1. Quality and Behavioral Health Linda C. Degutis, DrPH, MSN National Center for injury Prevention and Control, Centers for Disease Control and Prevention Abraham Wandersman University of South Carolina

2. Integrating Quality into Behavioral Health Care: A Public Health Perspective Scaccia, Castellow, & Wandersman (2012)

3. Overview Impact of behavioral health disorders on public health Use of 9 Quality Aims to structure quality in service delivery and support Framework for determining scope of analysis (continuum of care and levels) Possible next steps

4. Importance of Behavioral Health to Public Health Behavioral health disorders are linked to poorer physical health – Significant social cost (Table 1) Research-practice gap Implementation problems Insufficient accountability mechanisms

5. Table 1: Example Estimates of Cost of Behavioral Health Disorders IssueCost annually (in US Dollars)Source Direct Treatment Cost~148 Billion (2.5% of GNP) World Health Organization, 2003 Illicit Drug Use (crime, health, productivity 193 Billion National Drug Intelligence Center, (NDIC), 2011 Alcohol Use (crime, health, productivity) 185 Billion National Institute on Drug Abuse (NIDA), 2008 Total Cost (MH)* 300 Billion National Institute of Mental Illness, 2002 Total Cost (Substance Abuse)* 600 Billion NIDA, 2008

6. Nine Quality Aims in Behavioral Health 6 Process: Proactive Vigilant Transparent Efficient Outcomes: Equitable Risk-Reducing Health- Promoting Population-Centered Effective Positive Behavioral Health Outcomes

7. Continuum of Care & Levels Promoti on PreventionTreatmentRecovery Maintena nce National State Community (System of Care) Population Centered Effective Process Proactive Vigilant Transparent Efficient Outcomes Equitable Risk-Reducing Health- Promoting Organization Provider/ Consumer 7

8. Prescription Drug Overdose PromotionPreventionTreatmentRecovery Maintenance National Public awareness PRRInsurance ParityMonitor impact/ outcomes State Public awareness PDMPInsurance ParityMonitor outcomes Community (System of Care) Integration with physical health care Screening Risk identification Integration with physical health care Organization Prescribing guidelines Drug disposalMonitor outcomes Provider/ Consumer Prescription drug take-back 8

9. Suicide Prevention PromotionPreventionTreatmentRecovery Maintenance National Awareness Destigmatization National Action Plan Insurance parityMonitor outcomes State AwarenessDataInsurance parityMonitor outcomes Community (System of Care) Multi-sector collaboration Destigmatization Integration with physical health Screening, Risk identification Access to treatmentRe-entry services Organization GuidelinesBest practices, guidelines Quality monitoring Monitor outcomes Provider/ Consumer 9

10. Treatment Parity PromotionPreventionTreatmentRecovery Maintenance National outcomesAccess and coverage State outcomesAccess and coverage Community (System of Care) Integration of behavioral health and physical health Risk identification and reduction Organization Data Provider/ Consumer 10

11. Possible Future Steps Develop indicators for each aim Accountability process – Indicators  activities  outcomes Consider potential linkages with ACOs and quality measures Evaluation ideas

12. From Indicators to Outcomes with Getting To Outcomes A Results-Based Approach to Accountability in Planning, Implementation, and Evaluation Indicators for the Nine Quality Aims Needs and Resources (Step 1) Goals (Step 2) Best Practices (Step 3) Fit (Step 4) Capacities (Step 5) Plan (Step 6) Implementation (Step 7) Outcomes (Step 8) CQI (Step 9) Sustainability (Step 10)

13. Thank you