Implementing the IOM Report:
The TRI-State Policy Program
ACADEMY HEALTH
Mady Chalk, Ph.D.
Treatment Research Institute
June, 2006
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The Presentation
1. Implementing the IOM Report
2. Creating an Environment for Exchange
of Information and Identification of
Priority Policy Concerns in States
3. Developing a Mutual Assistance Effort
4. Identifying and Testing Solutions That
“Work”
5. Carrying Out Practical, Real World
Evaluations
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The IOM Report
• Health Care Focus, e.g., mainstream
medicine
• Linking Funding to Quality
• Patient-centered Care, e.g., longterm management support,
concurrent recovery monitoring
• Coordination of care
• Data accessibility
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State Level Policy and Substance
Abuse
• Discrepancy between what is known
and what is delivered
• Lack of incentives in public sector
funding to drive quality improvement
• Disconnected delivery arrangements
lead to ineffective treatment
• Workforce
• Data infrastructure
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State Priority Concerns
• Performance and Outcome
Measurement in Collaboration with
Treatment Providers
• Data Reporting and Management
• Collaborative Financing of All Types
• Integrating Substance Use and Health
Care: SBIRT; PRISM (mainstream
medicine); Concurrent Recovery
Monitoring
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State Priority Concerns (Con’t)
• Use of Incentives in Purchasing For:
• Treatment of priority populations
• Implementation of administrative
and clinical best practices to
improve access and retention
• Becoming “co-occurring capable”
• Creating a “medication friendly”
environment in treatment
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Creating the Environment
In order for States to work together
the environment must allow for:
• Continuity over time
• Unofficial deliberations
• Neutrality of sponsoring organization
• Moderating presence of some
disinterested members
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Creating the Environment
• Access to expert consultation and
background papers from research,
other businesses with similar issues
• Structured opportunity for regular
discussion
• Practical, real world evaluations
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Advantages of Mutual Assistance
• Practices, policies and procedures
have a higher likelihood of success
and practicality since they are
derived from common experience
rather than academic research;
• Findings of a consortium of states
will have greater political traction
than the same findings resulting from
a single state’s efforts;
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Advantages of Mutual Assistance
• Multiple issues can be worked on
simultaneously because more
sources of potential “solutions” are
identified;
• Documentation of comparative
results will become part of the
“evidence base” providing greater
legitimacy for state policies.
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The TRI-State Policy Program
TRI’s Role:
• Providing an Environment for Open
Exchange of Information, Identification of
Policy Concerns, and Problem-Solving
• Focusing on Specific Policy Areas That
Will Reform the Treatment System
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The TRI State Policy Program
TRI’s Role:
• Providing Strategic Information from
Some Other Industries That Can Be
Used By State SA Agencies
• Evaluating Implementation Experiments
• Hosting Long-Term Working Groups to
Develop Approaches to Knotty Policy
Problems
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How Will States Work Together?
• Prioritize a common set of two or
three policy, performance, business,
administrative and/or financing
issues;
• Describe and circulate promising
approaches that may have already
been tried by member states;
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How Will States Work Together?
• From the promising practices and
group discussion create a practical
evaluation of an improvement
protocol to implement within
member states;
• Analyze data from the evaluation and
produce “evidence” of effective
policies and practices that can be
disseminated widely.
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Some of the Issues States Face
Data Issues:
• Collecting and Using Data to Support
Policy Objectives:
– Cost Offset Data to Support Re-Allocation
of State Dollars
• Implementing WEB-Based Data
Systems to:
– Support Accurate Reporting by and
Immediate Feedback to Providers incl.,
Encounter Data
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Some of the Issues States Face
Working with Governors and
Legislatures To:
• Remove Regulatory Barriers That Impede
Implementation of Cross-Agency Financing
Approaches
• Remove Barriers to Medication-Assisted
Treatment of All Types
• Implement Performance-Based Purchasing
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Necessary, but Not Sufficient
• A Continuum of Care from Primary
Care, to Specialty Health Care, to
Specialty Treatment for Substance
Use Disorders and Mental Illnesses
• A Bridge Between Research and Tx
– So, Is Research Part of the Bridge or Is
It Part of the Gap?
– Can the Infrastructure Meet the Public’s
Demands?
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Some Thoughts About Quality Improvement
• Making the Case for Change
• Costs, Cost-offsets, Access
• Health Care and Substance Use
• Consumer Choice and the Continuum
of Care
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