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Moving theAddictions Treatment Field
ForwardDick Dillon
Innovaision, LLCSt. Louis, Missouri
Arthur SchutArapahoe House, Inc
Colorado
39th Advanced International Winter SymposiumJanuary 2013
Moving Forward
• Advocating for addictions to be regarded as an illness
• Be careful about that for which you advocate• We have caught the car, now what?
• Significant changes include…
o Moving back into the medical system
o Some of us will be the substance-use illness specialty providers for the transformed system
o Think of your programs as oncology or orthopedic clinics
Moving Forward
• Significant changes include…
o Electronic Medical Records
o Health Information Exchanges
o Health status and health outcomes
o Blended treatment approaches
Moving Forward
• Enhance Handoffs to and from “the health system/primary care”
• Organize services around episodes and a full continuum of care, rather than discrete levels of care or locations
• Increase diversity of professional staff to address major co-occurring conditions and deliver adjunctive services
Challenges
• Experience vs. education - No longer a “real” separate choice
• Brief interventions and case management alone are treatment
• Treatment and safe, drug free housing
Challenges
• Credentialing with third party payers
• Coding services delivered – need to be correct to result in payment
• Electronic claims processing
Finance
• IT is part of the essential foundation for service delivery.
• Sophisticated does not have to be complicated.
• Develop business processes anticipating Electronic Health Record (EHR).
Information Technology
• Effective, timely information sharing between clinicians, systems of care, and different provider organizations.
• Single entry data (efficient & reduces errors)
• Customer friendly information collection (unduplicated is efficient)
Information Technology
• Integrated with physical location services
• Target is to ultimately provide patient electronic access integrated with all clinical services
e-Treatment
• Smart phone, text messages, access to part of client’s clinical record, etc.
• Online support tools which can be used with and separate from formal treatment
• Innovative approaches including wearable medical devices, avatar therapy, etc.
• Secure login where clients can interact with providers
e-Treatment
• Success stories are great but “a lot of stories is not data”
• Reliable & accurate data are more important than lots of data
• Benchmarking – where is the thermometer by which we compare our organization’s performance – what is normal?
Metrics
• Evidence-Based Practices (EBP) need to be implemented with reportable fidelity measurement
• Results driven service delivery – what does the customer want as deliverables? What job is your customer hiring you to do?
• Health outcomes
Metrics
• Who are our health system customers?
• Where can we add value in the places we “touch”?
• What do we do that creates value for primary care and health systems?
• Is there a thorn in the paw that we can remove?
Health Partnership Opportunities
• “Fast Forward” – skip ahead to primary care integration
• Connecting our specialty care clients to primary careo At admissiono Coordinate careo Before dischargeo Arrange for a primary care “home”
Improved Partnership with Primary Care
• Provide consultation to primary care health professionals (need immediate access)
• Brief patient consult - 15 to 20 minutes sessions
Improved Partnership with Primary Care
• Intervening to help patients participate in the management of their illness to shorten hospital stays and improve health
• Partner around shared challenges – healthy babies, outreach, over-utilization, disruptive behavior, prescription medication addiction (pain management challenges), chronic illness management, improved health outcomes
Health Partnership Opportunities
• We are experts at dealing with difficult to reach patients
• We are experts at engaging patients that are seen as disruptive in other systems
• We are experts at de-escalation
• We have affection and tolerance for people who are addicted, when they are not at their best
Strengths = New and Diverse Opportunities
• We know how to manage a complex illness over a lifetime. We know recovery
• We understand what’s going on with the family in relation to the illness
• We understand how a range of external systems impact and can support a patient and family e.g., child welfare, employment, law enforcement, corrections, etc
Strengths = New and Diverse Opportunities
Resources
National Quality Forum
http://www.qualityforum.org/National Quality Forum (2007). National Voluntary Consensus Standards for
the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum.
http://www.qualityforum.org/Publications/2007/09/National_Voluntary_Consensus_Standards_for_the_Treatment_of_Substance_Use_Conditions__Evidence-Based_Treatment_Practices.aspx http://www.qualityforum.org/Publications/2005/10/Evidence-Based_Treatment_Practices_for_Substance_Use_Disorders.aspx
• NIATx – Network for the Improvement of Addiction Treatmentwww.NIATx.org
• NREPP – National Registry of Evidence-based Programs and Practiceshttp://www.nrepp.samhsa.gov/
• CSAT Inventory of Effective Substance Abuse Treatment Practiceshttp://csat.samhsa.gov/treatment.aspx
• Dennis McCarty The Realities of Evidence-Based Practices for Addiction Treatment
http://www.attcnetwork.org/find/news/attcnews/epubs/v1i2_article04.asp
Institute of Medicine of the National AcademiesImproving the Quality of Health Care for Mental and Substance-Use
Conditions: Quality Chasm Serieshttp://www.iom.eduInstitute of Medicine (2001). Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, DC: National Academy Press.Institute of Medicine (2006). Improving the Quality of Health Care for
Mental and Substance-Use Disorders: Quality Chasm Series. Washington, DC: National Academy Press.
http://www.iom.edu/Reports/2005/Improving-the-Quality-of-Health-Care-for-Mental-and-Substance-Use-Conditions-Quality-Chasm-Series.aspx
• Bridging the Gap Between Practice and Researchhttp://www.iom.eduInstitute of Medicine (1998). Bridging the Gap Between Practice and
Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: National
http://www.iom.edu/Reports/2003/Bridging-the-Gap-Between-Practice-and-Research-Forging-Partnerships-with-Community-Based-Drug-and-Alcohol-Treatment.aspx
Contact Info
Arthur Schut Dick DillonArapahoe House Innovaision, LLC8801 Lipan Street 7558 York DriveThornton, CO 80260 St. Louis, MO [email protected] [email protected]
