Carol Coussons de Reyes Administrator of the Office of Consumer Affairs

CAROL COUSSONS DE REYESADMINISTRATOR OF THE OFFICE OF CONSUMER AFFAIRS

DIVISION OF BEHAVIORAL HEALTH: DHHS NEBRASKA

COPRESENTER: LISA ALEXANDER CONSUMER ADVOCATE

Health Care Changes & the Average Nebraska Utilizing Behavioral Health Services:

What the OCA learned at Alternatives 2010:

Understanding & Opportunity to be Heard~

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

Who are the major voices in healthcare changes?

YouSAMHSAHHSLegislators

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

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.

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.

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)

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/

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 ofConsumer Affairs & Public Health:

DHHS Nebraska

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

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) 

SPEAKERS ON HEALTHCARE CHANGES

Shawn TerrellHealth Insurance Specialist: Office of Disability:

HHS

John ObrienHealthcare Reform Specialist: SAMHSA

Barbara Coulter Edwards: Director inThe Disabled and Elderly Health Programs

Group in the Center for Medicaid

HHS Website: Healthcare.gov

What is HEALTHCARE.GOV?

-A website with updates on healthcare insurance changes.

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)

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

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.

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

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

Where is Peer Services?

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

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 psychiatric

disabilities now constitute the largest and most rapidly expanding

subgroup of program beneficiaries.”(Drake, Skinner, Bond, & Goldman, 2009)

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?

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

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)

What is National HHS thinking?

Expand programs that assess & improve quality of care.Promote better practice coordination & medical homesTest Innovations & expand what worksPromote Electronic Healthcare RecordsPrevention & Elimination of Healthcare Associated

ConditionsFoster collaborations: Federal/State/Private

(Extracted from paper available on the internet at:http://www.hhs.gov/news/reports/quality/nhcqsap.html)

National Quality Strategy

Public/Private Partnerships for consistent, high quality, safe, affordable care

Sample Initiatives: Institute of Medicines: Crossing the Chasm of Quality FrameworkNational Priority Partnership’s “National Priorities & Goals”HHS Healthy People 2020AHRQ National Healthcare Quality Report & National Healthcare Disparities

ReportWhite House Let’s Move Initiative (Extracted from paper available on the internet at:http://www.hhs.gov/news/reports/quality/nhcqsap.html)

Principles Guiding the National Quality Strategy

Person Centered & Family EngagementStrategies address all ages, populations, service

locations, and sources of coverageEliminating health disparitiesDesign 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)

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)

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)

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)

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)

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)

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?

Places to Answer these US HHS Questions by

October 15, 2010:

Online:http://www.hhs.gov/news/reports/quality/nhcqsap.html

• In writing: Nancy WilsonRoom 3216 540 Gaither Road Rockville, MD 20850

• By fax:Agency for Healthcare Research & QualityAttention: Nancy Wilson301-427-1210(Extracted from paper available on the internet at:http://www.hhs.gov/news/reports/quality/nhcqsap.html)

Websites on Healthcare ChangesNational Health Care Quality Strategy & Plan: Online Form for Feedbackhttp://www.hhs.gov/news/reports/quality/nhcqsap.html

HealthCare.Govhttp://www.healthcare.gov/HealthCare.Gov in Spanishhttp://www.cuidadodesalud.gov/enes/

SAMSHA Strategic Initiatives:http://www.samhsa.gov/about/strategy.aspxOnline Form for Feedback on Strategic Initiativeshttp://feedback.samhsa.gov/forums/77283-samhsa-s-strategic-initiatives

10 x 10 Wellness Campaign: SAMHSAhttp://www.promoteacceptance.samhsa.gov/archtelPDF/Mental_Illness_Awareness_Week_Guide.pdf

Kaiser Foundation Reform Sitehttp://healthreform.kff.org/

US Dept of Health and Human Serviceshttp://www.hhs.gov/

National Council for Community Behavioral Health bloghttp://mentalhealthcarereform.org/

Campaign for Mental Health Reform (17 Organizations)http://www.mhreform.org/