1. Advancing Recovery Payer-Level System Improvements Baltimore Substance Abuse Systems October 2, 2008 Bonnie Campbell, LCSW bcampbell@bsasinc.org 410-637-1900 ext. 252

2. Advancing Recovery - Baltimore System-Level Aims Increase buprenorphine slots Increase buprenorphine slots Increase # and type of continuing care physicians Increase # and type of continuing care physicians Increase patients staying in continuing care for six months Increase patients staying in continuing care for six months Improve timeliness/efficiency of BSAS approval of provider budget modifications Improve timeliness/efficiency of BSAS approval of provider budget modifications

3. IMPACT OF AR SYSTEM – LEVEL CHANGE PROCESSES Increased buprenorphine slots - 181% Increased buprenorphine slots - 181% (new state grant and re-direction of existing funds) Increased continuing care physicians - 28% Increased continuing care physicians - 28% Increased patients in 6-mos continuing care-100% Increased patients in 6-mos continuing care-100% BSAS organizational improvements BSAS organizational improvements Created staff teams for contracts & budget approvals Created staff teams for contracts & budget approvals Created agency-wide CQI process Created agency-wide CQI process Increased provider involvement in developing BSAS policies and procedures Increased provider involvement in developing BSAS policies and procedures

4. Increased Buprenorphine Slots 181%

5. Increased Continuing Care Physicians - 28%

6. Increased patients in continuing care for 6 months - 100%

7. BSAS Change Process - Improved Approval of Provider Budget Modifications Formed Change Team Formed Change Team Change Leader/Facilitator Change Leader/Facilitator ADAA-Regional Manager, Grants Section Chief ADAA-Regional Manager, Grants Section Chief BSAS-President, Chief of Administration, Finance Director, Grants Accounting Supervisor, Grants Accountant, Chief of Program Operations, Health Program Analyst, Management Information Systems Director BSAS-President, Chief of Administration, Finance Director, Grants Accounting Supervisor, Grants Accountant, Chief of Program Operations, Health Program Analyst, Management Information Systems Director Treatment Providers - 2 Treatment Providers - 2

8. Improvement Process Reviewed data on budget modifications in FY07 (n=32) Reviewed data on budget modifications in FY07 (n=32) Time required for approval (average of 49 days) Time required for approval (average of 49 days) Progression of approvals (50% approved “out of order”) Progression of approvals (50% approved “out of order”) Were actual practices consistent with current policy & procedures (NO) Were actual practices consistent with current policy & procedures (NO) Flowcharted current actual practices Flowcharted current actual practices Identified problem areas Identified problem areas Duplication of effort among staff & providers Duplication of effort among staff & providers Lack of clarity on procedures among staff & providers Lack of clarity on procedures among staff & providers Program Analyst review occurred too late in the process Program Analyst review occurred too late in the process Identified improvements Identified improvements Reduced time of approval from 49 days to 30 days Reduced time of approval from 49 days to 30 days Created Routing Slip to facilitate staff approvals Created Routing Slip to facilitate staff approvals Created new Policy & Procedures and Provider Instructions Created new Policy & Procedures and Provider Instructions

9. Budget Modification - Next Steps Use new process for 2-3 actual cases Use new process for 2-3 actual cases Consider further improvements as needed Consider further improvements as needed Consider more efficient communication methods between provider, grants accountant, and health program analyst Consider more efficient communication methods between provider, grants accountant, and health program analyst Once procedures are finalized, train all BSAS staff & issue revised provider instructions Once procedures are finalized, train all BSAS staff & issue revised provider instructions Include budget modification instructions in award packets sent to all providers Include budget modification instructions in award packets sent to all providers