moving the addictions treatment field forward dick dillon innovaision, llc st. louis, missouri...

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 63105aschut@ahinc.org dickd@innovaision.com