SUMMARY REPORT
MEETING 23
Date:
Time:
Location:
Hosts:
Wednesday, May 29, 2013
2:00PM – 3:00PM
Sacramento, CA
UCLA Integrated Substance Abuse Programs (ISAP) & CA
Dept. of Alcohol and Drug Programs (ADP)
Topic:
Integration: Updates from the Field
Presenters: Darren Urada, PhD
UCLA Integrated Substance Abuse Programs
Review of ILC Meeting 22
UCLA ISAP
 The twenty-second ILC meeting, conducted April 24, 2013, covered
County Experiences with the Low Income Health Program (LIHP). Special
thanks to John Viernes (Los Angeles County) and Clara Boyden (San
Mateo County) for presenting and sharing their experiences with us.
Logistics
 Summary and materials discussed from the previous ILC meetings are
available at http://www.uclaisap.org/Affordable-Care-Act/html/learningcollaborative/index.html. Subsequent meeting materials will continue to be
posted on this site.
 The next ILC meeting will be held on June 26, 2013 from 11:00AM to
12:00PM. All further meetings are scheduled to be held at 11:00AM (PT)
on the 4th Wednesday of every month, unless otherwise noted.
ILC Meeting 23 Topic:
Integration: Updates from the Field
 During today’s learning collaborative, we will examine how the Affordable
Care Act will affect financing, workforce, and exchanges, and use
examples from other states and countries to gain some valuable insight on
how to successfully integrate SUD services with primary care.
Darren Urada
UCLA Integrated Substance Abuse Programs
Summary

Financing/Workforce
o Some believe that non-billable BH staff under an ACO model are all
moving toward becoming “billable” (though not literally) as long as they
are credentialed. ACOs will receive payments to care for people and if
specialty AOD counselors can be demonstrated to reduce costs, then that
will be part of their payment. The rules are still in progress and will vary
from state to state.
o Currently, under the Medicaid and Medicare expansion, 150 “pioneer”
Medicare ACOS all have access to this data and CMS is awaiting data
from them.
o FQHC/BH Partnership example:
 A behavioral health center was seeing medication-only patients
(paid by the minute).
 In the FQHC world, you get paid based on an encounter (the
national average rate is $143 per encounter).
 The medication-only patients were moved over to the FQHC
center, bringing in much more money due to the increased
number of encounters.
 This allowed the FQHC to then pay the BH center for some of
their services.
 Therefore, partnerships bring in more money.
 Consult with your legal counsel before trying this.
o The “sell”: The doctor really wants to hand off the crying patient to the BH
center. This allows the doctor to move on to the next patient and increase
revenue while still providing the patient with quality care.
o Overall, FQHCs need to see as many patients as possible.
o It is exclusive to California that counselors cannot get paid in FQHCs. In
other states such as Nebraska, all licensed mental health practitioners
(e.g. social workers, MFTs, and counselors) can bill at FQHCs.
o NOTE: Lectures from Steve Rosenberg and Patrick Gauthier, CATES
meetings, and the SARC meeting will provide further information on
financing and the workforce.
o CATES Follow-Up Webinars:
Topic
Integrating Services with Primary Care
Marketing
Contract Negotiations
Financing Strategies
Developing Payer Relations
Marketing
Integrating Services with Primary Care
Contract Negotiations
Date
June 19
June 26
July 2
July 10
July 17
July 18
July 23
July 31
Financing Strategies
Developing Payer Relations
August 7
August 14

Chronic Pain and Prescription Drugs
o Function and happiness are primary goals.
o Complete pain relief is completely unrealistic.
o Important not to use the term “addiction” if it applies when dealing with
chronic pain treatment. Doing so will often impede the practitioner’s ability
to reach patients who—presumably because of denial—will not want to
be referred to a specialty clinic.
 This emphasizes the need for integrated care so that patients
struggling with addiction can receive quality care without having to
cope with the negative stigma surrounding the disease.
 Also explains why the “RT” in SBIRT needs to be removed.
o When treating patients with chronic pain, need to re-evaluate broad
medical treatment.
o Must evaluate the patient for psychiatric co-morbidity, looking specifically
for symptoms of depression, personality disorder, addiction, and the like.
o Have the patient taper off opioids and other impairing medications.
o Substitute serial trials of non-narcotic pain medications.
o Use mindfulness practices and motivational contingencies to recondition.
o Non-pharmacologic treatment modalities include:
 Physical therapy
 Cognitive behavioral therapy
 Biofeedback
 Relaxation training and guided imagery
 Meditation and self-hypnotic techniques
o Cognitive behavioral therapy (CBT) has proven to be particularly effective
in reframing how the mind works through the principles of neuroplasticity.
o NOTE: For a detailed description of how to non-pharmacologically treat
patients with chronic pain, please see:
http://nationalcouncil.info/natcon2013/handouts/B1-Fishman-1.pdf

Lessons from Britain
o Patient-Centeredness
 In Britain, health care organizations have “In Your Shoes”
sessions where staff listens to patients talk about their
experiences with their care providers. The patients also fill out
feedback cards that help document ways to improve practices
based on patient responses.
 In hospitals, extend these sessions to staff by having staff
members summarize how they would like to be seen by their
service users. Then have follow-up meetings.
o Performance Measurement
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Net promoter score (NPS) calculated by asking each patient,
“How likely are you to recommend the services that you received
to day to a friend or family member, from 0 to 10?” and
determining average. It is required across all National Health
Services in Britain.
The following describes the different types of patients in regards to
the NPS:
 Promoters = Those scoring services with 9 or 10.
 Detractors = Those scoring services from 0 to 6.
 Those that score services as 7 or 8 are passively satisfied
or neutral.
If scores go down, a regulator will come in. If scores are good, left
alone.
Businesses with a high net promoter score (around 7.5) are likely
to grow very fast, and those that do poorly often go out of
business.
For more information on England’s National Treatment Agency,
please visit http://www.nta.nhs.uk/
Hot Spotting
o Jeffrey Brenner, M.D. identified high cost users and mapped where they
lived over the course of five years.
o There are healthcare cost hotspots—very concentrated numbers of high
cost users in small geographic areas.
o If we could incorporate these data into our approach, could help with
prevention and treatment outreach.
o Ex: One patient was going to two different hospitals that were running the
same tests. With lack of communication between them, they were
unaware and this drove up the cost of this patient’s services  The
system is flawed
o To see video of Atul Gawande talking about treating the needs of a highcost patient, please visit:
http://www.livestream.com/nationalcouncil/video?clipId=pla_27872969949e-44b0-873e-5e65b663ddfc
o Since these high cost users are the people bringing in the most money,
why would hospitals want to reform in this way?
1. Thinking long-term. They will soon be moving to an ACO model so
need to start building the infrastructure now so they can succeed
when that happens.
2. Will make it easier on the doctors to see more patients by
providing BH services. This saved time will bring in more money.
Exchanges
o There are going to be 8 regional exchanges, with slightly different plans.
o Spending $200 million for marketing, outreach, and promotion, but expect
a lot more money to come from foundations.
o
o
See: www.Coveredca.com
Under the Affordable Care Act, everyone is required to have health
insurance. Below is a table that describes the penalties for not doing so:
Year
2014
2015
2016

Penalty
$95 per adult or 1.0% of (income minus 10k individual/20k family),
whichever is greater
$325 or 2%
$695 or 2.5%
Source: http://www.healthinsurance.org/learn/obamacare-penaltycalculator/
Important Message
o “It is important to remember that January 1, 2014 is an important day, but
it is just one day; it will be tough day, month and year.”
o Source: Alan Weil, Executive Director, National Academy for State Health
Policy. Feb 5, 2013, ITUP Conference
APPENDIX 1 – AGENDA AND RELEVANT MATERIALS

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Introductions
Topic Discussion – Integration: Updates from the Field
Q and A
MATERIALS FOR THIS MEETING

PPT Presentation – Integration: Updates from the Field
Copies of materials can be found at UCLA ISAP’s ACA Resources Website:
http://www.uclaisap.org/Affordable-Care-Act/html/learningcollaborative/index.html.