1 Florida Alcohol and Drug Abuse Association Presented to the Behavioral Health Quarterly Meeting Pensacola, Florida April 23, 2014
2 Florida Alcohol and Drug Abuse Association Founded in 1981 Currently has 67 behavioral health care organizations as Members Members are in all parts of Florida from Key West to Pensacola
3 Services Provided by FADAA Members include: Outreach and Intervention Prevention and Wellness Residential Detoxification Addiction Receiving Facilities Residential Treatment Special residential and outpatient services to Pregnant and Parenting Women
4 Outpatient Services: Individual and Group Therapy Day Treatment Intensive Outpatient Program Case Management In-Home Services Aftercare and Recovery Support Supported Employment/Housing Support
5 Special Populations: Drug Courts Department of Corrections Child Welfare Veterans Elderly HIV
6 Treatment is effective: Overall treatment of addiction is as successful as treatment of other chronic diseases Rapid entry into treatment generates better longterm recovery outcomes Evidence-based practices enhance treatment outcomes
7 Managed Medical Assistance presents a major change for Providers. Substance Abuse will be included in Medicaid managed care for the first time. Some providers have limited experience in billing Medicaid for services. Concern about enrollment in the networks, what services will be covered, how prior authorization will operate, etc.
8 Managed Medical Assistance also presents opportunities for the integration of behavioral and primary care. Substance use disorders have high levels of comorbidity with other medical problems. Direct effects of consumption of the substance and the toxicity of possible contaminants impact health.
9 Indirect effects of substance use disorders related to associated lifestyles, such as infectious diseases, trauma, nutritional deficiencies, and consequences of intoxication impact health status. Many persons with substance use disorders experienced trauma as a child or young adult.
10 Examples of multiple medical issues: Cardiovascular conditions Gastritis or other GI complications Liver Disease Diabetes Neuropathy Pancreatitis Anemia Coronary Artery Disease Hypertension HIV
11 Substance Use Disorders impact on cost: In the southern region of the U. S., 393 acute care inpatient stays per 100,000 were for substance use disorders, and Medicaid paid 36.5% of the costs. Patients with severe mental or substance use disorders have higher rates of admission to emergency rooms; patients with co-occurring behavioral health disorders have rates of admission that are twice the rate of patients with other chronic conditions.
12 Substance Abuse Treatment can reduce health care costs: John Hopkins Healthcare reported a return on investment of $3.65 per $1 spent on substance abuse intervention. Several studies have shown that substance abuse treatment reduces overall health care costs for chronic patients ranging from $133 to $380 per month.
13 Opportunities for Integration of Behavioral and Physical Health Care Increase adult screening and use of practices such as Screening, Brief Intervention, Referral and Treatment. Improve screening and referrals with pregnant women and women of child bearing age. Implement models on integration with physical health care in primary and obstetrics/gynecology, hospitals, community health centers, and community behavioral health centers.
14 Opportunities for Integration (continued) Coordinate care at the service delivery level for persons with substance use disorders Use shared clinical protocols and levels of care, such as the ASAM, to improve coordination. Use electronic health records and linkages.
15 Challenges presented in the Child Welfare field: Children in Child Welfare are primarily Medicaid eligible Many of the children s parents mostly mothers are Medicaid eligible.
16 Disturbing Reports on Child Deaths Associated with Parental Substance Abuse. National Research shows that 60% to 80% of substantiated child abuse and neglect cases involve substance abuse. November 2013 Casey Family Program Report stated that very few of the parents received substance abuse treatment. The Miami Herald Series, Innocents Lost, showed that of 477 child deaths, 323 were related to parent substance use disorders.
17 Comprehensive, intensive, and appropriate substance abuse services must be immediately available to families. Services need to be: Family Based Gender Specific Provided immediately at the appropriate level of care and intensity Integrated with the treatment of other family members Coordinated with parental education and child care Case Management should be available to all families.
18 Managed Medical Assistance Health Plans are part of the solution for parental substance use disorders. Establish linkages with the Department of Children and Families and the local Community Based Care Lead Agency to ensure that the health plan is aware when a parent has a Dependency Case Plan and what the needed services are. Immediate access to appropriate treatment and recovery support Case coordination with the Community Based Care Lead to ensure integration of family services and uniform approach to case plan implementation.
19 Future Opportunities Substance abuse providers as integral part of provider networks. Adopt targeted adult screening for substance use disorders and referral mechanisms in primary care and other medical settings. Establish linkages from primary care to behavioral health care providers. Implement models for integration of behavioral and primary health care. Implement care coordination programs. Work together to make children safer in Florida.
20 Thank You! Mark Fontaine Executive Director Celeste Putnam Director of Behavioral Health
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