Bill Hogan, Commissioner Alaska Department of Health and Social Services

When and How Should Idaho Integrate Substance Abuse and Mental Health from a Structural Perspective?

When the Majority of Consumers (Clients, Patients) experience a Co-Occurring Disorder – Initial Data in Alaska indicated 65% of those Served in Separate Systems had “Both Problems”

Does Idaho have this Data? Or some way of determining the extent of the Problem?

When Family Members and Advocates consistently talk about consumers “falling through the cracks” and being “shuffled between the Substance Abuse system and Mental Health system.

When Providers have already moved in this direction – In Alaska many of our frontier, rural, remote and Alaska Native providers had already moved in this direction out of necessity and based on the people they were serving.

What Oversight Structure is Needed to Sustain Transformation?

Alaska created a Behavioral Health Integration Steering Committee designed to provide Executive Oversight – Membership included – the Governor’s Office; AK HSS / Division of Behavioral Health Director; Executive Directors of the AK Mental Health Trust Authority, the Mental Health Board and Advisory Board on Alcoholism and Drug Abuse – Started with a “Charter” Document

Alaska created an “Internal” Planning Committee to integrate the Divisions of Mental Health and Alcohol and Drug Abuse, the Office of Fetal Alcohol Syndrome (FAS) and to bring the various Medicaid Management and Oversight Functions into the new Division

Alaska created an “External” Stakeholders Group to develop an “Integrated” Behavioral Health Service Delivery System – Members included: Consumers, Family Members, Advocates, Providers, the University, Alaska Native providers, Legislators, Community Health Centers, Hospitals, etc.

Describe Logical Steps through System Re-Design

Create an “Integrated” Division of Behavioral Health – using Vision, Mission and Values process – and a “Functional” Organizational Structure – designed to support the “Integrated Behavioral Health Service System” you envision.

Focus on the Continuum of Services – Prevention, Early Intervention, Treatment and Recovery

Behavioral Health Statute Integrated Behavioral Health Regulations Quality Standards – Focus on

Competencies/Credentialing; Change Agent as Implementation Strategy

Identify the Population to be Served Design the System – “From the Ground Up” Financing – “Be Creative” – Grants, Fee for

Service, Case Rate, Capitation, etc. Information Exchange – AKAIMS Outcomes and System Performance – Start with

the Client – Client Status Review (CSR) – but also consider population measures – i.e. Suicide

Need a Full Time Coordinator/Manager – Someone who gets up every morning focused on this Initiative

Develop a Work Plan Establish Clear Goals and Benchmarks – Create

Short Term “Successes” Use Data and Measure what you are doing Modify and Adjust In other Words – Adopt a Continuous Quality

Improvement (CQI) Philosophy Communicate, communicate, communicate to:

Legislators, stakeholders, the public.

What Other Thoughts or Perspectives Might Alaska Have re: This Type of Initiative?

Integration occurs Locally at both the Clinical and Administrative Level

Adopt a “No Wrong Door” Philosophy – Consider “One Stop Shop” / Behavioral Health “Home”

Develop Standardized Screening Everyone Should get a “Comprehensive

Treatment Plan” – that addresses both problems

Services should be provided by the same agency where practical and feasible

When Considering Administrative Integration – think about Creating Efficiencies, talk openly about “Consolidation and Mergers”

Stay Focused on the “End Goal” / Outcomes Ensure you have Solid, Consistent Leadership Perseverance – Addressing “Change Fatigue” “Manage Expectations – “When will we be done?” Identify and Work with “Legislators” who are

“Champions”

How Does Alaska Manage for Quality Assurance and Accountability?

Accreditation Performance Based Contracting/Funding Ongoing Technical Assistance Audits Modifying or Altering Regulations Certification and Licensing

What Systems and Structures Need to be in Place to Implement an Outcomes-Based/Managed Care System?

General Agreement and Understanding of what Outcomes Providers are Expected to Achieve – Client Outcomes – Productivity/Employment, Housing, Staying out of the Criminal Justice System, “Social Connectedness”, etc.

Beginning to discuss what Constitutes a “Healthy Community” and what role do Behavioral Health Providers play in creating a healthy community

Need to be able to Receive and Send Data – Analyze the Data, etc. – AKAIMS

Re: Managed Care – there is Essentially “No” Managed Care in Alaska

Alaska has used various Managed Care Strategies – i.e. Prior Authorization, Limits on Services, Utilization Management/Review, etc. – but for the most part Alaska has been quite resistant.

One exception – SouthCentral Foundation – in Anchorage

How does Alaska ensure People are being served Effectively and Efficiently?

Effectively – Based on Client Outcomes and reduced rates of Suicide, Fetal Alcohol Spectrum Disorder, Crimes and Accidents where Alcohol and Drugs were involved, etc.

Efficiently – Reviewing Cost Data, Provider Productivity Standards, Consolidating Administrative Functions, etc.

Recommendations re: Draft Approach? Vision, Goals, etc. Oversight Structure – Need to “Institutionalize”

it – Does the BHTWG/Board – serve as this Entity?

Continuum of Services / Core Services Comprehensive Focus Regional Authorities? Provider Networks? Workforce? Primary Care / Behavioral Health Integration?

Comments? Questions? Documents you would like to see? People you would like to talk to?

Thanks

Bill Hogan, Commissioner, Alaska Dept. of Health and Social Services – William.Hogan@alaska.gov – 907-465-3030