1. Outpatient Behavioral Health Summit Pennsylvania Community Providers Association December 2009 Dale Jarvis, CPA Bea Dixon, PhD MCPP Healthcare Consulting Inc. Seattle, Washington

2. 2 Movie: Summit Planning

3. Healthcare Reform and the Integration of Primary Care and Behavioral Health Dale Jarvis 3

4. Health Reform: Implications for the Healthcare and Community Behavioral Healthcare Systems Healthcare Reform Legislation will result in the remaking of the public behavioral healthcare system 4

5. The Behavioral Health “Tipping Point” My Hypothesis: –We have finally reached the tipping point in understanding the importance of treating the healthcare needs of persons with serious mental illness and the behavioral healthcare needs of all Americans –Behavioral healthcare has become very important to managing Total Health Expenditures in the U.S. and bending the cost curve –This will drive widespread integration of Primary Care and Behavioral Health in the form of the Person-Centered Healthcare Home and will create greater demand for mental health and substance use treatment services –These changes will bring enormous opportunities and challenges to the Community Behavioral Healthcare system, which will need to demonstrate that it can provide evidence-based, high quality care that produces outcomes and manages total health expenditures 5

6. Movie: Canadian Police Chase 6

7. The Overall Design for Healthcare Reform U.S. health care reform legislation has been designed to address three issues 7

8. The Overall Design for Healthcare Reform The Path to a High Performance U.S. Health System – A 2020 Vision of the Policies to Pave the Way identified 10 Health Care Reform Policies that can save $3 trillion over 10 years ( Commonwealth Fund 2009) 8

9. Person-Centered Healthcare Homes 45 percent of Americans have one or more chronic conditions. Over half of these people receive their care from 3 or more physicians. Treating these conditions account for 75% of direct medical care in the U.S. Person-Centered Healthcare Homes is a key strategy

10. Person-Centered Healthcare Homes Healthcare Home Principles Ongoing Relationship with a PCP Care Team who collectively take responsibility for ongoing care Provides all healthcare or makes Appropriate Referrals Care is Coordinated and/or Integrated Quality and Safety are hallmarks Enhanced Access to care is available Payment appropriately recognizes the Added Value

11. Person-Centered Healthcare Homes It’s all about Improving Quality and managing Total Healthcare Expenditures ! 11

12. Person-Centered Healthcare Homes The Group Health Cooperative Experience 2002-2006: increase in patient access but also increase in provider burn-out 2007: healthcare home pilot for 12 months with 30 minute visits and: –15% more docs and 44% more mid-levels –17% more RNs and 18% more MAs/LPNs –72% more pharmacists 12

13. The Behavioral Healthcare Landscape The Safety Net Behavioral Healthcare System faces even greater challenges – Life expectancy of US: 78 years (purple) – Life expectancy of US SMI: 53 years – Life Expectancy of Sub-Sahara Africa: 50-55 (orange) 13

14. NASMHPD Morbidity and Mortality Report

15. Morbidity of Persons with Mental Health Disorders One behavioral health condition doubles medical expenditures, emergency room visits and hospital admissions for Medicaid enrollees 49% of Medicaid beneficiaries with disabilities have a psychiatric illness (this is new information ; previous studies that excluded pharmacy claims calculated the rate at 29%) 15 The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions Center for Health Care Strategies, Inc., October 2009

16. Reform Impact: More Consumers with Coverage 31% to 43% increase in Medicaid enrollees, depending on the bill Large reduction in uninsured (54% to 67%) 16

17. Reform Impact: More MH/SU Consumers with Coverage There are approximately 17 million Americans with Medicaid Coverage or are Indigent and Uninsured needing mental health services in a year; 54% (9 million) have Medicaid coverage Under the Senate Finance Committee Bill, at least 2/3 of the uncovered would likely shift into Medicaid or an Exchange, raising the coverage level to 84% 17

18. The Role of CBHOs in a Reformed Environment Community Behavioral Healthcare Organizations (CBHOs) have two important roles in a reformed health care environment that addresses the needs of persons with serious MH/SU disorders: 1) Serving as an integral part of Medical Homes and 2) Providing Specialty Behavioral Healthcare Services. 18

19. Clinical: Person-Centered Healthcare Homes 19

20. Movie: Don’t Get Misled Page 20

21. Questions or Comments?