A National View: Healthcare 2008 CBHC Annual Training Conference October 5, 2008 Charles Ingoglia,...

A National View: A National View: Healthcare 2008Healthcare 2008

CBHC Annual Training CBHC Annual Training ConferenceConferenceOctober 5, 2008October 5, 2008

Charles Ingoglia, MSWCharles Ingoglia, MSW

Vice President, National Council for Vice President, National Council for Community Behavioral HealthcareCommunity Behavioral Healthcare

www.nccbh.orgwww.nccbh.org

Today…talk aboutToday…talk about

Opportunities and ChallengesOpportunities and Challenges 2008 National Healthcare 2008 National Healthcare

DebateDebate National Council Public Policy National Council Public Policy

and The State of Medicaidand The State of Medicaid Taking Charge – relationships, Taking Charge – relationships,

quality and communicationsquality and communications


The National CouncilThe National Council

Not for profit association of 1500 Not for profit association of 1500 + mental health/addiction + mental health/addiction treatment and rehabilitation treatment and rehabilitation organizationsorganizations

Member organizations employ employ 250,000 staff and provide services 250,000 staff and provide services to 6 million adults and children to 6 million adults and children in communities across the in communities across the countrycountry


MembershipMembership

732 752

10071075

11961277

1398

0

200

400

600

800

1000

1200

1400

FY02 FY03 FY04 FY05 FY06 FY07 FY08YTD


Our Vision – the big Our Vision – the big picturepicture

A nation where there is A nation where there is prevention and early detection prevention and early detection of mental illnesses and of mental illnesses and addictions; and addictions; and everyoneeveryone has has access to the effective access to the effective treatments and supports treatments and supports essential to live, work, learn essential to live, work, learn and participate fully in their and participate fully in their communities.communities.


Our JobOur Job

The National Council is the The National Council is the interface between practice and interface between practice and policy.policy.

We are the national voice for We are the national voice for legislation, regulations and legislation, regulations and policies that protect, strengthen policies that protect, strengthen and expand access to mental and expand access to mental health and addictions services.health and addictions services.

Your job is to support others, our Your job is to support others, our job is to support you.job is to support you.


Members – Top IssuesMembers – Top Issues

Funding, Medicaid, MedicareFunding, Medicaid, Medicare Reform – privatization, Reform – privatization,

competition, managed carecompetition, managed care WorkforceWorkforce Health IntegrationHealth Integration TechnologyTechnology


Time of opportunityTime of opportunity

Surgeon General Satcher, President Surgeon General Satcher, President Bush’s New Freedom Commission, Bush’s New Freedom Commission, and The Institute of Medicine all and The Institute of Medicine all agree that: agree that:

mental health and freedom from mental health and freedom from addictions are vital to overall addictions are vital to overall healthhealth

effective treatments exist and effective treatments exist and recovery is possiblerecovery is possible


OpportunityOpportunity Up to 90% of people with a mental Up to 90% of people with a mental

illness that are treated with a illness that are treated with a combination of medication and combination of medication and therapy experience substantially therapy experience substantially reduced symptoms, enhanced quality reduced symptoms, enhanced quality of life & increased productivityof life & increased productivity

Science has revolutionized our Science has revolutionized our understanding of addictions – understanding of addictions – treatment has been shown to cut treatment has been shown to cut drug use in half, reduce crime by drug use in half, reduce crime by 80% & reduce arrests up to 64%.80% & reduce arrests up to 64%.


ChallengesChallenges Each year 100,000 + Americans die Each year 100,000 + Americans die

from alcohol and drug abuse.from alcohol and drug abuse. 50% jail/prison inmates have mental 50% jail/prison inmates have mental

health problem, 75% substance abuse.health problem, 75% substance abuse. 2/3 homeless - chronic alcoholism, 2/3 homeless - chronic alcoholism,

drug addiction, mental illness or drug addiction, mental illness or combination.combination.

25% of all hospital admissions have 25% of all hospital admissions have mental illness or addictions disorder.mental illness or addictions disorder.

25% social security payments are for 25% social security payments are for mental illnesses.mental illnesses.


Challenges Challenges

Staffing crisis - low prestige and salaries/ Staffing crisis - low prestige and salaries/ high turnoverhigh turnover

Limited use of outcome data to refine Limited use of outcome data to refine treatment/research based practicestreatment/research based practices

Limited use of knowledge based Limited use of knowledge based technology/neuroscience and biological technology/neuroscience and biological advances advances

Low rates of access, retention & adherence


ChallengesChallenges Ambivalence about healthcare: Ambivalence about healthcare:

chronic illnesses v. recovery; chronic illnesses v. recovery; integration?integration?

Complexity of serious mental Complexity of serious mental illnesses – early mortality – povertyillnesses – early mortality – poverty

Protecting individuals with mental Protecting individuals with mental illness from harm v. protecting illness from harm v. protecting societysociety

Late detection – complex U.S. systemLate detection – complex U.S. system


ChallengesChallenges No uniform standards of care and No uniform standards of care and

layers of regulation and oversight layers of regulation and oversight Multiple hospital and community Multiple hospital and community

providers with fierce competition providers with fierce competition for Medicaidfor Medicaid

Dependence on Medicaid and Dependence on Medicaid and limited to no access for non – limited to no access for non – MedicaidMedicaid


The Healthcare DebateThe Healthcare Debate



U.S. Healthcare SystemU.S. Healthcare System The financing system isThe financing system is

InefficientInefficient Inequitable, andInequitable, and Fiscally unsustainable.Fiscally unsustainable.

The delivery system isThe delivery system is FragmentedFragmented Not designed to care for chronic Not designed to care for chronic

diseasesdiseases Haphazard and poor qualityHaphazard and poor quality High use of unproven, marginal High use of unproven, marginal

therapies.therapies.


CostsCosts

In 2006, the U.S. spent In 2006, the U.S. spent $2,100,000,000,000 --$2.1 $2,100,000,000,000 --$2.1 trillion –on health care.trillion –on health care.

$1 out of every $6 spent in $1 out of every $6 spent in the U.S.the U.S.


CostsCosts

How Big is a Trillion?How Big is a Trillion?

1 million seconds1 million seconds Last weekLast week

1 billion seconds1 billion seconds Richard Richard Nixon’s Nixon’s resignation resignation

1 trillion seconds1 trillion seconds 30,000 BCE30,000 BCE


CostsCosts

47 million without health insurance47 million without health insurance 16% of GDP – no other country above 16% of GDP – no other country above

10%10% Fragmented array of insurers and Fragmented array of insurers and

providers drive high administrative providers drive high administrative costs: 25-35% compared to 15% costs: 25-35% compared to 15%

$5,711 per person, Switzerland $3,847; $5,711 per person, Switzerland $3,847; 31st in life expectancy31st in life expectancy

Insurance premiums doubled since Insurance premiums doubled since 2000 2000


Costs Costs We pay hospitals and doctors moreWe pay hospitals and doctors more Rely on specialists, using high cost Rely on specialists, using high cost

diagnostics & interventions offering diagnostics & interventions offering possibility of improvementpossibility of improvement

Little to no use of comparative Little to no use of comparative effectiveness/No budgeteffectiveness/No budget

75% of costs by 4-5% with chronic 75% of costs by 4-5% with chronic illnesses and at end of life.illnesses and at end of life.


CostsCosts

Extremely wealthy country; most like Extremely wealthy country; most like their providers – change for everyone their providers – change for everyone else, butelse, but

By 2028, health care will consume 28% By 2028, health care will consume 28% of GDP. This is as much as all federal, of GDP. This is as much as all federal, state and local governments currently state and local governments currently spend.spend.

By 2050, Medicare and Medicaid will By 2050, Medicare and Medicaid will consume all federal taxes.consume all federal taxes.““Even in fantasy, no one has yet come Even in fantasy, no one has yet come

up with a way to pay for Medicare.”up with a way to pay for Medicare.”


Solutions?Solutions? Managed care: largely unable to Managed care: largely unable to

reform care delivery/hated by allreform care delivery/hated by all Control drug costs, allow Medicare Control drug costs, allow Medicare

to negotiate: small piece of the pie to negotiate: small piece of the pie Pay for Performance: more to Pay for Performance: more to

providers already doing the right providers already doing the right thing, others won’t change for thing, others won’t change for additional 2% or 5%additional 2% or 5%

IT: IT: long termlong term can reduce paperwork can reduce paperwork burden, errors and repeated testsburden, errors and repeated tests


Solutions?Solutions?

Prevention/Disease Prevention/Disease management/Medical homes: not management/Medical homes: not clear if or when get savings:clear if or when get savings:

Skin in the game: 1974 to 1982 Rand Skin in the game: 1974 to 1982 Rand study - 30% saving when people paid study - 30% saving when people paid with same outcomes, exception low with same outcomes, exception low income people in poor healthincome people in poor health

Close hospital beds: match lower Close hospital beds: match lower spending regions save 20% to 30%spending regions save 20% to 30%


Healthcare ReformHealthcare Reform

True health care reform must fix True health care reform must fix both the financial and delivery both the financial and delivery systems.systems.

Unfortunately, most public Unfortunately, most public discussions focus exclusively on the discussions focus exclusively on the financing system and getting to (or financing system and getting to (or close to) universal coverage. They close to) universal coverage. They ignore delivery system reform.ignore delivery system reform.


Incremental ReformIncremental Reform

Incremental reform is business Incremental reform is business as usual.as usual.

If you like the current system, If you like the current system, you like incremental reform.you like incremental reform.

Builds on a broken system.Builds on a broken system. Fails to achieve universal Fails to achieve universal

coverage, no cost control, no coverage, no cost control, no improved delivery system.improved delivery system.


Political FeasibilityPolitical Feasibility

Many barriers to change:Many barriers to change:

1) 1) Rule ofRule of SatisfactionSatisfaction—85% of —85% of Americans have health insurance and Americans have health insurance and many are satisfied.many are satisfied.

2) 2) James Madison Rule ofJames Madison Rule of GovernmentGovernment—American government —American government was designed with many places for was designed with many places for special interests to kill legislation. special interests to kill legislation. With 16% of the GDP, health care has With 16% of the GDP, health care has many special interests.many special interests.


Political FeasibilityPolitical Feasibility

A majority of Americans are A majority of Americans are for health care reform. for health care reform. But they are divided But they are divided among many different among many different plans. After their plans. After their preferred reform, their preferred reform, their second choice is the status second choice is the status quo.quo.


2007 Lobbying Leaders US Chamber of Commerce

$52,750,000 General Electric $23,660,000 Pharmaceutical Rsrch & Mfrs of

America $22,733,400 American Medical Assn $22,132,000 American Hospital Assn

$19,734,545 AARP $19,540,000 Exxon Mobil $16,940,000


Healthcare Lobbying in 2007

Pharmaceuticals/Health Products $226,757,501

Hospitals/Nursing Homes $91,208,297

Health Professionals $70,378,540 Health Services/HMOs

$52,990,044 Misc Health $4,985,719Total spending:

$446,320,101


What we must do…What we must do… Broad, strong, engaged membership.Broad, strong, engaged membership. Assertive/focused policy agenda. Assertive/focused policy agenda. Strategic alliances - industry Strategic alliances - industry

leadership. leadership. Reputation for quality - expert Reputation for quality - expert

education & practice improvement education & practice improvement initiatives.initiatives.

Effective communications with Effective communications with members, media, advocates, members, media, advocates, policymakers & public.policymakers & public.


The National CouncilThe National Council

An assertive, focused An assertive, focused policy agendapolicy agenda


Assertive, focused policy Assertive, focused policy agendaagenda

Understanding and Defending Understanding and Defending MedicaidMedicaid

Parity/ MedicareParity/ Medicare VeteransVeterans Criminal Justice: Mentally Ill Offender Criminal Justice: Mentally Ill Offender

Treatment and Crime Reduction Treatment and Crime Reduction Act/Second Chance Act Act/Second Chance Act

Community Mental Health Services Community Mental Health Services Improvement Act Improvement Act - - Primary care in Primary care in behavioral sitesbehavioral sites



The State of MedicaidThe State of Medicaid


In 2007, Over 2/3 of States In 2007, Over 2/3 of States Offered New ProposalsOffered New Proposals

Governors in 34 states offered plans to Governors in 34 states offered plans to reduce uninsured children, parents, reduce uninsured children, parents, adults, aged and disabled in their state adults, aged and disabled in their state throughthrough Medicaid expansionsMedicaid expansions SCHIP expansionsSCHIP expansions DRA waiversDRA waivers Comprehensive Section 1115 waiversComprehensive Section 1115 waivers Prevention and better management Prevention and better management

of chronic conditionsof chronic conditions


2008 Response:2008 Response:

Expansion plans in Expansion plans in jeopardy or delayedjeopardy or delayed

States once again States once again freezing or cutting ratesfreezing or cutting rates


Illustrative Medicaid Dynamics; Ohio Department of Mental Health

State General Fund and MedicaidFY 1990 – FY 2007

millions

$200

$150

$100

$50

$0

-$50

-$100

-$150

$200

millions

$150

$100

$50

$0

-$50

-$100

-$1501990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Medicaid FFPMedicaid MatchRemaining GRF

20072006

The Squeeze


Federal Regulations Reflect Federal Regulations Reflect Federal GoalsFederal Goals

Make Medicaid look like Make Medicaid look like commercial health insurance.”commercial health insurance.”

““Medicaid should not be a Medicaid should not be a financing option for other financing option for other public systems for non-public systems for non-Medicaid purposes.”Medicaid purposes.”

““Rein in federal health Rein in federal health spending.”spending.”


It’s Raining Regulations!It’s Raining Regulations!

10 new regs in first six months of 10 new regs in first six months of federal fiscal year (15+ in last 2 federal fiscal year (15+ in last 2 years)years)

Most issued as either “interim Most issued as either “interim final” regulations or with final” regulations or with shortened public comment shortened public comment periods periods

Fighting new regs – Fighting new regs – Congressional moratoriumsCongressional moratoriums


Council Leadership - Rehab Council Leadership - Rehab Option/Case ManagementOption/Case Management

In DRA, Congress rejected Bush In DRA, Congress rejected Bush efforts to legislate changes - efforts to legislate changes - President uses administrative President uses administrative measures for $6.1 billion savings over measures for $6.1 billion savings over next 10 yearsnext 10 years

Council – member political heat, Council – member political heat, member testimony, rallying partners member testimony, rallying partners

Achieved moratoriumAchieved moratorium Working with Congress on legislation Working with Congress on legislation

to address rehab and case to address rehab and case management regs management regs



ParityParity


Commercial ParityCommercial Parity

Senator Paul Wellstone Mental Senator Paul Wellstone Mental Health Parity Act of 2007 – Health Parity Act of 2007 – parity parity for both mental health and for both mental health and addictions treatment servicesaddictions treatment services

Senate - introduced by Senators Edward Kennedy Senate - introduced by Senators Edward Kennedy (D-MA), Michael Enzi (D-WY), and Pete Domenici (D-MA), Michael Enzi (D-WY), and Pete Domenici (R-NM)/House - introduced by Representatives (R-NM)/House - introduced by Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) Patrick Kennedy (D-RI) and Jim Ramstad (R-MN)

Rally on 9/17; ad campaignRally on 9/17; ad campaign Agreement on content, added to Agreement on content, added to

rescue/tax bill (AMT)rescue/tax bill (AMT)


ParityParity

Use The Toll-Free Parity Hotline: 1-866-Use The Toll-Free Parity Hotline: 1-866-parity4parity4 (1-866-727-4894, the Parity Hotline reaches (1-866-727-4894, the Parity Hotline reaches the U.S. Capitol switchboard, which connects the U.S. Capitol switchboard, which connects you to your Senators' offices.)you to your Senators' offices.)

"I'm calling to ask that the Senator vote "I'm calling to ask that the Senator vote YES on the energy and tax package that YES on the energy and tax package that includes parity for mental health and includes parity for mental health and addiction services. This legislation must addiction services. This legislation must pass this month before Congress pass this month before Congress adjourns."adjourns."


MedicareMedicare Historic milestone – Congress ( HR 6331) Historic milestone – Congress ( HR 6331)

ending discrimination of outpt. mental ending discrimination of outpt. mental health benefits between 2010 and 2014health benefits between 2010 and 2014

Re-authorization of SCHIP - 2 provisions Re-authorization of SCHIP - 2 provisions related to Medicare:related to Medicare:1.marriage&family therapists and licensed 1.marriage&family therapists and licensed professional counselors as providersprofessional counselors as providers

2. additional covered services including 2. additional covered services including case management, ACT, rehabcase management, ACT, rehab

Vetoed by President but passage by Vetoed by President but passage by Congress is important legislative record Congress is important legislative record moving forwardmoving forward



VeteransVeterans


Veterans authorizationVeterans authorization

S. 38 calls for the VA to contract with S. 38 calls for the VA to contract with community providers to meet needs of community providers to meet needs of reserves and National Guardreserves and National Guard

Recent VA directive to all VISN'S that Recent VA directive to all VISN'S that describes expectations for access and describes expectations for access and services and calls for individual medical services and calls for individual medical centers to contract with community centers to contract with community providersproviders


Veterans appropriationsVeterans appropriations

$100 million to be allocated to $100 million to be allocated to community mental health community mental health organizations in the Veterans organizations in the Veterans Administration’s health care Administration’s health care budget line-item to increase budget line-item to increase mental health care for National mental health care for National Guard members, reservists, and Guard members, reservists, and family members of veterans with family members of veterans with service connected mental disordersservice connected mental disorders



Community Mental Community Mental Health Services Health Services Improvement ActImprovement Act


Community Mental Health Community Mental Health Services Improvement ActServices Improvement Act

Primary care in behavioral sites ***Primary care in behavioral sites *** Co-occurring disorders funding demoCo-occurring disorders funding demo Workforce improvements, salary studyWorkforce improvements, salary study Paperwork reduction - elimination of Paperwork reduction - elimination of

regulatory redundancyregulatory redundancy Advancing tech. & electronic health Advancing tech. & electronic health

recordrecord Rural behavioral health treatment Rural behavioral health treatment

incentivesincentives



Coming soonComing soon


Coming Soon Coming Soon

Federal funding stream to cover the Federal funding stream to cover the mental health treatment costs of the mental health treatment costs of the uninsured uninsured

Restore eligibility for social security Restore eligibility for social security disability for people with addictive disability for people with addictive disordersdisorders

Cost based re-imbursement that supports Cost based re-imbursement that supports salaries that can attract and retain salaries that can attract and retain skilled skilled staff staff

Chronic disease management project – Chronic disease management project – medical home medical home


Strategic relationshipsStrategic relationships

Chronic Disease, Healthcare, Medicaid Chronic Disease, Healthcare, Medicaid Coalitions, Medicaid DirectorsCoalitions, Medicaid Directors

Addiction Treatment Advocacy and Addiction Treatment Advocacy and Criminal Justice LeadershipCriminal Justice Leadership

Mental Health Groups – Campaign, Mental Health Groups – Campaign, NAMI, MHA, Consumers, NASMHPD, NAMI, MHA, Consumers, NASMHPD, GuildsGuilds

Feds – SAMHSA, HRSA, CMSFeds – SAMHSA, HRSA, CMS Presidential Election – Whole Health Presidential Election – Whole Health


Reputation for quality – Reputation for quality – Member BenefitsMember Benefits

Promoting Wellness - Promoting Wellness - Saving Saving LivesLivesSurvey on medical servicesSurvey on medical servicesHealth & Wellness RoundtablesHealth & Wellness RoundtablesPrimary Care and Behavioral Primary Care and Behavioral Health Learning Community - Health Learning Community - 23 organizations ***23 organizations ***

Primary Care/Behavioral Health Primary Care/Behavioral Health Collaborative Project ***Collaborative Project ***

Medical/healthcare homes ***Medical/healthcare homes ***


Primary Care/Behavioral Primary Care/Behavioral Health Collaborative ProjectHealth Collaborative ProjectObjectives:Objectives:

Safety net population in every community Safety net population in every community has seamless access to both mental has seamless access to both mental health/addiction and physical healthcare health/addiction and physical healthcare services. services.

Strong working partnership among mental Strong working partnership among mental health/addiction and physical healthcare health/addiction and physical healthcare providers, with roles defined, referral providers, with roles defined, referral protocols in place, and cross-placement of protocols in place, and cross-placement of clinical staff.clinical staff. Phases I and II : 12 sites in 10 statesPhases I and II : 12 sites in 10 states Phase III – 4 additional sitesPhase III – 4 additional sites


Project Goals Diagram

Primary Care Clinic Screen all patients for depression Screen all depressed patients for bipolar,

suicide, substance use Refer per protocols for specialty MH,

referral includes medical co-morbidity information

Provide depression care and care management for those not referred

Use PHQ – 9 for proactive follow-up and management of depression

Access to psychiatry to support PCP and care management and assure stepped care

Provide primary care services Support/information from PCPs to MH

regarding health status, joint planning for patients with medical co-morbidities

Data tracking regarding care processes and patient status

Current Referral Chasm Only 50% get to MH upon referral Little information flows between PCP and MH Patients get pushed back and forth, rather

than jointly served

Improved Referral Process Agree on who needs specialty MH and 100% of

them get there and get engaged Information flows between PCP and MH Patients are collaboratively cared for, with attention

to medical co-morbidities exacerbated by SGAs

Community Mental Health Provider Expedited support for referrals and

engagement Psychiatry training and support for PCPs Psychiatric evaluation and treatment for

referrals Track weight, lipids, glycemia for patients

on SGAs Support/information from PCPs regarding

health status, joint planning for patients with medical co-morbidities

Evidence based MH services and case management

Transition stable patients back to PCP per protocols

Data tracking regarding care processes and patient status


Reputation for quality – Reputation for quality – Member BenefitsMember Benefits

Continuity of Care -Access, Continuity of Care -Access, Engagement and Adherence ProjectEngagement and Adherence Project

Six Sigma Initiative ***Six Sigma Initiative *** Recruitment and RetentionRecruitment and Retention Psychiatric Leadership Project ***Psychiatric Leadership Project *** Middle Management and Middle Management and

Leadership Development – Culture Leadership Development – Culture diversity diversity

National Benchmarking Project ***National Benchmarking Project ***


Access and EngagementAccess and EngagementExecutive Staff Walkthrough Objectives: Experience Intake,

Assessment, and First Appointment Process from Client’s Perspective; Identify Barriers; and Identify Strategies for Improvement

Requirements: Site Teams Work in Pairs (One Client, One Observer/Recorder); and Mock Clients Complete All Paperwork/ Processes Client Completes


Access and EngagementAccess and Engagement

Number of data elements collected in the process = 1,854

Number of redundant elements = 564 Number required = 957 Staff time required to administer

original flow process = Four hours ten minutes

Staff time required to administer revised flow process = One hours twenty minutes


Quality – Member Quality – Member BenefitsBenefits

Criminal Justice Leadership Criminal Justice Leadership ForumForum

Project Helping Hands*** Project Helping Hands*** Awards of Excellence***Awards of Excellence*** JoBankJoBank International Community and International Community and

“Passport” program ***“Passport” program *** Mental Health First Aid ***Mental Health First Aid ***


Few are bigger, none are Few are bigger, none are betterbetter

National Council National Council ConferenceConference

The Hyatt RiverWalkThe Hyatt RiverWalk San Antonio, TexasSan Antonio, Texas April 5 - 8, 2009April 5 - 8, 2009


Conference AttendanceConference Attendance

607697

1032 10131179

1832

2100

0

500

1000

1500

2000

2500

2002 2003 2004 2005 2006 2007 2008


Effective Effective CommunicationsCommunications

Electronic and PrintElectronic and Print Public Policy Update Public Policy Update Technical Assistance NewsletterTechnical Assistance Newsletter State Policy FocusState Policy Focus National Council Magazine National Council Magazine Letter from LindaLetter from Linda Journal of Behavioral Health Services & Journal of Behavioral Health Services &

ResearchResearch Addictions/Co-occurring Disorders Addictions/Co-occurring Disorders

NewsletterNewsletter


Communications – Communications – messaging and marketingmessaging and marketing

National Council Live National Council Live Marketing - Message piece/ Policy Marketing - Message piece/ Policy

Guide/Annual ReportGuide/Annual Report Print Media – member stories and voices: Print Media – member stories and voices:

news, letters, op-eds and magazine news, letters, op-eds and magazine articles in trade and mainstream pressarticles in trade and mainstream press

Redesigned website, Redesigned website, www.nationalcouncil.org Offering stories of recoveryOffering stories of recovery Sharing member writingsSharing member writings National Council resourcesNational Council resources Special interactive sectionsSpecial interactive sections


How do we move our How do we move our agenda…agenda…

Change requires 4 things to coalesce:Change requires 4 things to coalesce:1) A 1) A problemproblem attracts widespread public attracts widespread public and political attention. and political attention. 2) A 2) A proposalproposal to solve the problem is to solve the problem is agreed on by the major actors. agreed on by the major actors. 3) There is a major actor or set of actors 3) There is a major actor or set of actors who vigorously who vigorously championchampion the policy the policy proposal.proposal.4) A 4) A transforming political eventtransforming political event creates creates an open policy window to enact the agreed an open policy window to enact the agreed upon proposal. Political opportunity is upon proposal. Political opportunity is unpredictable. We must be ready when unpredictable. We must be ready when the policy window opens.the policy window opens.


What do we need to succeed?

An organized and effective grassroots

Congressional champions


What we must do What we must do politically…politically…

Be informed, Be informed, www.thenationalcouncil.org -understand and influence the national -understand and influence the national dialogue: mental health and freedom dialogue: mental health and freedom from addictions are vital to overall from addictions are vital to overall health and effective treatments existhealth and effective treatments exist

Tell our story - Tell our story - commit to using our commit to using our influence: Congress doesn’t know us influence: Congress doesn’t know us very well and CMS doesn’t always like very well and CMS doesn’t always like usus


Build relationships with Build relationships with policy-makerspolicy-makers

• Meet them in Washington or the Meet them in Washington or the DistrictDistrict

• Get to know their staffGet to know their staff• Help them — contribute to their Help them — contribute to their

campaign, attend a fundraiser, put campaign, attend a fundraiser, put up yard signs, serve as a content up yard signs, serve as a content expert etc.expert etc.

• Maintain contactMaintain contact


Political action is the highest responsibility of a citizen.”

John F. Kennedy

“

“Political action is the highest responsibility of a citizen.”

John F. Kennedy

Hill Day: June 9 and 10 Hill Day: June 9 and 10

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