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Responding to the IOM Quality Chasm Report on Improving the Quality of Health Care for Mental Substance Use Conditions I

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Responding to the IOM Quality Chasm Report on Improving the Quality of Health Care for Mental   Substance Use Conditions I Powered By Docstoc
					Implementing the IOM Report:
The TRI-State Policy Program
         ACADEMY HEALTH
         Mady Chalk, Ph.D.
    Treatment Research Institute
            June, 2006



                              TRI
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           The Presentation

1. Implementing the IOM Report
2. Creating an Environment for Exchange
   of Information and Identification of
   Priority Policy Concerns in States
3. Developing a Mutual Assistance Effort
4. Identifying and Testing Solutions That
   “Work”
5. Carrying Out Practical, Real World
   Evaluations
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          The IOM Report


• Health Care Focus, e.g., mainstream
  medicine
• Linking Funding to Quality
• Patient-centered Care, e.g., long-
  term management support,
  concurrent recovery monitoring
• Coordination of care
• Data accessibility

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  State Level Policy and Substance
               Abuse


• Discrepancy between what is known
  and what is delivered
• Lack of incentives in public sector
  funding to drive quality improvement
• Disconnected delivery arrangements
  lead to ineffective treatment
• Workforce
• Data infrastructure

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     State Priority Concerns

• Performance and Outcome
  Measurement in Collaboration with
  Treatment Providers
• Data Reporting and Management
• Collaborative Financing of All Types
• Integrating Substance Use and Health
  Care: SBIRT; PRISM (mainstream
  medicine); Concurrent Recovery
  Monitoring

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   State Priority Concerns (Con’t)

• Use of Incentives in Purchasing For:
    • Treatment of priority populations
    • Implementation of administrative
      and clinical best practices to
      improve access and retention
    • Becoming “co-occurring capable”
    • Creating a “medication friendly”
      environment in treatment



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    Creating the Environment


In order for States to work together
  the environment must allow for:
• Continuity over time
• Unofficial deliberations
• Neutrality of sponsoring organization
• Moderating presence of some
  disinterested members


                                TRI
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    Creating the Environment


• Access to expert consultation and
  background papers from research,
  other businesses with similar issues
• Structured opportunity for regular
  discussion
• Practical, real world evaluations



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Advantages of Mutual Assistance

• Practices, policies and procedures
  have a higher likelihood of success
  and practicality since they are
  derived from common experience
  rather than academic research;

• Findings of a consortium of states
  will have greater political traction
  than the same findings resulting from
  a single state’s efforts;

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Advantages of Mutual Assistance

• Multiple issues can be worked on
  simultaneously because more
  sources of potential “solutions” are
  identified;

• Documentation of comparative
  results will become part of the
  “evidence base” providing greater
  legitimacy for state policies.

                                TRI
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   The TRI-State Policy Program


TRI’s Role:
• Providing an Environment for Open
  Exchange of Information, Identification of
  Policy Concerns, and Problem-Solving

• Focusing on Specific Policy Areas That
  Will Reform the Treatment System



                                    TRI
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  The TRI State Policy Program


TRI’s Role:
• Providing Strategic Information from
  Some Other Industries That Can Be
  Used By State SA Agencies
• Evaluating Implementation
  Experiments
• Hosting Long-Term Working Groups to
  Develop Approaches to Knotty Policy
  Problems

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How Will States Work Together?

• Prioritize a common set of two or
  three policy, performance, business,
  administrative and/or financing
  issues;

• Describe and circulate promising
  approaches that may have already
  been tried by member states;


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How Will States Work Together?

• From the promising practices and
  group discussion create a practical
  evaluation of an improvement
  protocol to implement within
  member states;

• Analyze data from the evaluation and
  produce “evidence” of effective
  policies and practices that can be
  disseminated widely.
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 Some of the Issues States Face

Data Issues:
• Collecting and Using Data to Support
  Policy Objectives:
  – Cost Offset Data to Support Re-Allocation
    of State Dollars
• Implementing WEB-Based Data
  Systems to:
  – Support Accurate Reporting by and
    Immediate Feedback to Providers incl.,
    Encounter Data

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  Some of the Issues States Face


Working with Governors and
Legislatures To:

• Remove Regulatory Barriers That Impede
  Implementation of Cross-Agency Financing
  Approaches
• Remove Barriers to Medication-Assisted
  Treatment of All Types
• Implement Performance-Based Purchasing

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  Necessary, but Not Sufficient


• A Continuum of Care from Primary
  Care, to Specialty Health Care, to
  Specialty Treatment for Substance
  Use Disorders and Mental Illnesses
• A Bridge Between Research and Tx
  – So, Is Research Part of the Bridge or Is
    It Part of the Gap?
  – Can the Infrastructure Meet the Public’s
    Demands?

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Some Thoughts About Quality Improvement



• Making the Case for Change

• Costs, Cost-offsets, Access

• Health Care and Substance Use

• Consumer Choice and the Continuum
  of Care

                                TRI
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