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March 23, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

Keeping Score: How New York Can Encourage Value-Based Health Care Competition

In standard economic theory, competitive markets are thought to produce the optimal allocation of resources through their use of pricing signals; but U.S. hospitals have long argued that competition is antithetical to their successful operation, given the unique characteristics of hospital markets, which include natural barriers to entry and hospitals' safety-net and medical-teaching roles.

This paper examines these core questions of competition in hospital markets as they relate to New York State, particularly in light of the state's ongoing Medicaid-reform efforts: it explores the implications of hospital consolidation in the Empire State for public payers, commercial payers, and patients-in terms of outcomes and costs.

  • Hospital mergers typically result in higher prices, with little improvement in quality; these results are most pronounced in markets that have already experienced a significant degree of hospital consolidation.
  • Proponents of greater hospital size tend to ignore the fact that many of the documented benefits derived from hospital mergers are tied to managerial quality, not to size.
  • Antitrust litigation-because it is infrequently used and does not address existing factors that limit competition in hospital markets-should be only one of several tools deployed by regulators.
Click here to read the full report.
2016 VBP Roadmap for Public Comment

The annual update to the 2016 Value Based Payment (VBP) Roadmap has been posted to the DSRIP website in draft form for public comment through April 18, 2016.  The Roadmap has been developed with the input of the Value Based Payment Workgroup and other stakeholders and updated based on the broad stakeholder engagement from a number of workgroups and subcommittees.  Public comments should be submitted
by 3:00 PM on April 18, 2016. The roadmap can be accessed here.

SAMHSA Advisory:  Using Buprenorphine for Opioid Use Disorder
SAMHSA has released a 
about medication-assisted treatment for opioid use disorders. The advisory reviews information on the use of buprenorphine as a treatment.  It includes information on new formulations of buprenorphine, its effectiveness and safety, contraindications and cautions (including medication interactions), treatment monitoring, and indications of misuse.

With Advanced Training, Peers Gain Credibility

A quiet revolution is taking place across the country that we may all want to be paying attention to: The emergence of advanced training for peers who have joined the behavioral health workforce. I'm going to use a broad brush to paint a context for this development, and then we'll take a deep dive into one project so we can learn how the moving parts fit together. Perhaps the most interesting questions is not "How is this happening" but rather, "Why is this happening?"

The recovery movement in behavioral health began to occur in force in the late 1990s, and on its heels came the emergence of the peer movement. Adding a peer to a program's workforce soon became a symbol of a program's willingness to take the recovery movement seriously. As a new profession, Peer Support Specialists-as they were initially regarded-faced many challenges, not the least of which were existing professionals that were confused by their presence.

As long as peers worked in peer-run organizations, their existence went unheeded by mainstream mental health programs. However, when peers began to be added to treatment teams, crisis programs, residential programs and hospitals, the resistance to their presence escalated exponentially.  Read more here.

March 29, 3 - 4 pm, SAMHSA-HRSA

March 30, 1 - 2 pm, Health Management Associates.

March 31, 1:30 - 2:30 pm, National Council for Behavioral Health

Implementing Recovery-oriented Practices: Assessing strengths and priorities
April 5, 12:30 - 1:30 pm, SAMHSA-HRSA

April 6, 3:30 - 5 pm, CMS & Truven Health
For more information on High Intensity Learning Collaborative (HILC) click here.



MARCH 2016
Developmental Disabilities Meeting
March 30:  11 am - 12 pm
GTM Only

APRIL 2016
Officers & Chairs - Call In
April 6:  8 am

Mental Hygiene Planning 
April 7:  11 am - 2 pm
GTM Only

Children & Families Committee

Director's Meeting 
April 19:  9:30 am - 11 am
GTM Only

Executive Committee 
April 19:  11 am - 12:30 pm
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Governor Cuomo Announces $6.8 Million to Expand Mental Health Services for Children

GovernorAndrew M. Cuomo last week announced $6.8 million in available funds to implement the Healthy Steps for Young Children program in 19 sites throughout New York State. This program, offered by the New York State Office of Mental Health, will fund the integration of a child and family development professional into pediatric and family medicine doctors' offices, to help identify, monitor and treat emerging behavioral and developmental health concerns in young children. 

"Early intervention can save lives, and with this funding, we are helping more children battling mental illness get on the path towards recovery," Governor Cuomo said. "This program will reach our youngest New Yorkers so that they have access to the services and support that they need for success later in life." 

These embedded child and family development professionals, known as Healthy Steps Specialists, will work with children from birth to age 5 to detect and monitor emerging behavioral and developmental issues, educate families about child development, help them implement healthy parenting practices, and link children and families to behavioral or developmental specialists when needed. In tandem with pediatricians and family medicine providers, this program will engage both the child and family during routine early-life doctor visits and provide screening services for the entire family, including screenings for maternal depression, developmental delays, and childhood traumas that often lead to emotional or chronic medical problems later in life. These enhanced early-life visits will offer an opportunity for families to find support in an accessible and non-stigmatizing environment. Read more here.
New York County Health Rankings Released

The 2016 County Health Rankings Report, which uses national data on more than 30 health measures, was released last Wednesday by the Robert Wood Johnson Foundation and the University of Wisconsin's Population Health Institute.

Health outcomes and health factors do not get combined into one score. Outcomes tend to reflect a reality at the time data is collected. Factors tend to reflect areas that could be affected by policy and include rates of smoking; physical inactivity; excessive drinking; access to medical care; crime, income and poverty; and air and water quality, housing problems and commute time.

Outcome measures were affected by the rate of residents reporting the number of days they felt in poor mental or physical health, and the rate of people reporting overall poor or fair health. Resident reports were greater than those in the top 10 percent of counties nationwide and slightly more than the New York average.

According to the new rankings, the five healthiest counties in New York are, in order, Saratoga, Nassau, Rockland, Putnam and Westchester.  Click here to read the full report.
New York Set to Require Electronic Prescriptions

In an effort to cut back on prescription drug errors and misuse, providers in the state of New York will be required to issue prescriptions electronically. New York is the first state to require electronic prescribing at the risk of penalty.

The law comes into effect later this month, amid multiple current efforts to combat and prevent opioid addiction issues, including new prescriber guidelines from the Centers for Disease Control, policy changes at the U.S. Food and Drug Administration and a Senate-passed bipartisan bill creating state grant programs.

The date for implementation of the New York law had to be pushed back because of software concerns. Minnesota has had the same requirement since 2011 but does not currently have any enforcement mechanism.

New York's law, called I-Stop, also mandates that providers check prescription monitoring programs before giving patients new prescriptions. That went into effect in 2013.  Read more here.
Output to Outcomes: A Comprehensive Outcomes Measures Database Designed Specifically for Behavioral Health Providers

Join MCTAC for a web-based tutorial on
Output to Outcomes: a comprehensive outcomes measures database designed specifically for behavioral health providers! 
Register now for this brief overview webinar on Tuesday, March 29th from 11-11:30 am

In the changing healthcare landscape, measuring outcomes is becoming increasingly vital to navigate system wide changes that emphasize value and quality of care. In order to help providers with this shift, the McSilver Institute for Poverty Policy and Research in partnership with the Community Technical Assistance Center of New York (CTAC) developed this database with generous support from the New York State Health Foundation.

Learn more about the assessment measures database during this webinar, which will include:
  • An in-depth tutorial of the site's functionality and features
  • An overview of the 365 measures available for diagnosing and monitoring a vast array of physical and behavioral health conditions
  • Guidance on how this resource connects to better understanding the populations you serve
  • An introduction to value-based and outcomes driven practice
All interested providers are encouraged to visit and register for Output to Outcomes ahead of the webinar. 
New Massachusetts Law Limits Opioid Prescribing to 7 day Supply

Calling it the most comprehensive state measure to date in combating the opioid addiction and overdose crisis, Massachusetts Gov. Charlie Baker this week signed legislation that in its final form reflected the art of the compromise. The new law now mandates substance abuse evaluation after overdose and limits initial prescriptions of opioids to seven-day supplies.

The governor received less than he originally sought, but a leader in the state's addiction treatment community says Baker largely succeeded in beginning to change the conversation about opioid prescribing and its consequences for some.

"The governor had said that his proposals were ideas intended to move the needle on the issue, and that this is about doing something different," says Raymond Tamasi, president and CEO of Gosnold on Cape Cod.

Tamasi last year served on a governor-supported task force that issued recommendations that have formed the basis for numerous Baker administration initiatives, including the legislation he submitted for state lawmakers' consideration. Tamasi says that more than half of the task force's 65 recommendations have been implemented so far.  Read more here.
Getting Painkillers Seems Easy. Getting Help to Fight Painkiller Addiction is Hard.

Addiction to prescription painkillers and heroin has grown so deadly that the Obama administration wants to spend more than $1 billion over the next two years fighting it. Nearly all of the money would go to making anti-addiction medications, including buprenorphine, more available.

Yet in the midst of the worst epidemic of unintentional drug overdose in U.S. history - mortality rates are four to fives times as high as in the mid-1970s, according to the Centers for Disease Control and Prevention - it can be harder to get drugs to treat an addiction than it is to get the drugs that feed it.

More than 28,000 Americans died from heroin and painkiller overdoses in 2014, according to the CDC. But fewer than half of the 2.2 million people who need treatment for opioid addiction are receiving it, Health and Human Services Secretary Sylvia Burwell said as President Obama's latest budget was released last month.

Peter Shumlin (D-Vt.) was among the first governors to address the opioid epidemic, devoting his entire State of the State address to the crisis in 2014. Since then, his administration and many of Vermont's private-practice doctors have made treatment more available than it is in most of the country.

Despite that, almost 500 addicts in this state of 626,000 people are on waiting lists to receive medication for opioid dependence. More than half will wait close to a year.
Nationwide, a shortage of doctors willing to prescribe buprenorphine, which reduces drug cravings, and a federal limit on the number of patients each doctor can treat, prevents many who could benefit from the medication from getting it.  Read more here.
American Board of Medical Specialties Recognizes New Subspecialty of Addiction Medicine

The American Board of Medical Specialties (ABMS) announced today the recognition of Addiction Medicine as a new subspecialty. The American Board of Preventive Medicine (ABPM), a Member Board of ABMS, sponsored the application for the new field to be a multispecialty subspecialty - meaning that physicians certified by any Member Board of the ABMS can become certified in addiction medicine. The ABMS subspecialty recognition of Addiction Medicine has been championed by the American Board of Addiction Medicine (ABAM), which has established a certification examination and Maintenance of Certification (MOC) process for addiction medicine physicians.

Addiction medicine is defined as the prevention of the risky use of substances, including nicotine, alcohol, prescription medications and other licit and illicit drugs, and the evaluation, diagnosis, treatment and management of the disease of addiction and related health conditions. Physicians specializing in this field also help family members whose health and functioning are affected by a loved one's substance use or addiction.  Read more here.
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.