of Minnesota's primary care clinics are certified health-care homes. Nationwide, only about 15 percent of primary care clinics are considered health-care homes.    Read more here .
This Simple Therapy Technique May Help Reduce Suicide Risk

Mental health treatment is nuanced and should be different for each individual. However, emerging research is finding that there are some  techniques that may work across the board  - and the latest discovery may be one of the most personal, yet simplest methods yet.

A recent paper published in the journal PLOS Medicine revealed that receiving a few specialized therapy sessions along with personal letters from a therapist could act as a mode of intervention for individuals at risk for suicide.

Researchers tested a technique called Attempted Suicide Short Intervention Program, on approximately 120 people who had recently been admitted to a hospital in Switzerland after an attempted suicide. 
Participants were placed in either a control group that received standard therapy, or the ASSIP group, which used therapy along with subsequent letters from their mental health professional.

The ASSIP group also went through three specialized sessions with their therapists that focused on particular topics. In the first meeting, patients recorded videos for their therapists, sharing their personal stories about what led them to self-harm. In the second meeting, the patient and therapist watched the recording together with an assignment to reflect on the incident after the session was over. In the last session, the patient and professional went over how to prevent suicide in the future and the patient formed long-term goals.  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.