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Behavioral Health Integration: Ideas to Action Charissa Fotinos, MD, MSc Deputy Chief Medical Officer Clinical Quality and Care Transformation March 15, 2019

Goals • Describe how Health Care Authority uses research to inform public policy • Review what types of research questions help inform public policy • Review and discuss some of the policy questions related to behavioral health integration at the systems level 3

What does HCA do • Implements the State’s Medicaid Program • Implements the State’s Public Employee and School Employee benefit programs • Develops benefits and coverage policies through legislation, contracts with insurers and value based purchasing arrangements • Leading statewide efforts on health care transformation and behavioral health integration 4

A Continuum Policy Panel Individual Practice System e c n e d Evi Payer Purchaser

Evidence Use at HCA 6

Washington State Evidence Based Programs/Processes • Pacific Northwest Evidence Based Practice Center – Drug Effectiveness Review Program – Medicaid Evidence Based Decisions Project (MED) • BREE Collaborative • Health Technology Clinical Committee – Aggregate Analytic, RTI, MED • WSIPP Washington State Institute for Public Policy • Evidence vendors (Hayes)

How do we decide what to cover? 8

Clinical Research and Evidence https: //www. cebm. net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2. 1. pdf 9

https: //gdt. gradepro. org/app/handbook. html#h. 50 o 1 ws 4 do 5 tz 10

Evaluating Qualitative Evidence file: ///H: /Documents/EBM/GRADE-CERqual. pdf 11

Knowing what works isn’t enough 12

When does this become a challenge? • Competing Interests: • Mc. Cleary Decision, Criminal Justice Costs, State hospital costs • Costly Drugs & Interventions: • Spinal muscular atrophy treatments, Chimeric Antigen Receptor Therapy ‘gene therapy’ for leukemia and rare eye disease • Optional Services per Federal Rules: • Access to care levels • Dental, Pharmacy, Eye glasses, Hearing aids (DME),

Legal Context Funding Distributive Justice Intervention Legislative Directives ‘Evidence’ Based Policy

Evidence and Policy

Paying for things that work isn’t enough How can we speed the uptake of effective interventions? • Patient centered outcomes research institute (PCORI) What interventions are not effective and should not be paid for? • Withdrawal management services for opioid use disorder 16

Policy Examples • Collaborative Care Code Implementation • Expansion of medication treatment for opioid use disorder • Involuntary detention – Mental health related – Substance abuse related • Others? 17

Collaborative Care Codes Fede ral Legislature New or augmented benefit Develop billing process Find the $ Define who, what, and where to bill ncy Validate the model’s fidelity Age Develop or change WAC Amend the State Plan w/CMS Program the billing system Create forms & guidance Provide training Monitor or report Validate & configure rates 18

Fede ral Legislature Medications for Opioid Use Disorder New or augmented benefit ncy Age Develop billing process Find the $ Validate the model’s fidelity Stakeholder survey Strong evidence Develop or change WAC Define who, what, and where to bill Amend the State Plan w/CMS Program the billing system Rate increase Validate & configure rates Create forms & guidance Provide training 19 Monitor or report

Fede Involuntary Treatment ral Legislature New or augmented benefit ncy Age Develop billing process Find the $ Evidence is not compelling Ricky’s Law Develop or change WAC Validate & configure rates Define who, what, and where to bill Amend the State Plan w/CMS Program the billing system What to measure and how? Standards not defined Create forms & guidance Provide training 20 Monitor or report Validate the model’s fidelity

How can researchers help? • Prioritize comparative effectiveness studies • Describe the process of and provide tools to help assess the fidelity of complex interventions • Ask and answer pragmatic questions that relate to addressing a person’s health needs in whatever setting they are most comfortable in. (ex. Primary care, opioid treatment program, community mental health center) 21

Discussion Time 22

Questions?

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