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4/29/15
Webinar Facilitator
UNDERSTANDING THE
AFFORDABLE CARE ACT
(ACA) AND SBIRT
Tracy McPherson, PhD
Senior Research Scientist
Substance Abuse, Mental Health and
Criminal Justice Studies
NORC at the University of Chicago
4350 East West Highway 8th Floor,
Bethesda, MD 20814
PRESENTED BY:
THE BIG INITIATIVE, NATIONAL SBIRT ATTC,
NORC, and NAADAC
[email protected]
April 29, 2015
Produced in Partnership…
2015 SBIRT Webinar Series
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Access Materials
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PowerPoint Slides
¨ 
CE Quiz
¨ 
Recording
¨ 
Free CEs
2/18/15 - Implementing SBIRT in Health Centers:
Examples from the Field
3/18/15 - SBIRT: A Brief Clinical Training for
Adolescent Providers
4/15/15 - All About SBIRT for Teens
4/29/15 - Understanding the Affordable Care Act
(ACA) and SBIRT
5/13/15 - SBI in Primary Care and Senior Care
Facilities for Older Adults at Risk for Possible
Substance Use Disorders and/or Depression
6/10/15 - A Military Culture Approach to SBIRT for
Veterans & Active Duty Personnel
7/22/15 - Drugs are a Local Phenomenon for
LGBTQ Populations: Implications for SBIRT
8/19/15 - Integrating SBI for Alcohol & Other
Drugs in Behavioral Health Settings Serving College
Students
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4/29/15
Technical Facilitator
Presenter
Misti Storie, MS, NCC
Eric Goplerud
Director of Training &
Professional Development
Senior Vice President
Substance Abuse, Mental Health
and Criminal Justice Studies
NAADAC, the Association
for Addiction Professionals
NORC at the University of
Chicago
[email protected]
[email protected]
Substance use risk did not match health
coverage pre-ACA and pre-MHPAEA
Objectives of this Presentation
100 Over 90% of
use and
90
• Access and coverage problems that ACA and
MHPAEA (Parity) were designed to address
Percentage
• Components of reform that impact access and
coverage of risky substance use and SUDs
• Indicators of progress in integrating substance
use screening and treatment into healthcare and
challenges still to be met
But likelihood of
coverage for
substance use
increases as
prevalence declines
problems
80
start
70 between the
ages of
60
12-20
People with SUDs die
an average of 22.5
years sooner than those
without a diagnosis
50
High risk alcohol/drug
use in the past year
40
Substance Use
Disorder in the
past year
30
20
65+
50-64
35-49
30-34
21-29
18-20
16-17
10
14-15
12-13
10
0
Age
Source: 2002 NSDUH and Dennis & Scott, 2007, Neumark et al., 2000
Health Insurance Coverage for SUD PreMHPAEA and ACA
Adolescents and Young Adults likely to have no
Health Insurance
•  21.6 million had SUDs (8.2% US pop 12 y.o. and older)
•  47.5 million Americans lacked health insurance
–  14.6% uninsured adults have SUDs
–  Treatment rate uninsured was12.8%
•  1/3 of those covered by individual insurance have no SUD
coverage; 5% in small group insurance no SUD coverage
•  Uninsured had higher rates of SUDs (13.6% eligible for
Medicaid expansion; 14.3% in health exchanges)
compared with Medicaid recipients (11.9%).
12
13
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Pre-ACA and Pre-MHPAEA: SUDs are Common, But
Treatment Rates are Low
Pre-ACA and Pre-MHPAEA: Costs Are a Barrier to Care
Percentage of men and women who say they or a family member have done each of
the following in the past year because of COST:
Few Get Treatment:
1 in 20 adolescents,
1 in 18 young adults,
1 in 11 adults
25%
15%
20%
33%
7.4%
Men
22%
Didn’t fill a prescription
32%
Women
7.0%
5%
0%
40%
Skipped a recommended medical test
or treatment
20.1%
20%
10%
27%
Put off or postponed getting needed
health care
12 to 17
18 to 25
15%
Cut pills or skipped doses of medicine
1.1%
0.4%
23%
0.6%
Abuse or Dependence in past year
Treatment in past year
26 or older
Source: SAMHSA 2010. National Survey On Drug Use And Health, 2010 [Computer
file]
10%
14%
Had problems getting mental health care
Source: Kaiser Family Founda3on Health Tracking Poll (conducted September 12-­‐18, 2013) hAp://kff.org/health-­‐reform/poll-­‐finding/kaiser-­‐health-­‐tracking-­‐poll-­‐september-­‐2013/ After 100+ years, why now?
Consumer can't afford
doctor
MHPAEA and ACA are about...
coverage and access
Consumer drops policy
due to high price and is
now uninsured
Consumer delays care,
goes to ER
Insurers shift cost to
consumer
Consumer can't pay
Providers shift cost to
Insurers
The way that ACA and MHPAEA is supposed to work
(and does in Medicaid expansion states)
Medicaid
Expansion
State/Federal
Marketplaces
Employer
Coverage
Extent of MHPAEA and ACA Parity Coverage
ERISA-governed self-insured plans
Yes, cost and size exemptions may apply
ERISA-governed fully insured plans
Yes, size and cost exemptions apply
State-regulated group and individual
insurance markets
Medicaid fee-for-service
Medicaid managed care
Yes, applies to issuers who sell
coverage to employers with 50+ empl.
No, CMS Medicaid standards apply.
Yes, CMS Medicaid managed care
standards apply. 4/10/15 NPRM
Yes
No
No
Yes, Essential Benefit, for small group
and individual offerings
No, but FEHBP adopted MHPAEA.
No, MHPAEA not adopted.
No, churches are exempt
Yes, but plan sponsors may opt out.
Separately administered CHIP plans
Medicare fee-for-service market
Medicare Advantage
Federal and State health insurance
exchanges
The Federal Employee Health Benefits
TriCare
Church plans
Nonfederal public-employee plans
19
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Substance Use Prevention and Treatment
Mandatory Essential Health Benefits
Role of Parity – MH and SUD
•  Large self-insured and group health covered by
MHPAEA
•  Medicare Part B co-insurance parity 2014
•  Essential Health Benefit (EHB) for new private
insurance must be at parity. One of 10 required benefits.
•  Children’s Health Insurance required parity
•  Medicaid Benchmark Benefit must be at parity.
•  Parity does extend to all individual and most small group
plans after January 1, 2014.
•  No individual plans will be grandfathered; private self-insured
small group plans can be grandfathered, and non-Federal
governmental small group plans can opt out.
1. Ambulatory services
6. Prescription drugs
2. Emergency services
7. Rehabilitative and habilitative
services and devices
3. Hospitalization
8. Laboratory services
4. Maternity and newborn
care
9. Preventive and wellness
services and chronic disease
management
5. Mental health and
substance use disorder
services, including
behavioral health treatment
10. Pediatric services, including oral
and vision care
•  Medicaid MCOs must be at parity: April 10, 2015 NPRM
ACA requires Private Health Plans to cover Preventive
Services
Parity and ACA extends Coverage of MH/SUD
New coverage for Expanded MH
MH and SUD care and SUD care
coverage
• Includes: Total
•  Self-­‐insured employer plans (ERISA plans) •  Individual insurance plans (plans purchased by individuals) Individuals currently
3.9
7.1
11
holding individual
Estimates
coverage indicate that 2.8 million adults may receive
•  Small and Large group plans (plans employers buy for workers) BH treatment through Medicaid expansions, and 3.1
Individuals currently
1.2
23.2
24.5
million
through participation in health insurance
with coverage
exchanges.
under small group
•  Plans that are “grandfathered” are exempt • Requirement also applies to plans that are available in the state Marketplaces because preven3ve services are considered an Essen3al Health Benefit plans
Uninsured
Total
27
---
27
32.1
30.4
62.5
Frank, R. G., Beronio, K., & Glied, S. A. (2014). Behavioral health
parity and the affordable care act. Journal of social work in disability &
rehabilitation, 13(1-2), 31-43.
Preven,ve Services Covered w/o Cost Sharing Cancer Chronic Condi,ons Vaccines Healthy Behaviors Pregnancy ü Breast Cancer ü Cardiovascular health ⁻  Hypertension screening ⁻  Lipid disorders screenings ⁻  Aspirin ü Td booster, Tdap ü Alcohol misuse screening and counseling (all adults) ü Type 2 Diabetes ü  Hepa,,s A, B –  Mammography for women 40+* –  Gene3c (BRCA) screening and counseling –  Preven3ve medica3on ü Cervical Cancer ‒  Pap tes3ng (women 21+ ) ‒  High-­‐risk HPV DNA tes,ng ♀
ü Colorectal Cancer ⁻ 
screening (adults w/ elevated blood pressure) ü Zoster ü Influenza, screening (adults, when follow up supports available) ü Varicella ü Osteoporosis One of following: screening (all women fecal occult blood 65+, women 60+ at tes3ng, colonoscopy, high risk) sigmoidoscopy (all adults) Counseling and behavioral interven3ons (obese adults) ü Meningococcal ü Pneumococcal ü Depression ü Obesity Screening ü MMR ü HPV (women and men 19-­‐26) ü Depression screening and brief counseling ü Tobacco counseling and cessa3on interven3ons ü Interpersonal and domes,c violence screening and counseling ♀
ü Diet counseling (adults w/high cholesterol, CVD risk factors, diet-­‐related chronic disease)
ü Tobacco and cessa,on interven3ons ü Alcohol misuse screening/counseling ü Rh incompa,bility screening ü  Gesta,onal diabetes screenings♀ ⁻  24-­‐28 weeks gesta,on ⁻  First prenatal visit (women at high risk for diabetes) ü Screenings ⁻ 
⁻ 
⁻ 
⁻ 
⁻ 
Hepa33s B Chlamydia (<24, hi risk) Gonorrhea Syphilis Bacteriurea ü Folic acid supplements (women w/repro capacity) ü Iron deficiency anemia screening ü Well-­‐woman visits ü BreasYeeding supports, ⁻  counseling , consulta,ons and equipment rental♀ 22
Reproduc,ve and Sexual Health ü STI and HIV counseling (adults at high risk; all sexually-­‐
ac,ve women♀) ü Screenings: ⁻  Chlamydia (sexually ac3ve women <24y/o, older women at high risk) ⁻  Gonorrhea (sexually ac3ve women at high risk) ⁻  Syphilis (adults at high risk) ⁻  HIV (adults at high risk; all sexually ac,ve women♀) ü Contracep,on (women w/repro capacity) ♀ ⁻  All FDA approved methods as prescribed, ⁻  Steriliza,on procedures ⁻  Pa,ent educa,on and counseling Health Exchanges – Individual & Small Group Markets
• Federally Facilitated Exchanges, State Partnership
Exchanges, and State-Operated Exchanges.
• Enrollment began on October 1, 2013, earliest start
January 1, 2014. Second enrollment period mostly
ended March 15, 2015.
• Scope is uninsured adults above 133 percent of the
Federal poverty level (plus discounted 5 percent of
income).
• Premium subsidies up to 400% poverty level
•  From 133% poverty in Medicaid expansion states
•  From 100% poverty in non-expansion states
SOURCE: U.S. DHHS, “Recommended Preventive Services.” Available at http://www.healthcare.gov/center/
regulations/prevention/recommendations.html.
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What Healthcare Plans Are Available?
Health Insurance Premium Tax Credit and
Cost Sharing Reductions
Cost Sharing Reduc,ons: Premium Tax Credits: Income Level Up to 133% FPL Premium as Percent of Income 2% of income 133-­‐150% FPL 3-­‐4% of income 150-­‐200% FPL 4-­‐6.3% of income 200-­‐250% FPL 6.3-­‐8.05% of income 250-­‐300% FPL 8.05-­‐9.5% of income 300-­‐400% FPL 9.5% of income *Of the second lowest cost Silver plan Income Level Reduc,on in Out-­‐of-­‐
Pocket Liability 100-­‐150% FPL 94% of the actuarial value* 150-­‐200% FPL 87% of the actuarial value 200-­‐250% FPL 73% of the actuarial value •  Platinum: Insurance pays 90
percent of covered medical
expenses.
•  Gold: Insurance pays 80 % of
covered medical expenses.
•  Silver: Insurance pays 70 % of
covered medical expenses.
•  Bronze: Insurance pays 60
percent of covered medical
expenses.
A Silver Metal Level plan must be
purchased to qualify for Cost Sharing
Reductions
Individual mandate
Medicaid expansion and non-expansion states
•  Require all citizens and legal residents (there are
some exceptions) to have health coverage in 2014.
•  What happens if someone does not meet this
deadline?
•  Will they go to jail?
NO!
•  Exceptions: Religious objections, Undocumented
immigrant, Incarcerated, American Indians and
Alaskan Natives, Income below the tax filing
threshold, The lowest cost plan option exceeds 9.5
percent of an individual’s income
American Mental Health Counselors Association. Dashed Hopes; Broken Promises; More Despair: How the
Lack of State Participation in the Medicaid Expansion Will Punish Americans with Mental Illness.
29
(2014). http://www.amhca.org/assets/content/AMHCA_DashedHopes_Report_2_21_14_final.pdf
Coverage in Medicaid Expansion States
Coverage in non-Medicaid Expansion States
Medicaid Expansion
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Accountable Care Organizations
Financing New Models of Care: Medical Homes
• Medical homes unite four of the most compelling areas
of modern health care:
•  the value of primary care,
•  patient-centered care,
•  advances in chronic care, and
•  the use of health information technology
• The ACA expands medical home through pilot
programs and creation of a Medicaid state plan option
in which states can permit Medicaid beneficiaries with
chronic conditions and serious mental health
conditions to designate a provider as a health home
(Nutting et al. 2009KFF 2010).
•  A provider-based organization -•  That takes responsibility for healthcare needs of a defined
population;
•  With goals of improving health, improving efficiency, and
improving patient satisfaction;
•  Primary care, hospitals, specialists
(can include SUDs & BH)
•  And produces shared savings
or other financial measures to
align incentives.
32
Implications of MHPAEA and ACA for SUD Prevention
and Treatment
Integrating behavioral health
and primary care
• SUD treatments will be provided within the primary care
setting.
• Reimbursement for treatment will be similar to other
chronic diseases needing long-term management.
Emphasizing prevention of
high risk alcohol use
So, what is happening and is
projected to happen?
• Preventive services for alcohol use risk is covered (e.g.,
routine screening of substance use and related problems,
brief intervention, and referral to treatment).
Allowing individuals with a
• Previously uninsured individuals (due to a pre-existing
pre-existing condition to have condition) will have insurance coverage for SUD treatment.
insurance coverage
• Individuals who received SUD treatment in the public
sector or from other specialty programs will receive SUD
care in the mainstream health care system.
Parity
Coverage
Location of care
Expanding Medicaid
• It will bring coverage to a large number of new enrollees.
• Substance use treatments including medications will be
covered.
35
Implications of MHPAEA and ACA for SUD Prevention
and Treatment
Increasing eligibility of
coverage for children up to
age 26 under their parents’
plans
Young adults – the group with an elevated rate of SUDs –
will be covered for prevention services and treatment for
SUDs.
Eliminating lifetime caps on
SUDs will be treated, managed, and monitored over a
essential benefits and
lifetime like other chronic illnesses.
supporting health care homes
New organizations bearing
financial and clinical risk,
using integrated EHRs
Medicaid health homes/Integrated care entities will
require access to SUD information in order to provide
patients with improved, coordinated care (2703 of ACA)
Substance use disorders and Addiction is viewed as disease of the brain
treatment integrated into
medical system
Increased role of physicians along with clinicians and peer
support recovery specialists to treat and sustain long term
recovery
36
SAMHSA (2014) Projections of National Expenditures for Treatment of Mental and
Substance Use Disorders, 2010-2020
37
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SAMHSA (2014) Projections of National Expenditures for Treatment of Mental and
Substance Use Disorders, 2010-2020
38
SUD Treatment Rate by State Parity Status:
Foreshadowing MHPEA and ACA Results?
SAMHSA (2014) Projections of National Expenditures for Treatment of Mental and
Substance Use Disorders, 2010-2020
39
Foreshadowing MHPAEA and ACA Impact:
Federal Employees Health Benefit Parity Evaluation
•  No difference in rates of access to substance use treatment between
FEHB and non-FEHB plans.
•  For patients receiving substance use treatment, out-of-pocket
spending declined significantly relative to non-FEHB plans
(difference=−$101.09)
•  Total spending for substance use treatment did not differ
•  10% more patients identified with a new SUD
•  No differences in initiation and engagement in substance use
treatment.
CONCLUSIONS—”parity improves insurance
protection but has little impact on utilization, costs to
plans, or quality of care.”
Wen, H., Cummings, J. R., Hockenberry, J. M., Gaydos, L. M., & Druss, B. G. (2013). State parity
laws and access to treatment for substance use disorder in the United States: implications for federal
40
parity legislation. JAMA psychiatry, 70(12), 1355-1362.
Azzone, V., Frank, R. G., Normand, S. L. T., & Burnam, M. A.
(2014). Effect of insurance parity on substance abuse treatment.
Do Health Insurance Plans in Exchanges Comply with
Parity? Maybe, most of the time (2015 study in 2 states)
Preparedness of Substance Use Providers for
MHPAEA and Parity
•  75% had quantitative treatment limits and prior
authorization requirements equivalent to medical-surgical
benefits
•  Health Reform Readiness Index (HRRI) for specialty SUD
treatment organizations for ACA.
•  427 SUD organizations participated -2010-2012
•  In smaller exchange, about half plans discrepant – mostly
prior authorization
•  Most in the early stages of preparation
•  In larger exchange, more likely to encounter inconsistent
financial requirements
•  Organizations with annual budgets < $5 million (n = 295)
were less likely to be prepared for ACA than organizations
with annual budgets > $5 million (n = 132).
•  Co-pays, co-insurance and deductibles
•  Substance use financial requirements greater than MH
•  Inappropriate matching behavioral health with medical specialists
Berry, K. N., Huskamp, H. A., Goldman, H. H., & Barry, C. L. (2015). A Tale of Two
States: Do Consumers See Mental Health Insurance Parity When Shopping on State
Exchanges?. Psychiatric Services.
41
42
Molfenter, T. D. (2014). Addiction treatment centers' progress in
preparing for health care reform. Journal of substance abuse
treatment, 46(2), 158-164.
43
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Screening and Brief Interventions in Hospital Emergency
Departments
Opportunities for SBIRT
Cochrane Collaboration review (McQueen et al, 2011)
14 RCTs, adults and adolescents
Hotspot 1:
Hospitals
Outcomes favor BI over non-treatment controls
• 
• 
• 
• 
Systematic review of ED SBI
12 RCTs with pre- and post-BI results
11 or 12 observed significant effects on
alcohol intake, risky drinking practices,
alcohol related negative consequences,
injury frequency
Significant drop in 6 month alcohol consumption
Significant drop in alcohol
consumption at 9 months
Self Report at 1 year favor BI
Significantly fewer deaths at
6 months and 1 year
Nilsen et al, J Sub Ab Treat. 2008
44
Hospital SBIRT for Acutely Medically Ill, Traumatically
Injured and ED Patients
Gundersen Lutheran Program Results
• Falmouth Hospital (MA)
• Denver General Hospital (CO)
• Gunderson Lutheran Hospital (WI)
• Oregon Health Sciences University (OR)
• Christiana Hospital (DE)
• Salina Regional Hospital (KS)
• Boston Medical Center (MA)
• Yale-New Haven (CT)
Built into Gunderson’s
Electronic Health Record
Total eligible Positive Screens
1790
Percentage
One Week Post Hospital Follow
UP: Patient report positive change
232
73%
One Month Post Hospital Follow
Up: Patient report positive change
96
62%
46
Integrating SBI reimbursement into the EHR
http://www.sbirtoregon.org/
SBIRT a Profit Center for Health System –
Inpatient, Emergency Department, Ambulatory
Clinics
Hospital SBIRT Reimbursement
Payer
Commercial
Insurance,
Medicaid
Commercial
Insurance,
Medicaid
Code
99408
99409
Medicare
G0396
Medicare
G0397
Medicaid
H0049
Medicaid
H0050
Description
Alcohol and/or substance abuse structured
screening and brief intervention services; 15
to 30min
Alcohol and/or substance abuse structured
screening and brief intervention services;
greater than 30min
Alcohol and/or substance abuse structured
screening and brief intervention services; 15
to 30min
Alcohol and/or substance abuse structured
screening and brief intervention services;
greater than 30min
Alcohol and/or drug screening (code not
widely used)
Alcohol and/or drug service, brief
intervention, per 15 min (code not widely
used)
ED Fee
Schedule
$85
$185
$32
$65
$24
$48
49
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Hotspot 2:
Prenatal Screening and Case Management
Kaiser-Permanente Northern California’s Early Start:
A transformational program that is cost beneficial
• Universal Screening of ALL
pregnant women
•  Screening questionnaire
•  Urine toxicology (with consent)
• Place a licensed mental health
provider in the department of OB/
GYN
• Link the Early Start appointments
with routine prenatal care
appointments
• Educate all women and providers
50
RATE OF INTRAUTERINE FETAL DEMISE (stillborn)
Maternal and Infant Mean Costs Comparison
Positive
Screen, No SA
Treatment
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$0
Stillborns (IUFDs) were 14.2 times more likely in the S group
than the SAF or C groups
SAF
SA
Maternal Total Costs
Hotspot 3:
Ambulatory Primary Care SBIRT
Infant Total Costs
S
Controls
Maternal and Infant Costs Combined
NORC Analysis of Key Elements to Successful
Integration of SBIRT into Primary Care
•  Intervention characteristics
•  Consolidated
for Implementation Research
•  Support mustFramework
come from leaders
•  Standardized, brief BH screener
•  Adapt substance risk assessment and intervention
•  Outer setting
•  Standardize SBI metrics for electronic records
•  SBI as an essential element of PCMHs
•  Remove provider communication restrictions
•  Remove reimbursement barriers
•  PC accountability to payers
•  Integrate SA services throughout PC-BH integration efforts
54
ASPE Briefing: SBIRT in FQHCs 3-25-15
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Key Elements to Successful SBIRT Integration in
Primary Care
SBIRT Reimbursement in Primary Care
•  Inner setting
•  Organizational development consultation
•  Competency-based training of BH clinicians in SA
•  SA records integrated as part of EHRs
•  Characteristics of Individuals
•  Continuing SA education for PC and BH personnel
•  SA training in pre-professional workforce development
•  Recognize FQHCs for outstanding SA care
•  Implementation
•  Create FQHC SUD quality enhancement center
ASPE Briefing: SBIRT in FQHCs 3-25-15, NORC
Provider Reported Benefits
Integrated Care
–  “People do come back…They may not be ready for help today, but [may in
future] because of relationships with [staff].”
–  “Screening is like prevention. You do screening to prevent things upsetting
or uh complications…I think we should be involved in the screening…”
Education
–  “When we first started some of the patients were kind of irritated…but I think
we’re getting better because I really don’t get that sense from the patients
anymore.”
–  “A lot [of patients] don’t realize how alcohol especially, but any other drugs,
[affect their medications and their health]. So that’s really an eye-opener for a
lot of folks I think.”
Readiness to Change
–  “There might be people who [screen positive] who wouldn’t have brought it up
on their own. Because you brought it up, they do share and they do want
help.”
Outlook with MHPAEA and ACA:
Transforming Substance Use Screening and Treatment
•  SUD screening and treatment will be widely dispersed through a variety of
different settings
•  Less federally-assisted, grant-funded, stand alone SUD facilities (where application of 42 CFR
Part 2 is clear)
•  Trending towards more integrated programs/care systems where both general medical and
MH/SUD treatment is delivered (ACOs, medical homes, health homes)
•  General health care industry used to being able to exchange health information freely
•  Hotspot locations will be early adopters of SBIRT
•  Any health facility can run a successful SBIRT program with the right preparation
and ongoing dedication.
•  Use of electronic record integration can secure billing efficiency/training.
•  Passage of laws does not immediately result in improved access, improved quality
or reduced costs – vigilance, advocacy and planning are needed to realize the
potential transformations
Hobson J, Stanton et al. SBIRT Protocol in Primary Care Settings, Collaborative Family
Healthcare Association 13th Annual Conference, October 27-29, 2011 Philadelphia
Change Happens:
Eric Goplerud Senior Vice President
Public Health
NORC at the University of Chicago
4350 East West Highway 8th Floor, Bethesda, MD 20814
[email protected] | office 301-634-9525 | mobile 301-852-8427
“Nothing is permanent, but change”
Heraclitus 535-475 BCE
Thank You!
“It is not the strongest of the species that
survive, nor the most intelligent, but the
one most responsive to change”
Charles Darwin 1809-1882
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4/29/15
References
References
Smyth, Hoffman, Fan, Hser, Years of potential life lost among heroin addicts 33 years after treatment. Prev. Med, 2007; 44(4) 132-140.
Jones, Moore, Sindelar, O’Connor, Schottenfeld, Fiellin. Cost analysis of clinic and office-based treatment of opioid dependence. Drug Alcohol
Depend. 2009;99(1-3): 132-140
Knudsen HK, Abraham AJ. Perceptions of state policy environment and adoption of medications in treatment of substance use disorders.
Psych Services. 2012:63(1);19-25.
Baser O, Chalk M, Fielin DA, Gastfriend DR. Cost and utilization outcomes of opioid-dependence treatments. Am J Managed Care,
2011:17(6);S235-248.
Clark RE, Samnaliev M, Baxter JD, Leung GY. The evidence doesn’t justify steps by state Medicaid programs to restrict opioid addiction
treatment with buprenorphine. Health Affairs. 2011:30(8);1425-1433.
Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999—2008 MMWR, November 4, 2011 / 60(43);1487-1492
Baser O, Chalk M, Fiellin DA, Gastfriend DR. Alcohol dependence treatments: comprehensive healthcare costs, utilization outcomes, and
pharmacotherapy persistence. Am J Manag Care. 2011:17(8);S222-234.
Bhati et al (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders. Washington, DC:
Urban Institute. Health Serve Res. 2006 February; 41(1): 192–213.
Susan L Ettner, David Huang, Elizabeth Evans, Danielle Rose Ash, Mary Hardy, Mickel Jourabchi, and Yih-Ing Hser The economic costs of
substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement, Journal of Substance Abuse
Treatment(2008)
Rose G. Sick individuals and sick populations. International Journal of Epidemiology 1985;14:32-38.
Goler, N. C., Armstrong, M. A., Osejo, V. M., Hung, Y. Y., Haimowitz, M., & Caughey, A. B. (2012). Early Start: A Cost–Beneficial Perinatal
Substance Abuse Program. Obstetrics & Gynecology, 119(1), 102-110.
Mauer B. Substance Use Disorders and The Person-Centered Healthcare Home. Washington DC: National Council for Community Behavioral
Healthcare; February 12, 2010 2010.
Porcerelli JH, Fowler SL, Murdoch W, Markova T, Kimbrough C. TRAINING FAMILY MEDICINE RESIDENTS TO PRACTICE
COLLABORATIVELY WITH PSYCHOLOGY TRAINEES. Int J Psychiatry Med. 2013;45(4):357-365.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into
practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug and alcohol dependence. 2003;70(2):S59-S77.
Mattick RP, Breen C, Kimber J, Davoli M, Breen R. Methadone maintenance therapy versus no opioid replacement therapy for opioid
dependence. Cochrane Database Syst Rev. 2003;2.
Kranzler HR, Kirk J. Efficacy of naltrexone and acamprosate for alcoholism treatment: A meta‐analysis. Alcoholism: Clinical and Experimental
Research. 2001;25(9):1335-1341.
•  Information about the Health SBIRT Initiative is posted at http://hospitalsbirt.webs.com/.
O'Donnell A, Anderson P, Newbury-Birch D, et al. The impact of brief alcohol interventions in primary healthcare: A systematic review of
reviews. Alcohol and alcoholism. 2014;49(1):66-78.
Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta‐analytic review of controlled investigations in
treatment‐seeking and non‐treatment‐seeking populations. Addiction. 2002;97(3):279-292.
Beich A, Thorsen T, Rollnick S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and
meta-analysis. Bmj. 2003;327(7414):536-542.
Berglund M, Thelander S, Jonsson E. Treating alcohol and drug abuse: an evidence based review. John Wiley & Sons; 2003.
Ballesteros J, Duffy JC, Querejeta I, Ariño J, González-Pinto A. Efficacy of Brief Interventions for Hazardous Drinkers in Primary Care:
Systematic Review and Meta-Analyses. Alcoholism: Clinical and Experimental Research. 2004b;28(4):608-618.
Cuijpers P, Riper H, Lemmers L. The effects on mortality of brief interventions for problem drinking: a meta‐analysis. Addiction. 2004;99(7):
839-845.
Jonas DE, Garbutt JC, Brown JM, et al. Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse. 2012.
Chang G. Brief interventions for problem drinking and women. J Subst Abuse Treat. 2002;23(1):1-7.
Kaner E, Beyer F, Dickinson H, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev.
2007;2.
Jackson R, Johnson M, Campbell F, et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in
adults and young people. Sheffield: University of Sheffield, School of Health and Related Research (ScHARR) Public Health Collaborating
Centre. 2010.
Latimer N, Guillaume L, Goyder E, Chilcott J, Payne N. Prevention and Early Identification of Alcohol Use Disorders in Adults and Young
People: Screening and Brief Interventions. Cost Effectiveness Review Sheffield: University of Sheffield, School of Health and Related Research
(ScHARR) Public Health Collaborating Centre. 2010.
Jenkins RJ, McAlaney J, McCambridge J. Change over time in alcohol consumption in control groups in brief intervention studies: systematic
review and meta-regression study. Drug and alcohol dependence. 2009;100(1):107-114.
Bernstein JA, Bernstein E, Heeren TC. Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: implications
for bias toward the null. Drug and alcohol review. 2010;29(5):498-507.
McCambridge J, Kypri K. Can simply answering research questions change behaviour? Systematic review and meta analyses of brief alcohol
intervention trials. PLoS ONE. 2011;6(10):e23748.
ASPE Briefing: SBIRT in FQHCs 3-25-15
References
ASPE Briefing: SBIRT in FQHCs 3-25-15
Ask Questions
Huibers MJ, Beurskens AJ, Bleijenberg G, van Schayck CP. The effectiveness of psychosocial interventions delivered by general practitioners.
Cochrane Database Syst Rev. 2003(2):CD003494.
Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use
by adults: A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. Apr 2004;140(7):557-568.
Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care:
systematic review and meta-analysis. Arch Intern Med. May 9 2005;165(9):986-995.
Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness.
Am J Prev Med. Feb 2008;34(2):143-152.
Jackson R, Johnson M, Campbell F, et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in
adults and young people. Sheffield: University of Sheffield, School of Health and Related Research (ScHARR) Public Health Collaborating
Centre. 2010.
Babor T, Robaina K, Nilsen P, Kaner E, Li Q. Rapid Review of Current Evidence for Health Promotion Actions for Hazardous and Harmful
Alcohol Use, With Specific Reference to Low and Middle Income Countries. Geneva, Switzerland: World Health Organization, Mainstreaming
Project, Division of Noncommunicable Diseases. 2011.
Jackson R, Johnson M, Campbell F, et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in
adults and young people. Sheffield: University of Sheffield, School of Health and Related Research (ScHARR) Public Health Collaborating
Centre. 2010.
Jonas DE, Garbutt JC, Brown JM, et al. Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse. 2012.
McCance-Katz EF, Kosten TR. Psychopharmacological treatments. Clinical Textbook of Addictive Disorders. Vol 3. New York, NY: Guilford
Press; 2005:588-614.
Coviello DM, Cornish JW, Lynch KG, Alterman AI, O’Brien CP. A Randomized Trial of Oral Naltrexone for Treating Opioid‐Dependent
Offenders. The American Journal on Addictions. 2010;19(5):422-432.
Ries RK, Miller SC, Fiellin DA. Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.
Saitz R, Palfai TA, Cheng DM, et al. Screening and Brief Intervention for Drug Use in Primary Care: The ASPIRE Randomized Clinical Trial.
JAMA. 2014;312(5):502-513. doi:10.1001/jama.2014.7862.
Aalto M, Pekuri P, Seppa K. Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study. Drug
Alcohol Rev. Jun 2003;22(2):169-173.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug Alcohol Rev. Mar 2004;23(1):11-18.
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In Our Last Few Moments…
2015 SBIRT Webinar Series
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2/18/15 - Implementing SBIRT in Health Centers:
Examples from the Field
3/18/15 - SBIRT: A Brief Clinical Training for
Adolescent Providers
4/15/15 - All About SBIRT for Teens
4/29/15 - Understanding the Affordable Care Act
(ACA) and SBIRT
5/13/15 - SBI in Primary Care and Senior Care
Facilities for Older Adults at Risk for Possible
Substance Use Disorders and/or Depression
6/10/15 - A Military Culture Approach to SBIRT for
Veterans & Active Duty Personnel
7/22/15 - Drugs are a Local Phenomenon for
LGBTQ Populations: Implications for SBIRT
8/19/15 - Integrating SBI for Alcohol & Other
Drugs in Behavioral Health Settings Serving College
Students
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