/ en Sun, 15 Jun 2025 00:56:12 -0500 Thu, 05 Jun 25 15:10:45 -0500 /news/headline/2025-06-05-house-passes-support-act-reauthorization-bill <p>The House June 4 passed the AHA-supported <a href="https://d1dth6e84htgma.cloudfront.net/1_H_R_2483_SUPPORT_for_Patients_and_Communities_Reauthorization_Act_of_2025_19914237dd.pdf" target="_blank">SUPPORT Act</a> (H.R. 2483) by a 366-57 <a href="https://clerk.house.gov/evs/2025/roll151.xml" target="_blank">vote</a>. The legislation reauthorizes key prevention, treatment and recovery programs for patients with substance use disorder, including programs to support the behavioral health workforce.</p> Thu, 05 Jun 2025 15:10:45 -0500 Substance Use Disorder /role-hospitals-shine-how-vanderbilt-expanded-its-integrated-care-model-opioid-exposed-infants <div class="container"><div class="row"><div class="col-md-9"><div class="row"><div class="col-md-4"><p><img src="/sites/default/files/2025-06/ths-vumc-shine-700x532.jpg" alt="Vanderbilt University Medical Center Shine logo features three fireflies under a shooting star" width="700" height="532"></p></div><p>Vanderbilt University Medical Center is growing its integrated, multidisciplinary care for infants and children who have been exposed to opioids while in utero.</p><p>In 2021, VUMC began the Firefly Program, in which OB-GYNs, pediatricians and psychiatrists offer a broad range of care, including neurodevelopmental monitoring, to babies from birth to 12 months of age. “Children with intrauterine exposure to opioids may experience differences in how their nervous system develops,” said Neill Broderick, Ph.D., assistant professor of pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “These differences can manifest in many ways, such as sensory integration differences, emotional and/or behavioral dysregulation and learning differences.”</p><p>Building off the success of the Firefly Program, VUMC now has a new initiative dedicated to infants and young children exposed to opioids in utero. SHINE (Support and Health for Infants with Neonatal Exposures) uses neurodevelopmental monitoring for the prevention and early detection of developmental delays and differences for children from birth to 6 years old. Using the same integrated approach as the Firefly Program, SHINE brings together general pediatrics; physical, occupational and speech therapy; and the Firefly Program to ensure that patients receive the full scope of care they need. The program also streamlines the care of the mother and the care of the child, improving the chances of success for both.</p><p><a href="https://news.vumc.org/2025/04/21/neurodevelopmental-care-initiative-supports-infants-and-young-children-exposed-to-opioids-in-utero/">Read more about the Firefly Program and SHINE</a>.</p></div></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/center/population-health">Improving Health and Wellness</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Mon, 02 Jun 2025 12:36:13 -0500 Substance Use Disorder /news/headline/2025-05-15-overdose-deaths-dropped-estimated-27-2024 <p>Overdose deaths in the U.S. fell 26.9% last year to 80,391, according to <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm" title="overdose stats">estimates</a> from the Centers for Disease Control and Prevention. The agency reported declines in deaths across all major drug categories, including stimulants and opioids. </p> Thu, 15 May 2025 14:58:18 -0500 Substance Use Disorder /advancing-health-podcast/2025-05-14-improving-behavioral-health-older-adults-lessons-henry-ford-health <p>Mental health and substance use disorders in older adults are frequently underdiagnosed and underserved. In this conversation, Zaira Khalid, M.D., senior staff geriatric psychiatrist at Henry Ford Behavioral Health Hospital, discusses the unique physical, emotional, and social needs of patients over 65, the hospital's compassionate and multi-disciplinary approach to whole-person care, and how to recognize the silent struggles of older loved ones and provide support.</p><hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br> </h2> </summary> <p> 00:00:01:02 - 00:00:27:03<br> Tom Haederle<br> Welcome to Advancing Health. Experts say mental health issues and substance use disorders in people over age 65 is underreported, under-diagnosed and deserves much more attention than it gets. In today's podcast, we learn more about how the brand new Henry Ford Behavioral Health Hospital created a designated unit dedicated to older adults to help focus on their behavioral health needs. </p> <p> 00:00:27:05 - 00:00:55:24<br> Rebecca Chickey<br> Hello, my name is Rebecca Chickey and I am the senior director of behavioral health for the ���������� Association. And it's my honor to be joined today by Dr. Zaira Khalid, who is the senior staff geriatric psychiatrist at Henry Ford Behavioral Health Hospital, which is located in West Bloomfield, Michigan. Today, our discussion is entitled Improving Behavioral Health for Older Adults: Lessons from Henry Ford Health. </p> <p> 00:00:55:26 - 00:01:25:08<br> Rebecca Chickey<br> Thank you so much for being here with us today. What I'd like the listeners to learn and hear first from you is what is the situation? What's the prevalence of psychiatric, or substance use disorders in individuals who are 65 and older? And what are the perhaps unique circumstances that older adults may experience that may drive conditions such as depression or anxiety? </p> <p> 00:01:25:10 - 00:01:50:15<br> Zaira Khalid, MD<br> Rebecca, thank you for having me. Thank you for shedding light on this very, very important topic that I think doesn't get enough attention and should be getting much much more attention just because of the need that there is. So in terms of mental health and substance use disorder treatment, it is definitely underreported and underdiagnosed in our elderly patients. </p> <p> 00:01:50:17 - 00:02:25:15<br> Zaira Khalid, MD<br> Having said that, the numbers are still very high. So, patients who we look at that may be, let's say admitted to the hospital with medical concerns and have medical comorbidities. Their prevalence of having psychiatric disorders is going to be anywhere between 40 to 50%. That's very, very high. Substance use disorders in the elderly...I believe the last time I saw a good study was in 2022. Eleven in 60 adults, older adults, had a substance use problem. </p> <p> 00:02:25:17 - 00:02:55:00<br> Zaira Khalid, MD<br> And that's only those that are being diagnosed. You know, I can tell you from personal experience, it's a lot higher than that. We just don't recognize it. So a lot of our elderly are struggling, not getting the help they need, not seeking the help they need due to various factors. But what leads them to where they are with their mental health and where they are with their psychiatric health are that they're a unique population, they go through stressors that the majority of the other population doesn't. </p> <p> 00:02:55:02 - 00:03:20:23<br> Zaira Khalid, MD<br> They're at a stage in life where they are losing their loved ones around them. They're losing their friends that they've had their entire life. They are retiring from their jobs, which is what gave them meaning in their life. Their kids are moved out of the home, busy with their lives. That was a huge part of their life that gave them meaning - parenting, raising their kids. </p> <p> 00:03:20:25 - 00:03:54:29<br> Zaira Khalid, MD<br> They're now sometimes, most of the time, having to give up their homes, and they're moving into assisted living or nursing homes. And it's a completely different environment, completely different level of independence. They're not driving anymore. So all of those things put together, I think, would be stressful for any one of us. And once you add on medical problems like not being able to walk as well, having diabetes, possibly a stroke, it just leads to sort of a concoction of items that's going to lead to poor outcomes </p> <p> 00:03:54:29 - 00:03:56:18<br> Zaira Khalid, MD<br> if not intervened. </p> <p> 00:03:56:21 - 00:04:23:18<br> Rebecca Chickey<br> Absolutely. I saw my own mother go through this, and now my husband's parents have done exactly what you've described. They've moved into an assisted living facility. My father in law is now 94 and wheelchair bound. And my mother in law is younger and still active. And so there's also that sort of strain. Luckily, they do still have friends that are their age that are in that same living facility </p> <p> 00:04:23:19 - 00:04:31:00<br> Rebecca Chickey<br> so that's helping offset. But, but it doesn't eliminate all the other challenges that you described. </p> <p> 00:04:31:02 - 00:04:34:27<br> Zaira Khalid, MD<br> Yeah. Social isolation is very real and very dangerous. </p> <p> 00:04:34:29 - 00:04:54:22<br> Rebecca Chickey<br> Absolutely. So tell me, in the design and the development of the new Henry Ford Behavioral Health Hospital, what did you do to better meet and accommodate the needs of the older adult population? Both perhaps from a physical design, but, additionally, from a treatment design. What's your approach? </p> <p> 00:04:54:25 - 00:05:20:29<br> Zaira Khalid, MD<br> Well, we wanted to make sure we had a designated spot and a separate unit, a physically separate unit that was dedicated to older adults so we could focus on the design being different and accommodate all their needs. Simple things like having handrails on the walls in the hallways so that they were able to hold them and walk, which, you know, is not something that you commonly see in an inpatient psychiatric hospital. </p> <p> 00:05:21:01 - 00:05:48:14<br> Zaira Khalid, MD<br> Having a courtyard outside that allows for more relaxation. It's surrounded by trees. There's benches, sunlight. Which is very different than some of the other courtyards we may have for a younger population where they we want them to be a little bit more active. So they've got basketball hoops and such. Things like having call lights. So, a psychiatric hospital, generally we don't have call lights because it can be a safety measure. </p> <p> 00:05:48:17 - 00:06:06:25<br> Zaira Khalid, MD<br> We don't want to have a lot of cords and strings. But for our geriatric unit, we wanted to make sure we have those in case there's a fall while they're using the restroom. We have more bathrooms on this unit that are ADA accessible and have shower chairs so they're able to sit and take a shower with handheld showers so they don't have to stand for too long. </p> <p> 00:06:07:02 - 00:06:29:17<br> Zaira Khalid, MD<br> Those would be kind of some of the design, major design elements that we've tapped into account. And the other was really having staff that has been trained and experienced in dealing with this population and knows what to look for. And it's not just about the treatment they get here, but also what we set them up with once they leave here and staff that has the knowledge of that. </p> <p> 00:06:29:17 - 00:06:51:19<br> Zaira Khalid, MD<br> So how do we set them up with resources that is going to keep them involved in the community, keep them active? And how do we give them tools that they can learn here and continue to utilize outside of here? So that's a social worker that is well versed in some of the resources we have here. The PACE program, which is designed for the elderly, day programs for the elderly. </p> <p> 00:06:51:21 - 00:07:18:22<br> Zaira Khalid, MD<br> We've got activity therapy that is used to doing activities that, you know, may be designed for those with less cognitive reserve, and sometimes it may just be as simple as musical instruments because that's the cognitive capacity we have. We had exercise equipment that some of the activity therapists can bring on to the unit and teach them how to do exercises, just, you know, sitting in the dayroom. </p> <p> 00:07:18:25 - 00:07:36:13<br> Zaira Khalid, MD<br> It's something that they can translate into their own living rooms when they get discharged. So we really wanted to make sure that the staff is able to identify those needs in these patients and help them teach some of the skills that they can also translate outside of here, because this is just a week of their life or two weeks of their life. </p> <p> 00:07:36:16 - 00:08:07:02<br> Rebecca Chickey<br> I had a thought while you were describing all the talents of the staff that you've recruited and wondering - I'm kind of leading the jury here. Also, staff who care and who look forward to working with individuals who are in perhaps their last decades of life. And it's been my experience working in health care for over 30 years now, that there's often less of a shortage for people to work in the labor and delivery unit. </p> <p> 00:08:07:09 - 00:08:20:28<br> Rebecca Chickey<br> They want to see the new life come forward. They want to work with the babies and the new moms. But geriatric care has had its own challenges. So has that been something too, that you've focused in on to find those people with that passion? </p> <p> 00:08:21:00 - 00:08:41:03<br> Zaira Khalid, MD<br> 100%. So everyone that works on the geriatric unit, the staff that has always voiced that they want to work on the geriatric unit and always has in the past. So our social worker has been in geriatrics for a long time. Our activity therapist has been in geriatrics for a long time. So I mean, I love working with the older adults, it's all I do. </p> <p> 00:08:41:05 - 00:09:00:12<br> Zaira Khalid, MD<br> So all of us share that passion and I think that's why we work so well as a team. I think that's why our patients can see that when they're here and getting the care that they want. So for sure, I think passion has a lot to with it. It's not a population that most people choose to work with or want to work with. Something </p> <p> 00:09:00:12 - 00:09:11:17<br> Zaira Khalid, MD<br> I've never understood why - I think it's the absolute best population, the sweetest population, and the most rewarding population you could work with. But the passion of the team is definitely there. </p> <p> 00:09:11:20 - 00:09:34:20<br> Rebecca Chickey<br> Wonderful. I think another, not to say that that what I'm about to say doesn't exist in individuals who are under the age of 65, but often individuals who are 65 or older may have physical illnesses as well. Their diabetes may have gotten to a certain stage or their congestive heart failure. So how do you integrate physical and behavioral health? </p> <p> 00:09:34:22 - 00:09:59:07<br> Zaira Khalid, MD<br> It's a wonderful question. So one of the things that I'm very passionate about is cut down their meds. A huge problem we have in our geriatric population is poly-pharmacy, meaning they see multiple doctors because they need to. And there's a lot of multiple medications being put in. And sometimes they interact. They cause side effects. Then medications are prescribed to counter those side effects. </p> <p> 00:09:59:07 - 00:10:25:25<br> Zaira Khalid, MD<br> And this is a population very sensitive to that. So we have a fantastic family medicine team that we work with very closely. They're in-house seven days a week. A wonderful pharmacist who helps us. And we really try to treat the patient as a whole. So for example, let's say someone gets admitted for uncontrolled anxiety and they've also got diabetes. </p> <p> 00:10:25:27 - 00:10:51:27<br> Zaira Khalid, MD<br> My first approach is not to go ahead and prescribe them something for anxiety. It's to look at their blood sugars, because we know fluctuations in blood sugars caused anxiety, geriatric or not. It's just it's much more prevalent in geriatrics because they're more sensitive to blood sugar fluctuations. So my first thing is let me work with my family medicine counterpart and let's get these blood sugars under control. </p> <p> 00:10:51:29 - 00:11:13:17<br> Zaira Khalid, MD<br> And if we're still seeing the anxiety, then yes, we will intervene with something that is safe, doesn't interfere with their diabetes medicines, their heart medicines, and try to treat those. Working with nutrition, who's here and making sure that these patients have the adequate diet, have the adequate protein levels in order to gain some strength back that they might have lost. </p> <p> 00:11:13:19 - 00:11:21:24<br> Zaira Khalid, MD<br> So putting all those teams together and really having that multidisciplinary approach to patient care, I think is what works really well. </p> <p> 00:11:21:27 - 00:11:33:22<br> Rebecca Chickey<br> Yeah. Whole person care. Who knew? The brain is connected to the rest of the body. Do you have a story you'd like to share for the listeners? A success story when you've seen this approach be used? </p> <p> 00:11:33:25 - 00:11:55:06<br> Zaira Khalid, MD<br> Yes. Actually, the diabetes medication, a story I just example I shared with you was a real life patient. So, I mean, these are all sort of lessons learned, and educating families on how important, you know, managing their blood sugars are. We see this day and night. Another very common thing that I see a lot of times is the sleep. </p> <p> 00:11:55:08 - 00:12:15:20<br> Zaira Khalid, MD<br> You know, a lot of our elderly have trouble sleeping. That leads to irritability the next day. That may lead to behaviors like agitation in a nursing home, or they're coming in because they might have hurt someone in a nursing home. And when we really kind of think back and look back into it, one of the biggest things is sleep. </p> <p> 00:12:15:20 - 00:12:36:19<br> Zaira Khalid, MD<br> It's not that they are agitated because they have bipolar disorder or they have something else going on. It's sleep and having to target that. And once they've gotten a good night's rest for a few nights, they're a completely different person. And I think we can all relate to that. I mean that nobody does well without sleep, but these patients and their brains are much more sensitive to that. </p> <p> 00:12:36:21 - 00:13:10:18<br> Rebecca Chickey<br> Absolutely. So I have a couple more questions before we wrap up. The first is if one of the listeners is thinking about creating such a program as yours in their own organization, whether it's in a freestanding psychiatric hospital like yours, or they're going to try to adapt it inside a general acute care hospital, do you have maybe 2 or 3 things that you think you did as you were planning for this that really provided the successful foundation that you're operating from now? </p> <p> 00:13:10:21 - 00:13:37:06<br> Zaira Khalid, MD<br> So I think number one is what you touched on earlier, having staff that is passionate about this population. It is not an easy population. There's a lot of medications, there's a lot of social factors that are involved. I think one of the other key elements is collaborating with your community resources. We can only do so much. They are going back into the community, and they're going to need those resources. </p> <p> 00:13:37:13 - 00:14:06:25<br> Zaira Khalid, MD<br> So knowing what those resources are, knowing how to refer patients to those resources is going to be extremely, extremely important. Those are two of the biggest things I think that leads to success when treating geriatric patients. And then having a collaborating counterpart that is going to be medicine, because these patients have significant comorbidities that you're going to need the help of your family medicine colleagues, or your internal medicine colleagues. </p> <p> 00:14:06:27 - 00:14:13:07<br> Zaira Khalid, MD<br> I think if you can work together as a team with them, you can really, really help these patients significantly. </p> <p> 00:14:13:09 - 00:14:33:27<br> Rebecca Chickey<br> Well, I'm so inspired. If I had the capability to go start one of these programs, I think I would do it right now. But, I don't. Thankfully, we have professionals like you and the wonderful team at Henry Ford Health. My last question to you is, do you have words of inspiration or a call to action that you'd like to share with the listeners of this podcast? </p> <p> 00:14:33:29 - 00:14:56:16<br> Zaira Khalid, MD<br> Sure. I think Call to Action, for me, the biggest thing would be check in on your older loved ones, please. I think a lot of them are part of a generation that doesn't talk about mental health. They're from a generation that did not necessarily believe in mental health. And, had the mindset of just keep pushing and it'll get better. </p> <p> 00:14:56:16 - 00:15:22:08<br> Zaira Khalid, MD<br> Just keep going and you'll get better. And sometimes it doesn't. Check in on them. Also, please keep a close eye on them for any substance use. We continue to see a rise in substance use in our elderly. It's really leading to a lot of other complications as well. So, you know, I'll give you an example. For example, if a grandmother falls down the stairs, our first instinct is she's old, she tripped and she fell. </p> <p> 00:15:22:10 - 00:15:46:18<br> Zaira Khalid, MD<br> We don't ever test her, or very rarely do we test her for alcohol. Was she intoxicated? Is that why she fell? It's not our first thought. So please look at those things. Look at their safety in their home. See if they're involved in the community or if they're spending all their weeks in their apartment. Get them involved volunteering at the library, community center. </p> <p> 00:15:46:25 - 00:15:55:23<br> Zaira Khalid, MD<br> Day programs, whatever it may be. Giving them a purpose, giving them a routine can be so, so beneficial for them. </p> <p> 00:15:55:25 - 00:16:06:13<br> Rebecca Chickey<br> That's wonderful and exceptional. And thank you so much for your willingness to share your passion, your time, your expertise and to inspire others on this really important journey. </p> <p> 00:16:06:16 - 00:16:14:27<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details></div> Wed, 14 May 2025 00:00:00 -0500 Substance Use Disorder /news/headline/2025-04-29-house-committee-advances-reauthorization-support-act <p>The House Energy and Commerce Committee held a <a href="https://energycommerce.house.gov/events/full-committee-markup-4" title="comm markup">markup</a> April 29 where it advanced the AHA-supported <a href="https://d1dth6e84htgma.cloudfront.net/21_H_R_2483_SUPPORT_for_Patients_and_Communities_Reauthorization_Act_of_2025_12aef9578c.pdf" title="Support Act">SUPPORT Act (H.R. 2483)</a>. The legislation would reauthorize key prevention, treatment and recovery programs for patients with substance use disorder. </p> Tue, 29 Apr 2025 14:42:17 -0500 Substance Use Disorder /news/headline/2025-01-08-samhsa-awards-1-million-grants-15-participants-medicaid-behavioral-health-program <p>The Substance Abuse and Mental Health Services Administration Jan. 7 <a href="https://www.samhsa.gov/newsroom/press-announcements/20250107/biden-harris-administration-awards-fourteen-states-washington-dc-ccbhc-medicaid-demonstration-planning-grants-expanding-access-mental-health-substance-use-disorder-services">announced</a> it will award $1 million grants to 14 states and Washington, D.C., to take part in the Certified Community Behavioral Health Clinic Medicaid Demonstration Program. The program provides states with sustainable funding to help them expand access to mental health and substance use services.  <br><br>The latest states selected are Alaska, Colorado, Connecticut, Delaware, Hawaii, Louisiana, Maryland, Montana, North Carolina, North Dakota, South Dakota, Utah, Washington and West Virginia. Participants must ensure patients have access to a comprehensive range of services that provide care coordination, incorporate evidence-based practices and give support based on a community needs assessment — including crisis services that are available 24/7.</p> Wed, 08 Jan 2025 14:25:57 -0600 Substance Use Disorder /news/headline/2024-12-18-cms-announces-state-participants-innovative-behavioral-health-model <p>The Centers for Medicare & Medicaid Services today <a href="https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model" title="ibh model">announced</a> Michigan, New York, Oklahoma and South Carolina state Medicaid agencies were selected to participate in its state-based Innovation in Behavioral Health Model. The eight-year IBH Model is intended to improve care quality and behavioral and physical health outcomes for Medicare- and Medicaid-enrolled adults with moderate to severe mental health conditions and substance use disorders. The pre-implementation period will begin Jan. 1, 2025, when states will begin to conduct outreach and recruit specialty behavioral health practices to participate in the model.</p> Wed, 18 Dec 2024 15:53:49 -0600 Substance Use Disorder /lettercomment/2024-11-20-aha-urges-congress-address-addiction-treatment-barriers <p>The Honorable Paul Tonko<br>U.S. House of Representatives<br>2369 Rayburn House Office Building<br>Washington, DC 20515</p><p>The Honorable Mike Turner<br>U.S. House of Representatives<br>2183 Rayburn House Office Building<br>Washington, DC 20515</p><p>Dear Representatives Tonko and Turner: </p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to respond to your questions about how hospitals and health systems across the country are working to expand access to addiction treatment and what additional steps Congress can take to eliminate the remaining barriers. We thank you for your bipartisan leadership in developing approaches to better meet the nation’s behavioral health care needs. </p><h2>AHA’S WORK ON ELIMINATING BARRIERS TO ADDICTION TREATMENT </h2><p>Physical and mental health care are inextricably linked, and everyone deserves access to high-quality behavioral health care, including medications for opioid use disorder (MOUD). The AHA has a long history of supporting hospitals and health systems across the country in their work to deliver behavioral health services to their patients and communities. In 2017 we released the first edition of our <a href="/opioids/stem-tide-addressing-opioid-epidemic-taking-action#Epidemic">Stem the Tide </a>toolkit to provide guidance and information to hospitals and health systems on partnering with patients, clinicians and the community to address the opioid epidemic.</p><p>In 2020 AHA released the next edition of this work, <a href="/opioids/stem-tide-addressing-opioid-epidemic-taking-action">The Opioid Stewardship Measurement Implementation Guide </a>— with ideas for driving improvements in opioid stewardship within hospitals and health systems and their communities — and <a href="https://soundcloud.com/advancinghealth/sets/the-power-of-prevention-and">The Power of Prevention and Treatment: An AHA Opioid Stewardship Podcast Series </a>to encourage discussion on how hospitals and health systems are improving access to opioid use disorder (OUD) care and what supports are needed to continue to improve care and access for patients and their communities. </p><p>Now, in 2024, we are encouraged by the progress to ease barriers to life-saving addiction medicine, but more work remains. AHA, through its affiliate Health Research & Education Trust, was recently awarded a <a href="/news/headline/2024-10-24-aha-receives-cdc-grant-address-opioid-stimulant-use-disorder-and-expand-infection-prevention-resources">grant </a>to support hospital and health system efforts to strengthen linkage to and retention in care for people with OUD and stimulant use disorder (StUD). Funded by the Centers for Disease Control and Prevention, this project aims to expand evidence-based and evidence-informed efforts to link people to care, treatment and recovery services for OUD and StUD. Specifically, the project seeks to develop resources that bolster cross-continuum collaboration and ultimately improve patient retention in and across three clinical settings: inpatient care, primary care and pharmacy. We will keep you updated on this project in the months to come. </p><p>AHA also has been working to reduce the stigma surrounding addiction and seeking treatment for substance use disorders (SUD) by partnering with behavioral health and language experts from member hospitals and partner organizations to release a series of downloadable posters — <a href="/people-matter-words-matter">People Matter, Words Matter </a>— to help create a culture of patient-centered, respectful language for addiction and SUD care. We have heard from our members that these posters have proved to be a valuable addition to their facilities to encourage more respectful dialogue among health care professionals and visitors alike. </p><h3>AHA Member Case Studies </h3><p>Nationwide, hospitals and health systems are engaged in extraordinary work to improve access to effective and high-quality treatment for SUDs. We felt it would be helpful to answer your questions by sharing a few examples from our members, in their own words, about what is going well and what challenges remain. Because each program is ongoing, it may have evolved or experienced changes in personnel since publication. We encourage you to take a look at our <a href="/advocacy/access-and-health-coverage/access-behavioral-health">website </a>for additional podcasts and resources. </p><ul><li><strong>Hospital Team Sets Patients Up for Successful Treatment and Recovery (</strong><a href="/advancing-health-podcast/2020-08-18-changing-way-we-approach-opioid-use-disorder"><strong>Case Study)</strong></a>. The Buprenorphine Team — or B team — was formed at Dell Seton Medical Center in Austin, Texas, in collaboration with Dell Medical School at the University of Texas at Austin. The B team consists of physicians, nurses, pharmacists, social workers, chaplains and other health care professionals who provide information about buprenorphine and the best care for those with SUD.</li><li><strong>Small Rural Hospital Helps Build ‘Bridge’ to Addiction Services with New Mobile Clinic (</strong><a href="/system/files/media/file/2023/03/Behavioral-Health-Case-Study-Phys-Integration-Baystate.pdf"><strong>Case Study)</strong></a><strong>.</strong> With several key community partners, Greenfield, Mass.-based Baystate Franklin Medical Center established a mobile, home-based treatment service for its rural community located about 100 miles northwest of Boston. Fueled by a $1 million grant from the Health Resources and Services Administration’s (HRSA) Rural Communities Opioid Response Program, the Franklin County and North Quabbin Bridge Clinic aims to help meet patients where they are — be it a recovery center, library, a home or the Salvation Army.<em> </em></li><li><strong>Partnerships to Address Substance Use Disorders (</strong><a href="https://soundcloud.com/advancinghealth/presbyterian/s-QbTMA"><strong>Podcast)</strong></a><strong>.</strong> Presbyterian Healthcare Services is a not-for-profit integrated health system in New Mexico with nine hospitals, a medical group and a health plan. In this podcast, Daniel Duhigg, D.O., medical director for addiction services at Presbyterian Healthcare Services, discusses how their Integrated Substance Use Disorder and Community Collaborative Initiative uses a holistic approach to strengthen and improve outcomes for patients, families and health plan members affected by SUDs.<em> </em></li></ul><h2>REMAINING POLICY AND REGULATORY BARRIERS<strong> </strong></h2><h3>Bolster Reimbursements for Behavioral Health Providers </h3><p>Traditional fee-for-service payment systems, including Medicare, inadequately reimburse providers across the behavioral health service continuum. Fee-for-service payment structures rarely reimburse for important time-based (as opposed to procedure-based) elements of behavioral health care, such as coordinating care across providers and settings or for care management that does not occur face-to-face, including referrals and case management. Current reimbursement levels also reflect an undervaluing of behavioral health services, which may require more evaluation, clinical expertise and time than certain medical services. For example, unlike anemia, schizophrenia cannot be identified with a blood test; similarly, diagnostic imaging can reveal broken bones but not depression. Because identification, diagnosis and treatment of behavioral health disorders often involve using multiple tools and therapies, a simple fee-for-service payment structure cannot capture the wide span of costs incurred by behavioral health specialists. In addition, separate funding streams and benefit structures for psychiatric and SUDs create barriers and limit the integration of behavioral health care with other medical and surgical services. This is particularly true for the Medicaid program, the largest payer of behavioral health care. </p><p>In addition to underpaying for care and thus limiting providers’ ability to take on new patients, it is important to consider how low reimbursement rates may discourage the recruitment and retention of the next generation of behavioral health professionals required to serve the growing need for behavioral health care. </p><h3>Repeal the Institution for Mental Diseases Exclusion </h3><p>As Congress continues to look for ways to improve access to needed SUD treatment services for Americans and to reduce the stigma associated with these health conditions, we encourage you to permanently repeal the Institution for Mental Diseases (IMD) exclusion of federal Medicaid funding to pay for inpatient behavioral health treatment (including SUD and mental health services) in certain inpatient facilities. SUD treatment requires access to the full continuum of care, including inpatient care, partial hospitalization, residential treatment and outpatient services. Different types of patients require different clinical services across the care continuum, and the IMD exclusion currently blocks critical elements of that care. These patient populations include adolescents, pregnant women, individuals with unstable housing, people with high relapse potential, and individuals who have OUD or other SUDs with co-occurring alcohol or benzodiazepine addictions. Investing only in outpatient or community-based care and failing to provide states with relief from the IMD exclusion would continue to deny many of these patients access to the most clinically appropriate care. To alleviate the dire shortage of inpatient psychiatric beds, <strong>Congress should permanently repeal the IMD exclusion to allow federal Medicaid dollars to pay for clinically appropriate inpatient care.</strong> </p><h3>Remove the 190-day Lifetime Limit </h3><p>As we work to better address the nation’s health needs by further integrating physical and behavioral health, the 190-day lifetime limit on coverage under Medicare is another remaining antiquated obstacle. Medicare currently covers only 190 days of inpatient care in a psychiatric hospital in a person’s lifetime. No other Medicare specialty inpatient hospital service has this type of arbitrary cap on benefits. For many patients, chronic mental illness will be a lifelong journey and could far exceed 190 days of inpatient treatment, leaving them to rely on other sources of financing (including Medicaid and Social Security) to pay for long-term services in non-psychiatric settings that may be inadequate for their care. </p><p>With the nation’s population aging and an increasing number of seniors and people with disabilities seeking inpatient care to address their behavioral health needs, now is the time to repeal this outdated and discriminatory policy and ensure that Medicare beneficiaries can receive necessary inpatient psychiatric care. <strong>The AHA supports bipartisan legislation such as the Medicare Mental Health Inpatient Equity Act of 2023 (H.R. 4946) to remedy this discriminatory policy.</strong></p><h3>Repeal In-person Telehealth Requirement for Behavioral Health </h3><p>Behavioral health is one specialty that has seen sustained growth in telehealth utilization. In fact, prior to the pandemic, telehealth visits accounted for less than 1% of behavioral health visits. During the pandemic, they peaked at about 40% of all behavioral health visits and have been sustained at around 36%.<sup>1</sup> There continues to be an increasing demand for behavioral health services, but additional flexibilities are required to ensure the people who need them most can access these services. </p><p>The Consolidated Appropriations Act of 2021 requires that a patient must receive an inperson evaluation six months before they can initiate behavioral telehealth treatment, plus an annual in-person visit. From an access perspective, requiring an in-person visit six months before and annually after may serve as an additional barrier to receiving care, particularly for patients in rural or underserved areas. </p><p>The progression to a permanent pathway for waiving in-person visits has been delayed due to concerns about diversion risk. We recognize and appreciate the important role the Drug Enforcement Agency (DEA) plays in mitigating the diversion risk. However, significant data demonstrates that increased access to MOUD is only associated with improved outcomes, not increased misuse risks, and any diversion risks can be mitigated with efforts already in place.<sup>2</sup> The DEA relies on a general assumption that because controlled substances <em>can</em> be misused, an increase in access results in increased risk. This assumption not only overstates the risk of diversion but also fails to consider the millions of Americans who may be harmed by an inability to access medically necessary medication through virtual prescribing. <strong>In many cases, seeing a provider in person is simply not an option for some patients, whether due to physician shortages, mobility issues or transportation challenges.</strong> For example, there is a national shortage of psychiatrists and other behavioral health providers; indeed, according to HRSA, 123 million people live in a mental health provider shortage area, and the American Psychiatric Association projects a shortage of over 12,000 psychiatrists by 2030.<sup>3,4</sup> Therefore, remote services are becoming increasingly important to link geographically dispersed patients to prescribers for medications like buprenorphine. </p><h3>Establish DEA Special Registration Process for Telemedicine for Administration of Controlled Substances </h3><p>The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 outlined specific requirements for in-person evaluations prior to prescribing controlled substances. In conjunction with these requirements, this law also outlined seven categories where telemedicine could be utilized, including but not limited to public health emergencies (PHEs) (the basis for the waiver during COVID-19), a special registration obtained from the attorney general, and other circumstances to be defined by regulation. The Ryan Haight Act went on in Sec. 311(h)(2) to specify that the attorney general shall promulgate regulations specifying circumstances in which a special registration for telemedicine prescribing may be issued and the procedures for obtaining such a special registration. In other words, it was never the intention of Congress to permanently and unilaterally restrict access to telemedicine prescriptions of controlled substances issued by legitimate prescribers for clinically appropriate purposes. </p><p>The SUPPORT Act of 2018 again mandated that the DEA, in coordination with the Department of Health and Human Services, promulgate special registration final regulations specifying: (1) the circumstances in which a special registration for telemedicine may be issued that authorizes prescribing of controlled substances without an in-person evaluation; and (2) the procedure for obtaining a special registration. The COVID-19 pandemic provided an opportunity for the DEA to learn from the broad utilization of telemedicine prescribing and set forth policies and pathways for providers to continue to safely administer prescriptions virtually, even after the PHE period ended. <strong>Unfortunately, despite the Ryan Haight Act requirement that the DEA establish a special registration process </strong><em><strong>nearly 16 years ago</strong></em><strong>, and subsequent reinforcement of this requirement over five years ago in the SUPPORT Act, the agency still has not created one.</strong> </p><p><strong>We ask Congress to consider the following: </strong></p><ul><li>Continue to urge the DEA to require proposed and final rulemaking from agencies for the special registration for telemedicine regulation.</li><li>Grant a permanent exception for separate registrations for practitioners in states with medical licensing reciprocity requirements.</li><li>Require agencies to provide a proposed interim plan if there is ever a gap in PHE waivers and rulemaking. </li></ul><h3>Medication-assisted Treatment in Emergency Departments </h3><p>To help prevent SUD relapses, Congress can also provide additional support for programs that fund hospital efforts to initiate medication-assisted treatment (MAT) in emergency departments (EDs). The SUPPORT Act requires Medicaid programs to cover MAT from October 2020 through September 2025, and it expands certain providers’ ability to treat up to 100 patients in the first year of receiving a waiver. However, access to these programs remains limited. The AHA supports making this change permanent, as well as expanding grant funding for hospitals and other entities to enable the development of protocols for discharging patients from the ED who have overdosed on opioids, which may include providing MAT, connecting patients with peer support specialists, and supporting referrals to community-based treatment.   </p><h3>Eliminate Prior Authorization for MOUD  </h3><p>Millions of Americans rely on commercial insurers for their health care coverage, including Medicare Advantage (MA) plans through the Medicare program. Unfortunately, practices such as prior authorization can result in inappropriate denials, additional burdens on providers and ultimately delays in a patient’s access to needed care. </p><p>The AHA remains particularly concerned with current prior authorization practices for MAT that are not evidence-based and lack uniformity with insurers. Because many mental health services are more time-based than physical health services, with fewer quantitative ways to measure outcomes, these processes take a disproportionate toll on behavioral health services. Studies have shown that, compared with patients whose insurance did not impose prior authorization restrictions on their medication, odds of treatment effectiveness were 19-29% lower due to lack of medication adherence.<sup>5</sup> Payer practices that restrict access to care include overly broad use of prior authorization, automatic denials (most of which are overturned upon appeal), inappropriate delays of approvals, and insufficient provider networks. </p><p>To address these practices within MAT, Congress should: </p><ul><li><strong>Require</strong> a list of drugs subject to prior authorization that is uniform across insurers to provide consistent information to patients and providers.</li><li><strong>Make clear</strong> that coverage across the entire treatment spectrum is necessary (rather than requiring prior authorization each time the prescription is filled).</li><li><strong>Pass</strong> comprehensive legislation to streamline prior authorization requirements such as the Improving Seniors’ Timely Access to Care Act. </li></ul><h3>Strengthen the Health Care Workforce </h3><p>The chronic underfunding for behavioral health services has hampered hospitals’ and health systems’ ability to retain critical staff, especially as the financial pressures of the past several years further eroded hospitals’ ability to subsidize these services. As the need for behavioral health services continues to rise, the nation is ill-prepared to respond to these needs due to severe shortages in the behavioral health workforce. A key action needed to support and expand the behavioral health workforce is the elimination of policies that make it harder for existing providers to treat patients. </p><p>Reducing barriers to licensure can help maximize limited provider capacity, particularly in areas with shortages of practitioners. <strong>The AHA supports efforts to ensure that licensure processes are streamlined for providers employed by hospitals and health systems operating across state lines and encourages additional research on the feasibility, infrastructure, cost and secondary effects of licensure.</strong> </p><p>We are committed to working with the health care field, Congress and the Administration to address long-term workforce. The AHA recommends the following suggestions to support the behavioral health workforce: </p><ul><li><strong>Reauthorize</strong> the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program.</li><li><strong>Invest</strong> in graduate medical education and increase slots for behavioral health in underserved areas.</li><li><strong>Streamline</strong> and simplify licensure application and processing by reducing the variability of scope-of-practice laws and support changes that drive integration of care teams. </li></ul><h2>CONCLUSION </h2><p>We thank you for your leadership and dedication to finding bipartisan solutions to address these important issues. As you know, there is still more work to be done to reduce barriers to receiving and administering behavioral health services, and we look forward to working with you on these future efforts. </p><p>Sincerely, </p><p>/s/ </p><p>Lisa Kidder Hrobsky<br>Senior Vice President, Legislative and Political Affairs </p><p>__________<br><sup>1</sup> Centers for Disease Control and Prevention. "Increased Use of Telehealth for Opioid Use Disorder Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose." CDC Online Newsroom, August 31, 2022. <a class="ck-anchor" href="https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html" id="https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html">https://www.cdc.gov/media/releases/2022/p0831-ccovid-19-opioids.html</a><br><sup>2</sup> Gary Qian, Keith Humphreys, Jeremy D. Goldhaber-Fiebert, Margaret L. Brandeau. "Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis." Drug and Alcohol Dependence 256 (2024). <a class="ck-anchor" href="https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub" id="https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub">https://www.sciencedirect.com/science/article/abs/pii/S0376871624000334?via%3Dihub</a> <br><sup>3 </sup><a href="https://data.hrsa.gov/topics/health-workforce/shortage-areas">https://data.hrsa.gov/topics/health-workforce/shortage-areas</a>  <br><sup>4</sup> <a href="https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/workforce-development">https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/workforce-development</a>  <br><sup>5 </sup>Boytsov, N., Zhang, X., Evans, K.A. <em>et al.</em> Impact of Plan-Level Access Restrictions on Effectiveness of Biologics Among Patients with Rheumatoid or Psoriatic Arthritis. <em>PharmacoEconomics Open</em>4, 105–117 (2020). <a href="https://doi.org/10.1007/s41669-019-0152-1">https://doi.org/10.1007/s41669-019-0152-1 </a> </p> Wed, 20 Nov 2024 13:25:30 -0600 Substance Use Disorder /advancing-health-podcast/2024-09-27-saving-peoples-lives-access-mental-health-and-addiction-services-rural-communities <p>Accessing mental health and addiction services can be especially difficult in rural communities, and solutions can be scarce. In this conversation, Brenda Romero, administrator at Presbyterian Española Hospital, discusses the methods for accessing treatment and the importance of the hospital's innovative and community-focused work.</p><hr><div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br>   </h2> </summary> <p> 00:00:00:09 - 00:00:21:21<br> Tom Haederle<br> Distance and lack of transportation. Obtaining a prescription and then paying for it. These are just some of the challenges that make accessing mental health and addiction services especially difficult in rural communities. </p> <p> 00:00:21:24 - 00:00:43:01<br> Tom Haederle<br> Welcome to Advancing Health, a podcast from the ���������� Association. I'm Tom Haederle with AHA Communications. Access to quality care in rural communities often presents problems that defy easy solutions. Still, there are workarounds, as we learn in this podcast hosted by Rebecca Chickey, the AHA's senior director for clinical affairs and workforce. </p> <p> 00:00:43:04 - 00:01:06:17<br> Rebecca Chickey<br> Indeed, it's an honor to be here today with Brenda Romero. I have known her for over a decade now. She is a past member of AHA's Committee on Behavioral Health, our national advisory committee that helps us with our advocacy and policy, as well as resource work. And that's why Brenda is here today as a CEO of a small rural hospital in New Mexico. </p> <p> 00:01:06:19 - 00:01:31:21<br> Rebecca Chickey<br> She has a great deal of experience, some of which she's going to share with you here today about improving access to mental health and addiction services in a small rural community. So, Brenda, welcome. Thank you for sharing your time and expertise. My first question to you is, what are a couple of the biggest challenges to accessing behavioral health in a rural community? </p> <p> 00:01:31:25 - 00:01:37:09<br> Rebecca Chickey<br> For those many, many listeners who live in an urban, metropolitan area, help them understand. </p> <p> 00:01:37:11 - 00:02:09:20<br> Brenda Romero<br> The first issue is access to the care in that rural communities don't usually have taxis. Transportation is an issue. And for people who are suffering from this illness, they're usually couch surfing or living out in the streets. And so finding them and getting them to the care is usually the first issue that we encounter. And the second is getting them the medication. The cost </p> <p> 00:02:09:20 - 00:02:38:15<br> Brenda Romero<br> of the medication can be up to $500 a month. And getting them the prescriptions is one thing, but then getting them the medications is another. Usually people with that presentation don't have a payor source, and so then it would require somebody giving them that money and willing to support that every single month. In order to increase compliance with medication treatment </p> <p> 00:02:38:20 - 00:03:03:26<br> Brenda Romero<br> we have started using some medications, like Brixadi, that we can give in the ER or in our infusion center, and it'll last a whole month. And we're using that type of medication for pregnant women that present and that we're not sure if we're going to see again for some time. And so that's been helpful. </p> <p> 00:03:03:28 - 00:03:27:15<br> Rebecca Chickey<br> So I'm going to hit home with a couple of things that you said for people who live in Chicago or New York or even Nashville, Tennessee, where I lived for a number of years. The fact that there's not a taxi is really sort of like, what? And I suppose that same lack of transportation services, you don't have an abundance of Uber drivers or Lyft drivers in your community either, right? </p> <p> 00:03:27:16 - 00:03:53:11<br> Brenda Romero<br> No, it's not available. And when you're talking about where these patients need to come from, we are in Espanola and there's about, there's less than 10,000 people that actually live in the city. And then there's Rio Arriba county, and it can be 100 miles to one of the borders. So we're talking about they come from surrounding communities. So it's not like somebody can walk there. </p> <p> 00:03:53:13 - 00:03:55:13<br> Brenda Romero<br> They need to find a ride. </p> <p> 00:03:55:15 - 00:04:18:17<br> Rebecca Chickey<br> And so that means relying on family or friends who may or may not also have transportation services. So just that physical capability of getting to the hospital or the emergency room is a challenge that many of our listeners probably can't imagine, but I can. Having grown up in rural Alabama, when EMS tried to get to my father, they couldn't find the house because there was no GPS at that time. </p> <p> 00:04:18:19 - 00:04:49:26<br> Rebecca Chickey<br> The next thing that you mentioned is the cost of the medications. So that's not unique to mental health. There always seems to be an article in the news or a discussion somewhere about the cost of medications, but these medications are for our most fragile patient populations because they often, and please correct me if I'm wrong, but they often have physical comorbidities as a result of or perhaps one of the reasons that they may be self-medicating with substances. </p> <p> 00:04:50:03 - 00:04:56:29<br> Rebecca Chickey<br> So their physical health and their mental health are often fragile and being challenged. Is that an accurate statement? </p> <p> 00:04:57:01 - 00:04:58:09<br> Brenda Romero<br> Yes. </p> <p> 00:04:58:11 - 00:05:16:02<br> Rebecca Chickey<br> And so because of that, tell me why it's so important to be able to provide a medication that lasts for a month. Is that to know that you don't have to worry after that because of compliance issues, because the patients are actually going to, they don't have to worry about that then. </p> <p> 00:05:16:05 - 00:05:48:23<br> Brenda Romero<br> Yes, it's not only compliance, but it's actually getting the medication. And so usually they don't have a payor source so they don't have Medicaid. And if they have Medicare due to a disability, they usually haven't signed up for part D or any of the other parts that they need to get payment for the medications, for prescriptions. And so if they were to try to go get their medications and be compliant with that, most times they wouldn't even get the medications because they can't pay for them. </p> <p> 00:05:48:26 - 00:06:07:24<br> Brenda Romero<br> And if a family member is willing to start them on it, like pay for the first month, it's pretty hard to get somebody to commit to just continue to pay for that. In order to get them on Medicaid, they would have to then get all the paperwork in order to apply. And they can apply online. </p> <p> 00:06:07:24 - 00:06:28:24<br> Brenda Romero<br> But some of these older folks don't have the capacity to be able to do that. They don't have the phone. They don't have the experience with getting on a website and filling in all the information that they need. And some of that information that they might need is to upload a copy of the birth certificate, and they might not have the birth certificate. </p> <p> 00:06:28:26 - 00:06:37:12<br> Brenda Romero<br> So the barriers are huge for them. They can't get there. And so I think that... </p> <p> 00:06:37:15 - 00:06:40:28<br> Rebecca Chickey<br> So what's your solution? What have you been creating, what have you been innovating. </p> <p> 00:06:40:28 - 00:07:01:18<br> Brenda Romero<br> So what we've done is we've started the treatment in the emergency room and then following them up in the clinic. And if we can get them started on medication, then we can buy more time to work with peer counselors, to work with case managers to help them get what they need in place in order to continue the treatment. </p> <p> 00:07:01:21 - 00:07:29:00<br> Brenda Romero<br> We are also encouraging the homeless shelters to work with the homeless population and to get them to our E.R. if they can do that. Presbyterian Healthcare Services, organization I work for, is now also asking if our paramedics can start giving out some of the medication when they respond to a call, if the patient is willing to start the treatment at the time. </p> <p> 00:07:29:07 - 00:07:37:17<br> Brenda Romero<br> So we're trying to figure out how to get the medications to folks where we can, even if they can't afford to do it. </p> <p> 00:07:37:19 - 00:08:04:08<br> Rebecca Chickey<br> So it sounds like you're taking advantage of every opportunity where there's a touchpoint with a patient that has this need. Yes. That's phenomenal. It's, I think, a broader sense of patient-centered care. You're going to where the patients are and providing the services. So do you think this innovative idea is replicable? Can it be implemented by other organizations in a similar crisis situation? </p> <p> 00:08:04:08 - 00:08:11:23<br> Rebecca Chickey<br> I would say because the challenges that you described almost seem insurmountable. But do you think others could replicate it? </p> <p> 00:08:12:00 - 00:08:35:21<br> Brenda Romero<br> Yes. Also, keeping in mind that, especially at the beginning, they're not going to have a payor source, right? So we're going to have to start that and not be reimbursed for that. But it makes a huge difference, not only most importantly to that person's life. Right? Like, who wants to be suffering like that? And then it starts improving their participation in society </p> <p> 00:08:35:21 - 00:09:02:27<br> Brenda Romero<br> and with their family members. And in our area it's a very family-oriented area, and most people who don't have a place to live will have a place to live if they sober up. And so reuniting those patients with their families is just, it would be an amazing thing to do. And then their reentry into their communities would be another win for everybody, right? </p> <p> 00:09:03:00 - 00:09:25:08<br> Brenda Romero<br> And makes it a safer place for the patient and for the communities that they live in. And so I think it's very, very important. I think it's worth it to everybody. There's something in it for everyone. And I think that one way to start is to assess what the barriers are, what are the barriers that those patients in your community are experiencing. </p> <p> 00:09:25:08 - 00:09:37:07<br> Brenda Romero<br> Because as you said, bigger communities have transportation. They have other ways to get around. So the patients in their community might not have the same barriers that we have in ours. </p> <p> 00:09:37:14 - 00:09:59:26<br> Rebecca Chickey<br> Yeah. As you were describing the long-term impact of this, if an individual gets on a medication that helps them remain sober for a month, then that gives them hope, then they may be able to get traction to go back and live with their family. Then they may be able to get a job. And that is something that is priceless, right? </p> <p> 00:09:59:29 - 00:10:26:15<br> Rebecca Chickey<br> You can't really put a price on giving someone their humanity back. But at the same time, the reality is that often no margin, no mission. So I realized that this is a new innovative initiative that you undertake, and so you probably haven't, you don't have hard data on that. But I would assume that what you're hoping is that you're going to see fewer emergency room visits, which we all know are costly. </p> <p> 00:10:26:17 - 00:10:54:12<br> Rebecca Chickey<br> I assume that you're going to have less use of emergency services outside, sending someone out to rescue someone who is in a crisis from a substance use disorder. And perhaps even you will see a reduction long term in things like cirrhosis, in things like congestive heart failure, in wound care for individuals, depending upon what the substance is. Is that what you're hoping for in the long run? </p> <p> 00:10:54:15 - 00:11:21:19<br> Brenda Romero<br> Yes. But most importantly, saving people, saving people's lives, right? They are at risk of death every day, premature death every day. And there's a lot of violence that's, you know, associated with this diagnosis. And so not only the patient's life, but their family and friends and other community members walking around. I mean, it would improve all of that also. </p> <p> 00:11:21:21 - 00:11:33:08<br> Rebecca Chickey<br> So it's a population health approach, I agree. Thank you. So much, one, for the work that you're doing. Boots on the ground, making a difference in individuals' lives. And thank you for sharing that inspiration with us here today. </p> <p> 00:11:33:10 - 00:11:34:27<br> Brenda Romero<br> Thank you. </p> <p> 00:11:35:00 - 00:11:43:10<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details> </div> Thu, 26 Sep 2024 23:07:39 -0500 Substance Use Disorder /2024-09-26/transforming-behavioral-health-journey <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-09/Iris-Telehealth-banner-1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Transforming the Behavioral Health Journey</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Transforming the Behavioral Health Journey</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="/system/files/media/file/2024/09/IrisTelehealth-TransformingBehavioralHealth-ke-092624.pdf" target="_blank"><img src="/sites/default/files/2024-09/Iris-Telehealth-cover-910x1220.jpg" alt="AHA Knowledge Exchange | Transforming the Behavioral Health Journey" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Finding the path to a sustainable, service continuum</h2><p>An estimated one in four Americans will require behavioral health services by 2026 according to Trilliant Health research. Behavioral health disorders include both mental illness and substance use disorders. Health systems increasingly are seeking ways to drive innovative, transformative change around this service line to solve critical challenges affecting behavioral health care delivery. This Knowledge Exchange ebook explores how hospitals and health systems are investing and partnering in behavioral health, where they face challenges and opportunities for strategic alignment and financial sustainability, and how they aim to leverage behavioral health to support their communities.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="/system/files/media/file/2024/09/IrisTelehealth-TransformingBehavioralHealth-ke-092624.pdf" title="AHA Knowledge Exchange | Transforming the Behavioral Health Journey" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat"><strong>Sponsored by: </strong><a href="https://iristelehealth.com/" target="_blank" rel="noopener nofollow"><img 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sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>10 strategic initiatives and investments that health leaders can prioritize for sustainable behavioral health services in their communities</h3><div class="sp_CTA5_section"><ul><li><strong>Identify community behavioral health needs and gaps</strong> in care to develop a comprehensive, integrated strategy as part of health and the continuum of care.</li><li><strong>Integrate physical and behavioral care in primary care settings</strong>, including pediatrics and obstetrics, as a way to focus on early prevention, screening and treatment.</li><li><strong>Partner, collaborate and joint venture</strong> with other hospitals, providers, schools and community organizations to build and create sustainable and coordinated behavioral health services.</li><li><strong>Research new approaches to addressing psychiatric emergencies</strong>, such as EmPath units and behavioral health urgent care, to determine the best fit for the needs of your community.</li><li><strong>Establish a coordinated community response to crisis situations</strong>, working in partnership with other health care providers, EMS, and law enforcement to provide the patient with the appropriate level of treatment and stabilization.</li><li><strong>Consider alternative use of vacant space in facilities and malls</strong> as locations for pieces of the behavioral health care continuum.</li><li><strong>Examine the existing continuum of behavioral health services</strong>, matched against community needs, and research options to fill the gaps and enhance the continuum.</li><li><strong>Where needed, augment substance use disorder care</strong> with detox units, long term injectables, and support with health related social needs, such as housing and employment.</li><li><strong>Improve access to behavioral health care in a multitude of ways</strong>, including telehealth, transportation to in-person care, peer-delivered interventions, and prescription digital therapeutics.</li><li><strong>Address workforce shortages through a multi-pronged approach including expansion of telehealth services</strong> across the care continuum, provision of integrated physical and behavioral care, use of peers/individuals with lived experience, and supporting the mental well-being of the behavioral health workforce.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media (max-width:991px) { .people { margin: auto; } .people p { text-align: center } } .ci_profile { margin-bottom: 30px; display: block; text-align:center /* this is for the "Executive Dialogue" page */ } @media (max-width:991px) { .ci_profile { text-align: center } } .ci_profile p { margin: 0 0 7px 0 } .ci_profile_name { font-weight: 700; font-size: 20px; } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .ci_profile_title { font-style: italic; line-height: 1.3em } .ci_profile_company { font-size: 1em; } p.ci_profile_award { font-size: .8em; text-align:center; color:#55555599; font-weight: 700 } .ci_profile_social { width: auto; } .ci_profile_social i { padding-right: 25px; font-size: 20px } .ci_profile_social a:last-of-type i { padding-right: 0px; } #ci_footer-social { font-size: 1.5em; padding-top: 0px; width: 100%; text-align: right; } @media (max-width:991px) { .ci_logo { margin-top: 25px } .ci_social p { text-align: center !important; } #ci_footer-social { text-align: center } } @media (min-width:769px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 3; /* 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src="/sites/default/files/2024-09/Augsburger_Marc_300x300.png" alt="Marc Augsburger" width="300" height="300"><p class="ci_profile_name">Marc Augsburger, MBA, BSN, RHCEOC</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Edgerton Hospital and Health Services</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Flanagan_Andrew_300x300.png" alt="Andrew Flanagan" width="300" height="300"><p class="ci_profile_name">Andrew Flanagan</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Iris Telehealth</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Hodshire_Jeremiah_300x300.png" alt="Jeremiah Hodshire" width="300" height="300"><p class="ci_profile_name">Jeremiah Hodshire</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Hillsdale Hospital</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Kirby_Rudy_300x300.png" alt="Ruby Kirby" width="300" height="300"><p class="ci_profile_name">Ruby Kirby, R.N.</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">West Tennessee Healthcare (Bolivar and Camden hospitals)</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Koekkoek_Doug_300x300.png" alt="Doug Koekkoek" width="300" height="300"><p class="ci_profile_name">Doug Koekkoek, M.D., FACP, SFHM</p><p class="ci_profile_title">Chief physician and clinical executive</p><p class="ci_profile_company">PeaceHealth</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/LaFrance_Judy_300x300.png" alt="Judy LaFrance" width="300" height="300"><p class="ci_profile_name">Judy LaFrance, MSN, R.N., NE-BC</p><p class="ci_profile_title">Chief administrative officer</p><p class="ci_profile_company">Hendrick Medical Center South</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Moore_Ed_300x300.png" alt="Edward Moore" width="300" height="300"><p class="ci_profile_name">Edward Moore</p><p class="ci_profile_title">President</p><p class="ci_profile_company">UMass Memorial Health Harrington Hospital</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Muller_Melinda_300x300.png" alt="Melinda Muller" width="300" height="300"><p class="ci_profile_name">Melinda Muller, M.D.</p><p class="ci_profile_title">Chief medical officer</p><p class="ci_profile_company">Legacy Health</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Romero_Brenda_300x300.png" alt="Brenda Romero" width="300" height="300"><p class="ci_profile_name">Brenda Romero, R.N., MSN</p><p class="ci_profile_title">Hospital chief executive</p><p class="ci_profile_company">Presbyterian Española Hospital</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-09/Trestman_Robert_300x300.png" alt="Robert Trestman" width="300" height="300"><p class="ci_profile_name">Robert Trestman, Ph.D., M.D.</p><p class="ci_profile_title">Professor and chair, department of psychiatry</p><p class="ci_profile_company">Carilion Clinic</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-04/Hoppszallern_Suzanna_300x300%20%281%29.png" alt="Suzanna Hoppszallern" width="300" height="300"><p class="ci_profile_name">Moderator:</p><p class="ci_profile_name">Suzanna Hoppszallern</p><p class="ci_profile_title">Senior Editor, Center for Health Innovation</p><p class="ci_profile_company">���������� Association</p></div></div></div>@media (min-width:768px){ .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc(33.3% - 2px) /*Safari Fix*/; } } .center_callout_3invert { background-color: #f6f6f6; text-align: center; 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