2 Integrating Primary and Behavioral Health Care Filipino American Cardiovascular Health Summit July 9, 2011 Trina Dutta, MPP, MPH HHS/Substance Abuse and Mental Health Services Administration

33 What does the data tell us? Of those young adults who had an STD in the past year 3.9% used both alcohol and illicit drugs, 3.1% were heavy drinkers (drank 5 or more drinks on the same occasion on 5 or more days in the past month), 2.1% used only alcohol but no illicit drugs, 2.1% used only illicit drugs but no alcohol, 1.3% did not use alcohol or illicit drugs Cocaine use is associated with myocardial infarction, acute myocardial ischemia, arrhythmias, sudden death, and cardiomyopathy (all exacerbated by alcohol use) Amphetamine use causes many of the same cardiac problems as cocaine Cardiomyopathy and arrhythmias can be caused by alcohol abuse alone Injection drug use leads to endocarditis (inflammation of the inside lining of the heart chambers and heart valves) Hospitalizations for endocarditis relating to injection drug use increased by 38-66% in the US between and

44 What does the data tell us? 70% of Maine’s population with SMI has 1 chronic health condition, 45% have 2, and 30% have >3 (among the general population, 1/5 Americans have multiple chronic conditions) MA Department of Mental Health (DMH): among persons 25 to 44, CVD mortality was 6.6x higher among DMH clients than the general population CVD was the primary cause of death in persons with mental illness (MO, OK, RI, TX, UT, VA: average data from ) Rates of smoking

55 What does the data tell us? Nearly 12M visits made to hospital EDs in 2007 involved people with a mental disorder, substance abuse problem, or both (accounts for 1/8 of the 95M visits to EDs by adults in 2007) Of these visits, 2/3 involved those with a mental disorder, 1/4 was for those with a substance abuse problem, and the rest involved those dealing with both Of the 12M ED visits: Depression and other mood disorders accounted for 43% of the visits; 26% were for anxiety disorders; 23% involved alcohol-related problems Mental health and/or substance abuse-related visits were 2½ times more likely to result in hospital admission than visits not involving these 41% of mental disorder and/or substance abuse-related visits resulted in hospitalization Medicare was billed for 30% of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26%; the uninsured for 21%; and Medicaid for 20%

66 Percentages of Asians Aged 12 or Older Reporting Past Month Cigarette Use: Source: SAMHSA, 2002, 2003, and 2004 NSDUHs.

77 Treatment Admissions, by Race and Primary Substance of Abuse: 2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

88 Percentages of Asian Youths Aged 12 to 17 Reporting Past Year Alcohol Use, by Racial/Ethnic Subgroups: Annual Averages Based on 1999 and 2000 NHSDAs

99 Percentages of Asian Youths Aged 12 to 17 Reporting "Binge" Alcohol Use, by Racial/Ethnic Subgroups: Annual Averages Based on 1999 and 2000 NHSDAs

10 Why is integration important?

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13 Technical Assistance Center: SAMHSA/HRSA Center for Integrated Health Solutions (CIHS) In partnership with HHS/Health Resources and Services Administration (HRSA) Goal: To promote the planning and development of integrated primary and behavioral health care for those with SMI, addiction disorders and/or individuals with SMI and a co-occurring substance use disorder, whether seen in specialty mental health or primary care safety net provider settings across the country Purpose: –To serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development

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15 Affordable Care Act, Section 2703 “State Option to Provide Health Homes for Enrollees with Chronic Conditions”* Goal: enhanced integration and coordination of primary, acute, behavioral health (mental health and substance use), and long-term services and supports for persons across the lifespan with chronic illness The health home provision provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for State Medicaid programs *Led by Centers for Medicaid and Medicare (CMS), in partnership with SAMHSA, ASPE, HRSA, and AHRQ

16 Affordable Care Act, Section 2703 Population Served Eligible individuals are those with chronic conditions, meaning an individual who is eligible for medical assistance under the State plan or under a waiver of such plan and has at least –2 chronic conditions; or –1 chronic condition and is at risk of having a second chronic condition; or –1 serious and persistent mental health condition Chronic conditions must include: –A mental health condition –A substance use disorder –Asthma –Diabetes –Heart disease –Being overweight, as evidenced by having a BMI >25

17 Required Services Comprehensive care management; Care coordination and health promotion; Comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; Patient and family support (including authorized representatives); Referral to community and social support services, if relevant; and Use of health information technology to link services, as feasible and appropriate. Affordable Care Act, Section 2703

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19 Substance Abuse Treatment Facility Locator Services Provided: –Substance abuse treatment –DetoxificationMethadone maintenance (facility may also use buprenorphine in maintenance) –Methadone detoxification (facility may also use buprenorphine in detoxification) –Halfway house –Buprenorphine services Type of Care: –Outpatient –Partial hospitalization/Day treatment –Residential short-term treatment (30 days or less) –Residential long-term treatment (more than 30 days) –Hospital inpatient Special Language Services: –ASL or other assistance for hearing impaired –American Indian and Alaska Native languages –Spanish –Foreign languages other than Spanish

20 Special Programs/Groups: –Adolescents –Persons with co-occurring mental and substance abuse disorders –Persons with HIV/AIDS –Gays and lesbians –Seniors/older adults –Pregnant/postpartum women –Women/Men –Residential beds for clients' children –DUI/DWI offenders –Criminal justice clients Forms of Payment Accepted: (NOTE: Check with facility for details. Applicability varies according to individual circumstances.) –Medicaid –State financed insurance (other than Medicaid) –Medicare –Private health insurance –Military insurance (e.g., VA, TRICARE) –Self payment –Access to Recovery (ATR) voucher Payment Assistance: (NOTE: Check with facility for details. Applicability varies according to individual circumstances.) –Sliding fee scale (fee based on income and other factors.) –Payment assistance (Check with facility for details) Substance Abuse Treatment Facility Locator

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23 Thank you! Trina Dutta, MPP, MPH