1 00:00:05,141 --> 00:00:08,177 GOOD MORNING. IT IS A 2 00:00:08,177 --> 00:00:09,912 PLEASURE TO OPEN THIS VERY 3 00:00:09,912 --> 00:00:11,547 INTERESTING PANEL. I WANT TO 4 00:00:11,547 --> 00:00:12,982 THANK EVERYONE FOR THEIR 5 00:00:12,982 --> 00:00:16,252 ATTENTION AND PARTICIPATING IN 6 00:00:16,252 --> 00:00:20,556 IT IS. 7 00:00:20,556 --> 00:00:22,224 THIS IS SOMETHING THAT IS 8 00:00:22,224 --> 00:00:24,627 CRUCIAL IN MANY WAYS FOR SUCCESS 9 00:00:24,627 --> 00:00:27,163 IN DELIVERING SCIENCE FOR 10 00:00:27,163 --> 00:00:28,330 INTERVENTION AND TREATMENT AND 11 00:00:28,330 --> 00:00:32,134 SUSTAINING THEM AND THAT IS THE 12 00:00:32,134 --> 00:00:33,335 ECONOMICS BEHIND IT. 13 00:00:33,335 --> 00:00:35,271 IN GENERAL, WE HAVE FOCUSED VERY 14 00:00:35,271 --> 00:00:39,608 MUCH ON RESEARCH THAT TARGETS 15 00:00:39,608 --> 00:00:41,177 THOSE THERAPEUTIC INTERVENTIONS 16 00:00:41,177 --> 00:00:42,778 WITHOUT PAYING ATTENTION ON THE 17 00:00:42,778 --> 00:00:44,513 PRACTICALITIES OF ENSURING THAT 18 00:00:44,513 --> 00:00:48,250 THOSE INTERVENTIONS WILL BE 19 00:00:48,250 --> 00:00:51,454 SUSTAINED OR MAINTAINED THROUGH 20 00:00:51,454 --> 00:00:54,023 DIFFERENT ENVIRONMENTS AND WHERE 21 00:00:54,023 --> 00:00:56,592 UPON HEALTH ECONOMICS BECOMES SO 22 00:00:56,592 --> 00:00:59,462 VERY CRUCIAL. WE CAN DESIGN 23 00:00:59,462 --> 00:01:00,930 THERAPEUTICS THAT ARE VERY, VERY 24 00:01:00,930 --> 00:01:02,865 EFFECTIVE IN THE LABORATORY 25 00:01:02,865 --> 00:01:03,199 SETTING. 26 00:01:03,199 --> 00:01:07,803 AND THEN WE SEE THEM DIE WHEN 27 00:01:07,803 --> 00:01:10,406 THEY ARE BROUGHT INTO THE 28 00:01:10,406 --> 00:01:11,874 CLINIC. THEY NEVER MAKE IT 29 00:01:11,874 --> 00:01:13,742 AVAILABLE FOR PEOPLE THAT NEED 30 00:01:13,742 --> 00:01:16,712 THEM WHO DON'T TAKE BENEFIT FROM 31 00:01:16,712 --> 00:01:20,249 THEM. 32 00:01:20,249 --> 00:01:22,685 THIS IS WR UPON HEALTH ECONOMICS 33 00:01:22,685 --> 00:01:26,021 AS I HAVE SEEN IT SHOULD BE AN 34 00:01:26,021 --> 00:01:27,456 INTEGRATED PART OF THE RESEARCH 35 00:01:27,456 --> 00:01:29,792 AS WE DESIGN IT AND DO IT AND 36 00:01:29,792 --> 00:01:31,360 EVALUATE IT. IT IS NOT JUST 37 00:01:31,360 --> 00:01:33,329 WILL IT BE -- WILL IT MAKE A 38 00:01:33,329 --> 00:01:34,964 DIFFERENCE IN THE PROCESS THAT 39 00:01:34,964 --> 00:01:39,535 WE ARE LOOKING AT BUT IS IT IN A 40 00:01:39,535 --> 00:01:42,938 WAY THAT IT CAN BE SUSTAINED BY 41 00:01:42,938 --> 00:01:44,874 THE SYSTEMS THAT WE HAVE BUILT 42 00:01:44,874 --> 00:01:47,743 TO DO THAT TREATMENT AND 43 00:01:47,743 --> 00:01:50,813 SERVICES THAT FOLLOW THEM. 44 00:01:50,813 --> 00:01:52,781 HOWEVER, AS I LOOK ON, TODAY YOU 45 00:01:52,781 --> 00:01:55,518 WILL HEAR SOME VERY INTERESTING 46 00:01:55,518 --> 00:01:56,986 PERSPECTIVES ON HEALTH 47 00:01:56,986 --> 00:01:57,286 ECONOMICS. 48 00:01:57,286 --> 00:01:59,522 YOU WILL SEE THEM AND I'M 49 00:01:59,522 --> 00:02:00,756 SUPPOSED TO SPEAK ABOUT 50 00:02:00,756 --> 00:02:02,625 SUBSTANCE USE AND OVERDOSES AND 51 00:02:02,625 --> 00:02:04,426 THEN WE HAVE MENTAL HEALTH. 52 00:02:04,426 --> 00:02:06,762 I WANT TO START BY SAYING THAT 53 00:02:06,762 --> 00:02:10,466 WE SHOULD BASICALLY RECOGNIZE AS 54 00:02:10,466 --> 00:02:13,035 WE ARE SPEAKING ABOUT HEALTH 55 00:02:13,035 --> 00:02:15,237 ECONOMICS THAT IT MAKES NO SENSE 56 00:02:15,237 --> 00:02:17,606 OVERALL TO SEPARATE SUBSTANCE 57 00:02:17,606 --> 00:02:19,074 USE FROM MENTAL HEALTH 58 00:02:19,074 --> 00:02:20,242 CONDITIONS. 59 00:02:20,242 --> 00:02:22,778 IF THERE IS GOING TO BE -- I 60 00:02:22,778 --> 00:02:25,447 MEAN, A WAY THAT WE CAN BRING 61 00:02:25,447 --> 00:02:28,117 THEM INTO THE CLINIC, WE HAVE TO 62 00:02:28,117 --> 00:02:31,987 FIGURE OUT HOW TO INTEGRATE THEM 63 00:02:31,987 --> 00:02:32,221 BETTER. 64 00:02:32,221 --> 00:02:36,725 THE REALITY BEING IS THAT WE CAN 65 00:02:36,725 --> 00:02:38,627 IMPLEMENT AN INTERVENTION FOR 66 00:02:38,627 --> 00:02:40,229 SUBSTANCE USE DISORDER. IF WE 67 00:02:40,229 --> 00:02:42,932 ARE NOT IMPLEMENTING IT 68 00:02:42,932 --> 00:02:44,533 COMPLEMENTARY FOR MENTAL HEALTH 69 00:02:44,533 --> 00:02:46,635 CONDITION THAT IS SO FREQUENTLY 70 00:02:46,635 --> 00:02:47,770 MORBID, IT IS VERY LIKELY THAT 71 00:02:47,770 --> 00:02:51,240 THE PERSON THAT IS RECEIVING THE 72 00:02:51,240 --> 00:02:52,775 TREATMENT WILL NOT RESPOND 73 00:02:52,775 --> 00:02:54,176 PROPERLY. 74 00:02:54,176 --> 00:02:57,346 SIMILARLY, IF WE ARE NOT 75 00:02:57,346 --> 00:02:59,915 SENSITIVE TO THE CRUCIALNESS OF 76 00:02:59,915 --> 00:03:00,916 MONITORING SUBSTANCE USE IN 77 00:03:00,916 --> 00:03:03,819 PEOPLE WITH MENTAL ILLNESS, WE 78 00:03:03,819 --> 00:03:06,055 MAY BE MISSING AN OPPORTUNITY TO 79 00:03:06,055 --> 00:03:07,923 ACTUALLY DO AN INTERVENTION THAT 80 00:03:07,923 --> 00:03:10,426 WILL IMPROVE THEIR OUTCOMES OF 81 00:03:10,426 --> 00:03:12,061 MENTAL DISORDER ITSELF. 82 00:03:12,061 --> 00:03:14,263 SO I THINK THAT I WOULD LIKE TO 83 00:03:14,263 --> 00:03:16,832 START BY SAYING THAT AS WE GO 84 00:03:16,832 --> 00:03:18,801 THRU OUT THE DISCUSSION ALL DAY 85 00:03:18,801 --> 00:03:23,339 LONG THAT WE NEED TO CONCEIVE OF 86 00:03:23,339 --> 00:03:25,407 MODELS ABLE TO INTEGRATE THESE 87 00:03:25,407 --> 00:03:26,742 TWO CONDITIONS THAT ARE PART OF 88 00:03:26,742 --> 00:03:29,945 THE BRAIN DISORDERS AND FOR 89 00:03:29,945 --> 00:03:33,182 WHICH BIOLOGY HAS TOLD US ALL 90 00:03:33,182 --> 00:03:35,884 ALONG THAT ACTUALLY OUR COMMON 91 00:03:35,884 --> 00:03:37,620 FACTORS THAT MAKE PEOPLE 92 00:03:37,620 --> 00:03:39,989 VULNERABLE TO THEM AND VIA 93 00:03:39,989 --> 00:03:44,226 GENETIC VULNERABILITIES OR 94 00:03:44,226 --> 00:03:46,061 ENVIRONMENTAL AND DEVELOPMENTAL 95 00:03:46,061 --> 00:03:48,430 PROCESSES THAT MAKE YOU 96 00:03:48,430 --> 00:03:51,100 SENSITIVE TO ONE OR HIGHER RISK 97 00:03:51,100 --> 00:03:54,370 FOR ONE OR THE OTHER. THERE IS 98 00:03:54,370 --> 00:03:56,238 ENORMOUS OVERLAP AND LOOKING AT 99 00:03:56,238 --> 00:03:57,706 STUDIES OF THE BRAIN, YOU WILL 100 00:03:57,706 --> 00:04:00,242 FIND OUT THERE IS NOT A 101 00:04:00,242 --> 00:04:01,477 PARTICULAR REGION OF THE BRAIN 102 00:04:01,477 --> 00:04:03,112 BELONGING TO ADDICTION AND ONE 103 00:04:03,112 --> 00:04:05,681 TO SERIOUS MENTAL ILLNESSES. 104 00:04:05,681 --> 00:04:08,183 IN FACT, THE BRAIN WORKS THROUGH 105 00:04:08,183 --> 00:04:10,419 PROCESSES AND EXTENT TO WHICH A 106 00:04:10,419 --> 00:04:11,553 GIVEN [INDISCERNIBLE] IS 107 00:04:11,553 --> 00:04:12,721 EFFECTED IN ONE CONDITION. 108 00:04:12,721 --> 00:04:16,225 WE CAN SEE IT ALSO MANIFESTED IN 109 00:04:16,225 --> 00:04:17,826 ANOTHER. 110 00:04:17,826 --> 00:04:20,229 IT IS VERY MUCH DEPENDENT IN NOT 111 00:04:20,229 --> 00:04:22,564 JUST ONE FACTOR WHETHER IT 112 00:04:22,564 --> 00:04:26,402 EMERGES AS AN ISOLATED 113 00:04:26,402 --> 00:04:27,536 DESENSITIVITY OF DEPRESSION, 114 00:04:27,536 --> 00:04:29,505 WHICH IS VERY RARE TO HAVE JUST 115 00:04:29,505 --> 00:04:33,809 BY ITSELF OR AS A SEPARATED 116 00:04:33,809 --> 00:04:36,111 ENTITY OF ALCOHOL USE DISORDER 117 00:04:36,111 --> 00:04:37,913 BY ITSELF OR OPIOID USE 118 00:04:37,913 --> 00:04:38,180 DISORDER. 119 00:04:38,180 --> 00:04:41,116 IT IS RATHER A VARIETY OF 120 00:04:41,116 --> 00:04:43,185 FACTORS THAT DETERMINE THE 121 00:04:43,185 --> 00:04:45,988 TRANSITION INTO ONE OR THE 122 00:04:45,988 --> 00:04:46,355 OTHER. 123 00:04:46,355 --> 00:04:48,290 SO IN -- AS WE -- AS WE THINK 124 00:04:48,290 --> 00:04:50,492 ABOUT WHAT ARE THE ISSUES THAT 125 00:04:50,492 --> 00:04:53,262 WE NEED TO PAY ATTENTION TO, I 126 00:04:53,262 --> 00:04:56,231 WOULD WELCOME ALSO THROUGH THIS 127 00:04:56,231 --> 00:04:58,767 MEETING THOUGHTS AND 128 00:04:58,767 --> 00:05:01,036 RECOMMENDATIONS VIS-À-VIS WHAT 129 00:05:01,036 --> 00:05:03,038 ARE SOME OF THE MOST IMPORTANT 130 00:05:03,038 --> 00:05:08,177 AREAS THAT WE NEED TO TRAVERSE 131 00:05:08,177 --> 00:05:10,546 AT THIS POINT IN TIME WHEN WE 132 00:05:10,546 --> 00:05:12,848 ARE OBSERVING, I THINK, FOR THE 133 00:05:12,848 --> 00:05:15,951 FIRST TIME, FORTUNATELY, 134 00:05:15,951 --> 00:05:18,253 RECOGNITION THAT WE NEED TO 135 00:05:18,253 --> 00:05:20,889 ADDRESS CHRONIC DISEASES IN OUR 136 00:05:20,889 --> 00:05:21,423 COUNTRY. 137 00:05:21,423 --> 00:05:24,026 IT SO HAPPENS THAT MOST -- AMONG 138 00:05:24,026 --> 00:05:27,062 THE MOST PERVASIVE CHRONIC 139 00:05:27,062 --> 00:05:29,098 DISEASES ARE SUBSTANCE USE, 140 00:05:29,098 --> 00:05:31,800 INCLUDING MENTAL ILLNESS OR 141 00:05:31,800 --> 00:05:33,068 MENTAL ILLNESS INCLUDING 142 00:05:33,068 --> 00:05:34,103 SUBSTANCE USE. 143 00:05:34,103 --> 00:05:39,608 IF WE CONCEIVE OF MAKE IING THE 144 00:05:39,608 --> 00:05:41,543 HEALTH OF AMERICANS GREAT AGAIN, 145 00:05:41,543 --> 00:05:43,712 WE NEED TO ADDRESS MODELS THAT 146 00:05:43,712 --> 00:05:47,783 WILL BE ABLE TO ACTUALLY PROVIDE 147 00:05:47,783 --> 00:05:49,351 THAT CARE FOR THOSE WITH 148 00:05:49,351 --> 00:05:51,653 SUBSTANCE USE AND MENTAL HEALTH 149 00:05:51,653 --> 00:05:53,889 -- OTHER MENTAL HEALTH 150 00:05:53,889 --> 00:05:54,456 CONDITIONS. 151 00:05:54,456 --> 00:05:58,160 IT IS THIS LINE OF THINKING IN 152 00:05:58,160 --> 00:06:00,996 MY BRAIN, WHICH IS SOMETHING 153 00:06:00,996 --> 00:06:02,698 THAT HAS ALWAYS SORT OF 154 00:06:02,698 --> 00:06:05,434 DISTURBED ME HOW WE SEPARATE 155 00:06:05,434 --> 00:06:07,936 THESE TWO CONDITIONS, GENERATED 156 00:06:07,936 --> 00:06:09,838 MODELS OF CARE THAT ACTUALLY 157 00:06:09,838 --> 00:06:14,109 START BY PROPERLY TRAINING 158 00:06:14,109 --> 00:06:15,144 CLINICIANS TO RECOGNIZE AND TO 159 00:06:15,144 --> 00:06:19,114 TREAT BOTH OF THE CONDITIONS BY 160 00:06:19,114 --> 00:06:22,684 THEMSELVES OR MORE FREQUENTLY AS 161 00:06:22,684 --> 00:06:26,955 THEY OCCUR CO-MORBIDLY BECOMES A 162 00:06:26,955 --> 00:06:27,823 CRUCIAL ONE. 163 00:06:27,823 --> 00:06:29,191 ANOTHER CRUCIAL COMPONENTS I 164 00:06:29,191 --> 00:06:31,493 HOPE THAT WE ARE ABLE TO ADDRESS 165 00:06:31,493 --> 00:06:32,628 THROUGHOUT ALL OF THE 166 00:06:32,628 --> 00:06:35,864 DISCUSSIONS IS WE PAY A LOT OF 167 00:06:35,864 --> 00:06:38,767 ATTENTION ON TREATMENT AS ACUTE 168 00:06:38,767 --> 00:06:39,101 INTERVENTION. 169 00:06:39,101 --> 00:06:42,371 WE NEED TO RECOGNIZE. THIS IS, 170 00:06:42,371 --> 00:06:44,973 AGAIN, FUNDAMENTAL TO HEALTH 171 00:06:44,973 --> 00:06:47,309 ECONOMICS THAT IS NOT JUST ACUTE 172 00:06:47,309 --> 00:06:49,144 PHASE THAT WE NEED TO PAY 173 00:06:49,144 --> 00:06:50,045 ATTENTION TO. 174 00:06:50,045 --> 00:06:52,514 WHAT HAPPENS AFTER THAT ACUTE 175 00:06:52,514 --> 00:06:54,583 PHASE HAS STABILIZED OR WHAT WE 176 00:06:54,583 --> 00:06:57,486 HAVE DESCRIBED VERY MUCH IN THE 177 00:06:57,486 --> 00:07:01,023 SUBSTANCE USE FIELD AS RECOVERY. 178 00:07:01,023 --> 00:07:03,425 SO HOW -- WITHOUT THAT 179 00:07:03,425 --> 00:07:06,628 INVESTMENT IN RECOVERY, THE 180 00:07:06,628 --> 00:07:07,996 ECONOMICS DON'T WORK OUT 181 00:07:07,996 --> 00:07:11,733 PROPERLY. LIKELIHOOD OF PEOPLE 182 00:07:11,733 --> 00:07:14,470 TO SUSTAIN THAT WELLBEING 183 00:07:14,470 --> 00:07:15,938 WITHOUT SUPPORT THAT IS 184 00:07:15,938 --> 00:07:18,574 NECESSARY FOR MANY OF THEM IN 185 00:07:18,574 --> 00:07:20,142 RECOVERY, THEY WILL RELAPSE. 186 00:07:20,142 --> 00:07:22,811 SO I HOPE THAT AS WE GO 187 00:07:22,811 --> 00:07:24,346 THROUGHOUT THE DAY TODAY AND IN 188 00:07:24,346 --> 00:07:27,049 OUR DISCUSSIONS AND PANELS THAT 189 00:07:27,049 --> 00:07:29,451 ISSUE OF HEALTH ECONOMICS AS WE 190 00:07:29,451 --> 00:07:31,620 ARE TARGETING IN TREATMENT 191 00:07:31,620 --> 00:07:33,856 SHOULD ALSO EXPAND INTO 192 00:07:33,856 --> 00:07:34,490 RECOVERY. 193 00:07:34,490 --> 00:07:45,033 I WILL BE AMISSED ALSO IF I -- 194 00:07:53,842 --> 00:07:56,478 I REALIZE I WAS CUT OFF. I WILL 195 00:07:56,478 --> 00:07:58,380 COME BACK AND WANT TO END BY 196 00:07:58,380 --> 00:08:00,816 SAYING THAT AS WE GO THROUGH THE 197 00:08:00,816 --> 00:08:02,551 DISCUSSION, LET'S NOT FORGET 198 00:08:02,551 --> 00:08:05,153 ABOUT THE HEALTH ECONOMICS NOT 199 00:08:05,153 --> 00:08:07,556 JUST OF TREATMENT BUT RECOVERY 200 00:08:07,556 --> 00:08:09,558 AND PLEASE LET'S NOT FORGET 201 00:08:09,558 --> 00:08:13,095 ABOUT IMPORTANCE OF HEALTH 202 00:08:13,095 --> 00:08:17,933 ECONOMICS FOR PREVENTION. 203 00:08:17,933 --> 00:08:20,369 IN THE PROCESS AND DIALOGUE WE 204 00:08:20,369 --> 00:08:22,204 WILL CONSIDER CASCADE OF CARE 205 00:08:22,204 --> 00:08:23,472 FROM EARLY PREVENTION TO 206 00:08:23,472 --> 00:08:25,507 TREATMENT ADDRESS ACUTE NEEDS OF 207 00:08:25,507 --> 00:08:29,711 THE INDIVIDUAL AND TO THEN ITS 208 00:08:29,711 --> 00:08:29,978 RECOVERY. 209 00:08:29,978 --> 00:08:31,446 WITH THAT OI WANT TO THANK 210 00:08:31,446 --> 00:08:32,381 EVERYONE FOR PARTICIPATING IN 211 00:08:32,381 --> 00:08:34,683 THE MEETING. I WILL TAKE A TURN 212 00:08:34,683 --> 00:08:37,953 AT THE MICROPHONE BACK TO THE 213 00:08:37,953 --> 00:08:38,353 ORGANIZERS. 214 00:08:38,353 --> 00:08:39,021 THANK YOU. 215 00:08:39,021 --> 00:08:43,358 >> THANK YOU SO MUCH. REALLY 216 00:08:43,358 --> 00:08:45,027 APPRECIATE YOUR SUPPORT FOR THE 217 00:08:45,027 --> 00:08:47,996 HEALTH ECONOMICS MEETING AND 218 00:08:47,996 --> 00:08:50,098 INTRODUCE ANDREA WHO IS ACTING 219 00:08:50,098 --> 00:08:51,667 DIRECTOR OF NIMH WHO WILL 220 00:08:51,667 --> 00:08:57,773 PROVIDE REMARKS FROM THE NIMH 221 00:08:57,773 --> 00:09:06,782 PERSPECTIVE. 222 00:09:06,782 --> 00:09:17,326 >> ANDREA BECKEL-MICHENER , WERE 223 00:09:21,563 --> 00:09:24,199 YOU ABLE TO JOIN? 224 00:09:24,199 --> 00:09:25,667 >> THANK YOU. I COULDN'T HIT 225 00:09:25,667 --> 00:09:28,337 THE CAMERA OR MIC THERE FOR A 226 00:09:28,337 --> 00:09:29,171 MOMENT. I APOLOGIZE. 227 00:09:29,171 --> 00:09:31,106 THANK YOU SO MUCH. I WANT TO 228 00:09:31,106 --> 00:09:34,343 ADD MY EXTENSION OF THE WARM 229 00:09:34,343 --> 00:09:37,012 WELCOME NORA GAVE TO ALL 230 00:09:37,012 --> 00:09:39,915 PARTICIPANTS AND ALSO THANK THE 231 00:09:39,915 --> 00:09:45,320 STAFF AT NIMH AND NIDA AND HEAL 232 00:09:45,320 --> 00:09:46,655 FOR THEIR WORK ORGANIZING THIS 233 00:09:46,655 --> 00:09:49,791 EVENT THIS IS AN INTERESTING 234 00:09:49,791 --> 00:09:51,293 FORUM FOR PARTIES AND 235 00:09:51,293 --> 00:09:53,295 INDIVIDUALS WITH LIVED 236 00:09:53,295 --> 00:09:54,830 EXPERIENCE WITH SUBSTANCE USE 237 00:09:54,830 --> 00:09:56,498 DISORDERS AND SERIOUS MENTAL 238 00:09:56,498 --> 00:09:58,634 ILLNESS TO LEARN ABOUT ADVANCES 239 00:09:58,634 --> 00:10:00,769 AND OPPORTUNITIES AND HEALTH 240 00:10:00,769 --> 00:10:01,336 ECONOMICS RESEARCH. 241 00:10:01,336 --> 00:10:04,539 ALL THINGS NORA SAID REALLY 242 00:10:04,539 --> 00:10:06,241 RESONATED. IT IS A GREAT 243 00:10:06,241 --> 00:10:07,876 EXAMPLE HOW COLLABORATIVE 244 00:10:07,876 --> 00:10:10,779 DISCUSSIONS AND EFFORTS CAN 245 00:10:10,779 --> 00:10:12,280 IDENTIFY OPPORTUNITIES TO LEAD 246 00:10:12,280 --> 00:10:14,716 TO MEANINGFUL BREAKTHROUGHS IN 247 00:10:14,716 --> 00:10:15,617 RELEVANT AREAS OF SCIENCE. 248 00:10:15,617 --> 00:10:18,920 A LITTLE MORE ON HEALTH 249 00:10:18,920 --> 00:10:21,189 ECONOMICS RESEARCH AT NIMH. WE 250 00:10:21,189 --> 00:10:23,025 HAVE COMMITTED TO INVESTMENTS IN 251 00:10:23,025 --> 00:10:26,828 THE ARENA LEADING TO INNOVATIONS 252 00:10:26,828 --> 00:10:28,497 TRANSFORMING MENTAL HEALTH 253 00:10:28,497 --> 00:10:31,667 SERVICES DELIVERY. BACK IN THE 254 00:10:31,667 --> 00:10:33,568 1980S, DR. AGNES DEVELOPED A 255 00:10:33,568 --> 00:10:35,704 PORTFOLIO OF RESEARCH GRANTS TO 256 00:10:35,704 --> 00:10:37,739 STUDY ECONOMIC FEASIBILITY OF 257 00:10:37,739 --> 00:10:40,575 EQUAL COVERAGE FOR MENTAL HEALTH 258 00:10:40,575 --> 00:10:43,278 AND MEDICAL CARE AND PRIVATE 259 00:10:43,278 --> 00:10:43,945 HEALTH INSURANCE PLANS. 260 00:10:43,945 --> 00:10:47,182 THIS BODY OF RESEARCH PROVIDED 261 00:10:47,182 --> 00:10:49,418 ECONOMIC RATIONALE AND 262 00:10:49,418 --> 00:10:50,585 SCIENTIFIC FOUNDATION FOR WHAT 263 00:10:50,585 --> 00:10:52,821 BECAME MENTAL HEALTH PARITY AND 264 00:10:52,821 --> 00:10:57,092 ADDICTION EQUITY ACT OF 2008 AND 265 00:10:57,092 --> 00:10:58,694 REALLY IMPORTANT LEGISLATION 266 00:10:58,694 --> 00:10:59,528 LEADING TO INCREASES IN ACCESS 267 00:10:59,528 --> 00:11:01,596 TO CARE FOR TENS OF THOUSANDS OF 268 00:11:01,596 --> 00:11:03,165 PERSONS WITH MENTAL ILLNESS IN 269 00:11:03,165 --> 00:11:03,598 THE UNITED STATES. 270 00:11:03,598 --> 00:11:05,801 THIS IS A EXAMPLE OF IMPACT OF 271 00:11:05,801 --> 00:11:06,902 THIS TYPE OF RESEARCH. 272 00:11:06,902 --> 00:11:09,671 WE HAVE AN ONGOING COMMITMENT TO 273 00:11:09,671 --> 00:11:11,206 THIS TYPE OF RESEARCH, INCLUDING 274 00:11:11,206 --> 00:11:15,577 A FOCUS ON COMPARING ALTERNATIVE 275 00:11:15,577 --> 00:11:17,979 FINANCING MODELS TO PROMOTE 276 00:11:17,979 --> 00:11:19,848 EFFECTIVE AND EFFICIENT CARE. 277 00:11:19,848 --> 00:11:24,286 ALSO, OVER THE LAST YEAR, NIMH 278 00:11:24,286 --> 00:11:28,223 HAS SUPPORTED INITIATIVES TO 279 00:11:28,223 --> 00:11:29,691 ECONOMIC-BASED RESEARCH 280 00:11:29,691 --> 00:11:31,026 INCLUDING TWO NOTICES OF SPECIAL 281 00:11:31,026 --> 00:11:33,028 INTEREST AND ONE ENCOURAGES 282 00:11:33,028 --> 00:11:35,764 STUDIES OF IMPACT ON POLICY 283 00:11:35,764 --> 00:11:37,065 INTERVENTIONS AIMED AT 284 00:11:37,065 --> 00:11:37,966 ADDRESSING SOCIAL DETERMINANTS 285 00:11:37,966 --> 00:11:41,069 OF HEALTH TO IMPROVE FUNCTIONING 286 00:11:41,069 --> 00:11:42,404 AND WELL-BEING FOR PEOPLE WITH 287 00:11:42,404 --> 00:11:44,606 SERIOUS MENTAL ILLNESSES WHILE 288 00:11:44,606 --> 00:11:47,709 THE OTHER SEEKS RESEARCH ON 289 00:11:47,709 --> 00:11:50,212 IMPACT OF FINANCING AND PAYMENT 290 00:11:50,212 --> 00:11:52,214 MECHANISMS TO IMPROVE BEHAVIORAL 291 00:11:52,214 --> 00:11:55,450 HEALTH ACCESS UTILIZATION AND 292 00:11:55,450 --> 00:11:55,717 OUTCOMES. 293 00:11:55,717 --> 00:11:56,651 HIGH-QUALITY CARE IS ALWAYS A 294 00:11:56,651 --> 00:11:59,588 GOAL AND AS SUCH WE HAVE TO 295 00:11:59,588 --> 00:12:03,925 DEFINE WHAT HIGH QUALITY CARE 296 00:12:03,925 --> 00:12:06,561 MEANS. IN THE PAST YEAR NIMH IS 297 00:12:06,561 --> 00:12:09,264 FUNDED 6 SCALE R01 GRANTS AND 298 00:12:09,264 --> 00:12:11,800 FOUR PILOT R34 GRANTS TO SUPPORT 299 00:12:11,800 --> 00:12:14,102 DEVELOPMENT AND VALIDATION OF 300 00:12:14,102 --> 00:12:15,971 ACCESS MEASURES AND OUTCOME 301 00:12:15,971 --> 00:12:18,373 FOCUSED QUALITY MEASURES IN 302 00:12:18,373 --> 00:12:20,041 MENTAL HEALTH CARE. 303 00:12:20,041 --> 00:12:20,876 FINALLY, THE MOST IMPORTANT 304 00:12:20,876 --> 00:12:23,178 THING IS TO MOVE FROM RESEARCH 305 00:12:23,178 --> 00:12:25,113 TO TREATMENT. 306 00:12:25,113 --> 00:12:27,149 WE FUND RESEARCH TO EXAMINE 307 00:12:27,149 --> 00:12:29,184 INCENTIVES FOR PROVIDERS AND 308 00:12:29,184 --> 00:12:32,154 PAYERS AS WELL AS SOCIOECONOMIC 309 00:12:32,154 --> 00:12:33,588 ISSUES EFFECTING PATIENTS AND 310 00:12:33,588 --> 00:12:35,423 FAMILIES AND RESEARCH CAN HELP 311 00:12:35,423 --> 00:12:37,526 ADDRESS QUESTIONS THAT ARE KEY 312 00:12:37,526 --> 00:12:39,461 TO IMPROVING MENTAL HEALTH 313 00:12:39,461 --> 00:12:40,495 TREATMENT AND SERVICE DELIVERY 314 00:12:40,495 --> 00:12:42,130 AND OUTCOMES INCLUDING 315 00:12:42,130 --> 00:12:44,232 UNDERSTANDING THE BARRIERS, 316 00:12:44,232 --> 00:12:46,635 ECONOMIC BARRIERS, CHALLENGES, 317 00:12:46,635 --> 00:12:48,003 AND OPPORTUNITIES TO PROMOTE 318 00:12:48,003 --> 00:12:51,673 ACCESS TO EVIDENCE-BASED CARE. 319 00:12:51,673 --> 00:12:53,642 WOVEN THROUGHOUT IT IS VITAL TO 320 00:12:53,642 --> 00:12:55,944 ININSIGHTS AND NEEDS OF PEOPLE 321 00:12:55,944 --> 00:12:57,712 WITH LIVED EXPERIENCE TO 322 00:12:57,712 --> 00:13:00,415 IDENTIFY APPROACHES AND HIGHEST 323 00:13:00,415 --> 00:13:03,018 POTENTIAL TO ENHANCE SERVICE 324 00:13:03,018 --> 00:13:05,053 ACCESS AND QUALITY CARE. 325 00:13:05,053 --> 00:13:07,022 SO IN CLOSING, ONCE AGAIN, 326 00:13:07,022 --> 00:13:08,456 THANKS FOR JOINING TODAY AND WE 327 00:13:08,456 --> 00:13:10,292 ARE LOOKING FORWARD TO 328 00:13:10,292 --> 00:13:13,328 CONTINUING TO WORK TOGETHER. 329 00:13:13,328 --> 00:13:14,329 PLEASE FEEL FREE TO ASK 330 00:13:14,329 --> 00:13:16,565 QUESTIONS OF SPEAKERS AND ENGAGE 331 00:13:16,565 --> 00:13:18,400 WITH RESEARCH PRESENTERS. 332 00:13:18,400 --> 00:13:19,835 I'M REALLY LOOKING FORWARD TO 333 00:13:19,835 --> 00:13:20,268 DISCUSSIONS TODAY. 334 00:13:20,268 --> 00:13:24,239 NOW I WILL TURN IT BACK OVER TO 335 00:13:24,239 --> 00:13:26,708 MY COLLEAGUES AT NIMH TO GIVE AN 336 00:13:26,708 --> 00:13:28,143 OVERVIEW OF TODAY'S WORKSHOP. 337 00:13:28,143 --> 00:13:32,981 >> THANK YOU SO MUCH DR. 338 00:13:32,981 --> 00:13:34,149 BECKEL-MICHENER . WE WANT TO 339 00:13:34,149 --> 00:13:36,885 THANK YOU FOR ATTENDING THE 340 00:13:36,885 --> 00:13:39,020 MEETING TODAY AND RESEARCHERS 341 00:13:39,020 --> 00:13:41,756 AND FACILITATORS. THIS 342 00:13:41,756 --> 00:13:43,325 REPRESENTS A COLLABORATION ON 343 00:13:43,325 --> 00:13:45,894 NATIONAL INSTITUTE OF DRUG ABUSE 344 00:13:45,894 --> 00:13:47,462 AND NATIONAL INSTITUTE OF MENTAL 345 00:13:47,462 --> 00:13:49,130 HEALTH THIS IS THE SECOND 346 00:13:49,130 --> 00:13:51,066 MEETING OF THIS TYPE FOLLOWING 347 00:13:51,066 --> 00:13:52,834 FIRST IN 2023 AND GREAT 348 00:13:52,834 --> 00:13:56,137 OPPORTUNITY TO SHOW RESEARCH AND 349 00:13:56,137 --> 00:13:58,039 HEALTH ECONOMICS AND SHOWING -- 350 00:13:58,039 --> 00:14:00,041 WE THANK THE HEAL INITIATIVE FOR 351 00:14:00,041 --> 00:14:01,209 SUPPORTING THIS MEETING. 352 00:14:01,209 --> 00:14:03,345 DURING TODAY'S MEETING WE WILL 353 00:14:03,345 --> 00:14:07,649 HAVE FIVE PANELISTS FOCUSING ON 354 00:14:07,649 --> 00:14:09,017 HEALTH ECONOMIC RELATED RESEARCH 355 00:14:09,017 --> 00:14:10,752 AND TREATMENT AND IMPLEMENTATION 356 00:14:10,752 --> 00:14:12,287 APPROACHES AND HEALTH CARE 357 00:14:12,287 --> 00:14:14,956 FINANCING AND DELIVERY MODELS 358 00:14:14,956 --> 00:14:16,224 AND NEEDS AND SPECIAL 359 00:14:16,224 --> 00:14:18,760 POPULATIONS REINTEGRATING MENTAL 360 00:14:18,760 --> 00:14:20,228 HEALTH SUBSTANCE USE AND PRIMARY 361 00:14:20,228 --> 00:14:22,397 CARE AND NEEDS OF PATIENTS AND 362 00:14:22,397 --> 00:14:26,968 FAMILIES AND END OF EACH PANEL 363 00:14:26,968 --> 00:14:29,271 FACILITATORS WILL FACILITATE 15 364 00:14:29,271 --> 00:14:31,206 MINUTE QUESTION AND ANSWER 365 00:14:31,206 --> 00:14:32,474 SECTION. FEEL FREE TO SUBMIT 366 00:14:32,474 --> 00:14:33,775 QUESTIONS TO THE PRESENTERS 367 00:14:33,775 --> 00:14:35,510 THROUGH THE Q & A FUNCTION AND 368 00:14:35,510 --> 00:14:37,879 THERE WILL BE A FEW BREAKS 369 00:14:37,879 --> 00:14:40,181 THROUGHOUT THE DAY THAT ARE 370 00:14:40,181 --> 00:14:42,417 NOTED ON THE SLIDES AND MEETING 371 00:14:42,417 --> 00:14:46,421 IS RECORDED AND AVAILABLE ON NIH 372 00:14:46,421 --> 00:14:48,256 WEBCAST. THERE MAY BE A WEEK 373 00:14:48,256 --> 00:14:50,458 DELAY UNTIL THE MEETING IS 374 00:14:50,458 --> 00:14:51,893 AVAILABLE IN THE PAST SECTION OF 375 00:14:51,893 --> 00:14:54,896 THE EVENT SECTION OF THE NIH 376 00:14:54,896 --> 00:14:58,300 VIDEO CAST AND WE CAN TRANSITION 377 00:14:58,300 --> 00:15:01,770 TO THE FIRST SESSION SHOWCASING 378 00:15:01,770 --> 00:15:03,471 ECONOMIC EVALUATION APPROACHES. 379 00:15:03,471 --> 00:15:08,243 I WILL TURN IT TO OUR FACILITATE 380 00:15:11,913 --> 00:15:12,013 OR. 381 00:15:12,013 --> 00:15:14,015 >> OKAY. IT DOESN'T LOOK LIKE 382 00:15:14,015 --> 00:15:16,651 TEAMS IS LETTING ME TURN ON MY 383 00:15:16,651 --> 00:15:18,019 CAMERA NOW. 384 00:15:18,019 --> 00:15:20,789 IT WORKED A MOMENT AGO. 385 00:15:20,789 --> 00:15:23,658 HOPEFULLY YOU CAN ALL HEAR ME? 386 00:15:23,658 --> 00:15:24,592 >> YES. 387 00:15:24,592 --> 00:15:27,696 >> GREAT. GOOD MORNING EVERYONE 388 00:15:27,696 --> 00:15:29,297 I'M ERIKA CRABLE AND WE WILL 389 00:15:29,297 --> 00:15:31,232 START THE WORKSHOP COVERING A 390 00:15:31,232 --> 00:15:32,867 SUPER IMPORTANT TOPIC, HOW TO 391 00:15:32,867 --> 00:15:35,003 USE DIFFERENT ECONOMIC 392 00:15:35,003 --> 00:15:37,806 EVALUATION APPROACHES TO PROMOTE 393 00:15:37,806 --> 00:15:42,210 IMPLEMENTATION, SUSTAINMENT AND 394 00:15:42,210 --> 00:15:43,144 SCALE-UP FOR EFFECTIVE -- 395 00:15:43,144 --> 00:15:44,846 ECONOMIC BARRIERS ARE CONSIDERED 396 00:15:44,846 --> 00:15:48,049 LATE IN THE GAME AS A REASON TO 397 00:15:48,049 --> 00:15:49,784 NOT SUSTAIN EVIDENCE-BASED 398 00:15:49,784 --> 00:15:51,353 PRACTICE BEYOND A RESEARCH 399 00:15:51,353 --> 00:15:51,753 TRIAL. 400 00:15:51,753 --> 00:15:53,188 WE WILL CHANGE COLLECTIVE 401 00:15:53,188 --> 00:15:55,290 THINKING AND FUTURE ACTIONS 402 00:15:55,290 --> 00:15:57,392 TODAY AND TOGETHER WE WILL LEARN 403 00:15:57,392 --> 00:15:59,828 ABOUT DIFFERENT ECONOMIC 404 00:15:59,828 --> 00:16:01,162 EVALUATION APPROACHES, TOOLS AND 405 00:16:01,162 --> 00:16:02,764 WAYS TO ENGAGE DECISION MAKERS 406 00:16:02,764 --> 00:16:05,367 SO WE IDENTIFY ECONOMICALLY 407 00:16:05,367 --> 00:16:06,801 FEASIBLE EVIDENCE-BASED 408 00:16:06,801 --> 00:16:09,537 PRACTICES AND ECONOMICALLY 409 00:16:09,537 --> 00:16:10,672 FEASIBLE IMPLEMENTATION 410 00:16:10,672 --> 00:16:13,808 STRATEGIES LEADING TO LONG-TERM 411 00:16:13,808 --> 00:16:15,043 SUSTAINMENT. WE NEED DURABLE 412 00:16:15,043 --> 00:16:18,179 RESULTS NOT JUST IMPLEMENTATION 413 00:16:18,179 --> 00:16:19,814 EFFORTS WORKING UNDER 414 00:16:19,814 --> 00:16:20,548 WELL-FUNDED RESEARCH CONDITIONS. 415 00:16:20,548 --> 00:16:23,985 AS WE BEGIN THE PANEL USE THE Q 416 00:16:23,985 --> 00:16:25,754 & A BOX TO SHARE QUESTIONS YOU 417 00:16:25,754 --> 00:16:27,789 HAVE AT ANY TYPE. WE WILL 418 00:16:27,789 --> 00:16:28,690 COLLECT QUESTIONS AND RESPOND 419 00:16:28,690 --> 00:16:30,558 AFTER ALL OUR PRESENTATIONS IN 420 00:16:30,558 --> 00:16:32,127 THE FIRST PANEL HAVE FINISHED 421 00:16:32,127 --> 00:16:34,095 AND WILL KICK OFF A DISCUSSION 422 00:16:34,095 --> 00:16:36,197 ABOUT A PRESENTATION ABOUT A 423 00:16:36,197 --> 00:16:38,166 COOL CUSTOMIZED ECONOMIC 424 00:16:38,166 --> 00:16:42,404 MODELING TOOL DAVID SMELSON FROM 425 00:16:42,404 --> 00:16:46,841 UMASS MEDICAL SCHOOL AND TODD 426 00:16:46,841 --> 00:16:50,712 OLMSTEAD CREATED WITH MASS 427 00:16:50,712 --> 00:16:53,415 HEALTH MASSACHUSETTS AID AGENCY. 428 00:16:53,415 --> 00:16:54,749 I WILL HAND IT TO THEM. 429 00:16:54,749 --> 00:16:56,217 >> THANK YOU FOR THE OPPORTUNITY 430 00:16:56,217 --> 00:16:58,119 TO PRESENT TODAY. MAKING SURE 431 00:16:58,119 --> 00:17:03,825 TODD HAS CONTROL OF THE SLIDES. 432 00:17:03,825 --> 00:17:04,159 >> YES. 433 00:17:04,159 --> 00:17:07,495 >> PERFECT. THANK YOU SO MUCH. 434 00:17:07,495 --> 00:17:10,198 MY NAME IS DAVID SMELSON IN THE 435 00:17:10,198 --> 00:17:13,435 DEPARTMENT OF MEDICINE AT U MASS 436 00:17:13,435 --> 00:17:14,536 MEDICAL SCHOOL AND PRESENTING 437 00:17:14,536 --> 00:17:18,073 TODAY WITH TODD WHO IS IN 438 00:17:18,073 --> 00:17:22,110 DEPARTMENT OF HEALTH AND 439 00:17:22,110 --> 00:17:23,678 ECONOMIC HEALTH AT CORNELL 440 00:17:23,678 --> 00:17:25,447 UNIVERSITY. 441 00:17:25,447 --> 00:17:27,148 THANK YOU TO THE NIH FOR GENERAL 442 00:17:27,148 --> 00:17:28,950 FUNDING ABOUT WORK WE WILL TALK 443 00:17:28,950 --> 00:17:30,952 ABOUT TODAY AND I RECEIVED 444 00:17:30,952 --> 00:17:36,224 FUNDING FROM NIDA AND NIMH AND 445 00:17:36,224 --> 00:17:41,096 TODD RECEIVES FUNDING FROM NIMH 446 00:17:41,096 --> 00:17:44,632 NIDA AND NIMH LBA NEXT SLIDE I 447 00:17:44,632 --> 00:17:47,135 WILL GIVE AN OVERVIEW OF A 448 00:17:47,135 --> 00:17:48,136 MULTICOMPONENT INTERVENTION WE 449 00:17:48,136 --> 00:17:49,838 ARE STUDYING THROUGH HEAL 450 00:17:49,838 --> 00:17:51,139 INITIATIVE CALLED MISSION TO 451 00:17:51,139 --> 00:17:53,808 ADDRESS ADDICTION AND MENTAL 452 00:17:53,808 --> 00:17:56,411 HEALTH AND IN THIS PARTICULAR 453 00:17:56,411 --> 00:17:57,846 CASE OPIOID USE DISORDER AND I 454 00:17:57,846 --> 00:17:59,747 WILL TALK ABOUT THE MEDICAID 455 00:17:59,747 --> 00:18:02,951 BILLING PROCESS WE WENT THROUGH 456 00:18:02,951 --> 00:18:03,985 FOR REIMBURSEMENT AND 457 00:18:03,985 --> 00:18:05,720 SUSTAINABILITY AND TODD WILL 458 00:18:05,720 --> 00:18:07,622 TALK ABOUT PLANNED ECONOMIC 459 00:18:07,622 --> 00:18:09,958 ANALYSIS AND DOING THAT ALL IN 460 00:18:09,958 --> 00:18:10,492 10 MINUTES . 461 00:18:10,492 --> 00:18:14,095 THANK YOU. MISSIONS AND 462 00:18:14,095 --> 00:18:15,830 MULTICOMPONENT COLLABORATIVE 463 00:18:15,830 --> 00:18:17,365 CARE DEFINES THREE 464 00:18:17,365 --> 00:18:18,299 EVIDENCE-BASED PRACTICES 465 00:18:18,299 --> 00:18:20,201 A BUNCH OF EVIDENCE WITHIN THE 466 00:18:20,201 --> 00:18:21,903 PRACTICES THAT WE INTEGRATED IN 467 00:18:21,903 --> 00:18:24,672 A SYSTEMATIC WAY AND THOSE 468 00:18:24,672 --> 00:18:26,007 PRACTICES ARE CRITICAL TIME 469 00:18:26,007 --> 00:18:28,243 INTERVENTION DUAL RECOVERY AND 470 00:18:28,243 --> 00:18:30,879 PEER SUPPORT AND IN THE NEXT FEW 471 00:18:30,879 --> 00:18:33,214 SLIDES I WILL GIVE A BRIEF 472 00:18:33,214 --> 00:18:34,682 OVERVIEW WHAT THE INTERVENTION 473 00:18:34,682 --> 00:18:36,184 FEELS LIKE AND WANT TO SAY THAT 474 00:18:36,184 --> 00:18:38,820 IT FOCUSES ON HARM REDUCTION 475 00:18:38,820 --> 00:18:40,822 PHILOSOPHY AND IS A TEAM-BASED 476 00:18:40,822 --> 00:18:42,957 MODEL AND CASE MANAGER AND PR 477 00:18:42,957 --> 00:18:45,160 TEAM THAT DELIVERS SERVICES 478 00:18:45,160 --> 00:18:47,295 APPROXIMATELY 20 CLIENTS PER 479 00:18:47,295 --> 00:18:49,464 TEAM AND HIGH MODEL AND 480 00:18:49,464 --> 00:18:50,565 TREATMENT LENGTH IS 6 TO 12 481 00:18:50,565 --> 00:18:52,233 MONTHS AND IN THIS PARTICULAR 482 00:18:52,233 --> 00:18:56,204 CASE STUDYING 6-MONTH 483 00:18:56,204 --> 00:18:56,538 INTERVENTION. 484 00:18:56,538 --> 00:18:58,173 NEXT SLIDE, PLEASE. 485 00:18:58,173 --> 00:19:00,842 SO WHOOPS. ONE BEFORE. THANKS. 486 00:19:00,842 --> 00:19:02,343 THE FIRST EVIDENCE-BASED 487 00:19:02,343 --> 00:19:04,245 COMPONENT IS CRITICAL TIME 488 00:19:04,245 --> 00:19:05,880 INTERVENTION AND TIME-LIMITED 489 00:19:05,880 --> 00:19:07,882 FORM OF CASE MANAGEMENT. FOCUS 490 00:19:07,882 --> 00:19:11,052 IS REALLY ON LINKING PEOPLE TO 491 00:19:11,052 --> 00:19:12,253 COMMUNITY-BASED CARE AND 492 00:19:12,253 --> 00:19:15,456 PROVIDING RECOVERY SUPPORTS AND 493 00:19:15,456 --> 00:19:17,225 MISSION IS TIME-LIMITED 494 00:19:17,225 --> 00:19:18,860 INTERVENTION AND WANT TO HELP 495 00:19:18,860 --> 00:19:20,228 PEOPLE ENGAGE IN THE COMMUNITY 496 00:19:20,228 --> 00:19:22,096 AND IS REALLY THE FIRST STAGE 497 00:19:22,096 --> 00:19:24,065 AND FOCUS AT THE BEGINNING. 498 00:19:24,065 --> 00:19:26,801 IT GETS LESS INTENSIVE OVER TIME 499 00:19:26,801 --> 00:19:28,436 AND TRYING OUT SERVICES IN THE 500 00:19:28,436 --> 00:19:30,171 COMMUNITY AND MAKING ADJUSTMENTS 501 00:19:30,171 --> 00:19:33,174 AND TRANSFERRING CARE BECAUSE AT 502 00:19:33,174 --> 00:19:34,609 THE END 6 MONTHS TREATMENT IS 503 00:19:34,609 --> 00:19:34,909 OVER. 504 00:19:34,909 --> 00:19:38,279 AGAIN, IT FOLLOWS A STEP-DOWN 505 00:19:38,279 --> 00:19:39,714 APPROACH THAT IS DELIVERED BY 506 00:19:39,714 --> 00:19:42,183 CASE MANAGER AND PEER THAT DO 507 00:19:42,183 --> 00:19:44,152 SLIGHTLY DIFFERENT THINGS AND 508 00:19:44,152 --> 00:19:45,386 CASE MANAGER MIGHT FOCUS ON 509 00:19:45,386 --> 00:19:47,722 LINKING PEOPLE TO TRADITIONAL 510 00:19:47,722 --> 00:19:49,591 HEALTH CARE SETTINGS AND PEER 511 00:19:49,591 --> 00:19:52,627 MIGHT FOCUS ON 12-STEP THERAPY 512 00:19:52,627 --> 00:19:55,863 AND OTHER RECOVERY ACTIVITIES. 513 00:19:55,863 --> 00:19:56,864 NEXT SLIDE. 514 00:19:56,864 --> 00:20:00,668 SECOND COMPONENT IS INTEGRATED 515 00:20:00,668 --> 00:20:02,637 -- 13 GROUP SESSIONS THAT FOCUS 516 00:20:02,637 --> 00:20:04,939 ON THE INTEGRATION OF MENTAL 517 00:20:04,939 --> 00:20:07,442 HEALTH AND SUBSTANCE ABUSE AND 518 00:20:07,442 --> 00:20:10,111 THEY ARE MOTIVATION BASED CBT 519 00:20:10,111 --> 00:20:12,080 AND RELAPSE PREVENTION DELIVERED 520 00:20:12,080 --> 00:20:15,817 BY CASE MANAGER AND EACH OF THE 521 00:20:15,817 --> 00:20:16,718 SESSIONS HAS WORKSHEETS 522 00:20:16,718 --> 00:20:20,121 ASSOCIATED WITH IT. IT IS A 523 00:20:20,121 --> 00:20:21,856 PRETTY STRUCTURED INTERVENTION. 524 00:20:21,856 --> 00:20:23,625 NEXT SLIDE, PLEASE. 525 00:20:23,625 --> 00:20:25,126 THIRD COMPONENT IS PEER SUPPORT 526 00:20:25,126 --> 00:20:26,494 MENTIONING BEFORE PEERS DO A 527 00:20:26,494 --> 00:20:28,396 SORT OF COMMUNITY OUTREACH THAT 528 00:20:28,396 --> 00:20:30,498 ALSO RUN STRUCTURED GROUPS THAT 529 00:20:30,498 --> 00:20:32,634 WERE DEVELOPED BY PEERS FOR 530 00:20:32,634 --> 00:20:34,335 PEERS AND THERE ARE 11 531 00:20:34,335 --> 00:20:35,603 STRUCTURED SESSIONS THAT AGAIN 532 00:20:35,603 --> 00:20:38,373 FOLLOW THE SAME FORMAT WITH DRT 533 00:20:38,373 --> 00:20:43,978 WITH WORKSHEETS AS PART OF THE 534 00:20:43,978 --> 00:20:44,912 SERVICE DELIVERY. 535 00:20:44,912 --> 00:20:45,546 NEXT SLIDE. 536 00:20:45,546 --> 00:20:47,348 JUST A SECOND ABOUT OUTCOMES. 537 00:20:47,348 --> 00:20:50,184 SO, AGAIN, THERE IS A LOT OF 538 00:20:50,184 --> 00:20:51,486 EVIDENCE BEHIND COMPONENTS THAT 539 00:20:51,486 --> 00:20:54,188 WE HAVE INTEGRATED AND MISSION 540 00:20:54,188 --> 00:20:57,125 ITSELF IN STUDIES WE HAVE SHOWED 541 00:20:57,125 --> 00:20:58,626 IMPROVEMENT TO HEALTH SYMPTOMS 542 00:20:58,626 --> 00:21:00,295 AND FUNCTIONING AND REDUCTION 543 00:21:00,295 --> 00:21:03,498 AND SUBSTANCE USE AND IMPROVING 544 00:21:03,498 --> 00:21:05,133 HEALTH OUTCOMES REDUCTION AND 545 00:21:05,133 --> 00:21:06,634 REHOSPITALIZATIONS AND WE HAVE 546 00:21:06,634 --> 00:21:10,071 HIGH ENGAGEMENT RATES BETWEEN 75 547 00:21:10,071 --> 00:21:12,707 AND 80% AT 6 MONTHS AND 548 00:21:12,707 --> 00:21:16,244 INCREASED ACCESS ENGAGEMENT AND 549 00:21:16,244 --> 00:21:18,546 MITIGATION FOR OPIOID USE 550 00:21:18,546 --> 00:21:19,080 DISORDER AND ALCOHOL USE 551 00:21:19,080 --> 00:21:22,183 DISORDER AND MENTAL HEALTH. 552 00:21:22,183 --> 00:21:25,353 NEXT SLIDE? 553 00:21:25,353 --> 00:21:25,720 PLEASE. 554 00:21:25,720 --> 00:21:27,488 NEXT SLIDE? 555 00:21:27,488 --> 00:21:28,890 MIGHT BE STUCK. 556 00:21:28,890 --> 00:21:31,025 >> I'M TRYING. 557 00:21:31,025 --> 00:21:32,960 >> IT IS OKAY. 558 00:21:32,960 --> 00:21:36,264 >> NOT LETTING ME ADVANCE. 559 00:21:36,264 --> 00:21:42,970 >> TECHNOLOGY. 560 00:21:42,970 --> 00:21:43,971 THAT IS NOT GREAT. 561 00:21:43,971 --> 00:21:45,406 >> THERE WE GO. 562 00:21:45,406 --> 00:21:46,708 >> TOO FAR. HANG ON. 563 00:21:46,708 --> 00:21:48,242 >> THERE WE GO. 564 00:21:48,242 --> 00:21:49,143 >> I'M SORRY. 565 00:21:49,143 --> 00:21:53,414 >> DON'T WORRY. DON'T WORRY. 566 00:21:53,414 --> 00:21:57,552 JUST TO SAVE IT, STAFF USED A 567 00:21:57,552 --> 00:21:59,387 TREATMENT MANUAL TO DELIVER 568 00:21:59,387 --> 00:22:01,222 MISSION TO INCREASE FIDELITY AND 569 00:22:01,222 --> 00:22:03,991 EACH CLIENT GETS A WORKBOOK WITH 570 00:22:03,991 --> 00:22:07,061 EXERCISED DIMENSION. 571 00:22:07,061 --> 00:22:08,863 NEXT SLIDE, PLEASE. 572 00:22:08,863 --> 00:22:13,368 QUESTION WITH MULTICOMPONENT 573 00:22:13,368 --> 00:22:15,169 INTERVENTION APPRECIATING NORA'S 574 00:22:15,169 --> 00:22:16,771 COMMENT IN THE BEGINNING AND 575 00:22:16,771 --> 00:22:18,740 COSTS TO HAVE SCALE AND SUSTAIN 576 00:22:18,740 --> 00:22:20,274 INTERVENTIONS AND WE STARTED TO 577 00:22:20,274 --> 00:22:22,210 WORK WITH LOCAL MEDICAID 578 00:22:22,210 --> 00:22:23,311 AUTHORITY THATS WITH A GREAT 579 00:22:23,311 --> 00:22:24,812 PARTNER FOR US TO TRY TO FIGURE 580 00:22:24,812 --> 00:22:28,249 OUT HOW TO GET REIMBURSE FORD 581 00:22:28,249 --> 00:22:29,117 ALL COMPONENTS OF MISSION. 582 00:22:29,117 --> 00:22:32,787 WE REALLY WANTED TO FIGURE OUT 583 00:22:32,787 --> 00:22:34,455 NOT ONLY THE CORE COMPONENTS BUT 584 00:22:34,455 --> 00:22:37,625 IF ANY OTHER SERVICES HOW TO GET 585 00:22:37,625 --> 00:22:39,093 REIMBURSED FOR THAT AND YOU CAN 586 00:22:39,093 --> 00:22:41,729 SEE ON THIS SLIDE IS ALL 587 00:22:41,729 --> 00:22:43,631 REIMBURSEMENT CODES WE 588 00:22:43,631 --> 00:22:45,533 COLLABORATIVELY CAME UP WITH AND 589 00:22:45,533 --> 00:22:47,935 UNIT RAITY FOR MASSACHUSETTS 590 00:22:47,935 --> 00:22:52,039 THAT -- THAT THEY REIMBURSED AT. 591 00:22:52,039 --> 00:22:53,741 NEXT SLIDE. 592 00:22:53,741 --> 00:22:56,577 SO THE OTHER QUESTION WITH 593 00:22:56,577 --> 00:22:57,211 MULTICOMPONENT INTERVENTION IS 594 00:22:57,211 --> 00:23:00,114 SLIDE BEFORE THAT, TODD. 595 00:23:00,114 --> 00:23:01,149 THANKS. 596 00:23:01,149 --> 00:23:04,652 IT IS REALLY HOW PROGRAMS WILL 597 00:23:04,652 --> 00:23:07,922 OFFER -- IT IS A BIG INVESTMENT 598 00:23:07,922 --> 00:23:09,090 TO HIRE TWO STAFF AND HAVE THEM 599 00:23:09,090 --> 00:23:11,993 THINK ABOUT HOW TO MAKE INITIAL 600 00:23:11,993 --> 00:23:13,127 INVESTMENT. WE WORK WITH A LOT 601 00:23:13,127 --> 00:23:15,430 OF SOLUTIONS TO DEVELOP A 602 00:23:15,430 --> 00:23:16,998 CUSTOMIZED MODELING TOOL WHERE 603 00:23:16,998 --> 00:23:19,934 YOU CAN THINK ABOUT THINGS LIKE 604 00:23:19,934 --> 00:23:22,203 CASE LOAD SIZES AND IF YOU 605 00:23:22,203 --> 00:23:24,472 WANTED HIGHER OR LOWER CASE LOAD 606 00:23:24,472 --> 00:23:26,307 SIZES OR SERVICE ENGAGEMENT WHAT 607 00:23:26,307 --> 00:23:30,878 YOU ARE PREDICTING FOR YOUR 608 00:23:30,878 --> 00:23:33,481 CLIENTS AND STAFF. THAT WOULD 609 00:23:33,481 --> 00:23:34,949 HELP YOU DETERMINE REVENUE YOU 610 00:23:34,949 --> 00:23:37,819 WOULD GENERATE. THAT IS PROVEN 611 00:23:37,819 --> 00:23:40,254 TO BE AN ACTUALLY VERY HELPFUL 612 00:23:40,254 --> 00:23:41,689 TOOL FOR US AND TODD WILL TURN 613 00:23:41,689 --> 00:23:43,257 IT OVER YOU TO AND YOU WILL TALK 614 00:23:43,257 --> 00:23:45,726 ABOUT THE REVENUE AS WELL AS 615 00:23:45,726 --> 00:23:47,128 COST ANALYSIS. 616 00:23:47,128 --> 00:23:50,264 THANK YOU SO MUCH FOR LISTENING. 617 00:23:50,264 --> 00:23:54,101 >> THANK YOU, DAVID. EXCEL 618 00:23:54,101 --> 00:23:56,103 MODELING POOL DAVID SHARES HAS 619 00:23:56,103 --> 00:23:59,807 REALLY COOL FEATURES INCLUDING 620 00:23:59,807 --> 00:24:01,309 ABILITY TO HAVE NET PROFIT FOR 621 00:24:01,309 --> 00:24:03,344 EXAMPLE 6 MONTHS IMPLEMENTATION 622 00:24:03,344 --> 00:24:06,747 WITH MISSION OF FULL FIDELITY WE 623 00:24:06,747 --> 00:24:08,216 PROJECT GROSS CLINIC CAL REVENUE 624 00:24:08,216 --> 00:24:11,352 IS $270,000 AND NETTING OUT 625 00:24:11,352 --> 00:24:15,556 FULLY LOADED STAFFING COST NET 626 00:24:15,556 --> 00:24:18,793 PROFIT OF $177,000 THAT IS GREAT 627 00:24:18,793 --> 00:24:20,228 AND YOU CAN TELL HERE MISSION IS 628 00:24:20,228 --> 00:24:22,230 NOT EXACTLY CHEAP AND REMAINS A 629 00:24:22,230 --> 00:24:23,731 QUESTION WHETHER IT IS POSSIBLE 630 00:24:23,731 --> 00:24:25,900 TO GET MORE VALUE OUT OF MISSION 631 00:24:25,900 --> 00:24:28,102 AND 2 OUT OF 3 OF ITS PARTS 632 00:24:28,102 --> 00:24:31,839 INSTEAD OF USING ALL THREE 633 00:24:31,839 --> 00:24:32,139 COMPONENTS. 634 00:24:32,139 --> 00:24:35,142 IN THIS WHICH 2 PARTS SHOULD BE 635 00:24:35,142 --> 00:24:36,911 BUNDLED TOGETHER TO GET MOST 636 00:24:36,911 --> 00:24:39,280 VALUE AND BRINGING US TO CURRENT 637 00:24:39,280 --> 00:24:42,083 STUDY DESCRIBING NEXT ALONG WITH 638 00:24:42,083 --> 00:24:44,085 PLANNED ECONOMIC ANALYSIS AND 639 00:24:44,085 --> 00:24:46,921 STUDY IS RANDOMIZED CONTROL 640 00:24:46,921 --> 00:24:49,023 TRIAL AND OPIOID USE AND MENTAL 641 00:24:49,023 --> 00:24:51,425 HEALTH DISORDERS RECEIVING 642 00:24:51,425 --> 00:24:52,827 MEDICATION FOR OPIOID USE 643 00:24:52,827 --> 00:24:53,194 DISORDER. 644 00:24:53,194 --> 00:24:54,896 WE HAVE FIVE STUDY ARMS AND 645 00:24:54,896 --> 00:24:58,699 FIRST ARM IS MOUD ALL BY ITSELF 646 00:24:58,699 --> 00:25:00,268 AND SECOND ARM IS FULL-MROEN 647 00:25:00,268 --> 00:25:02,803 MISSION ALONG WITH MOUD AND LAST 648 00:25:02,803 --> 00:25:05,573 THREE STUDY ARMS IS DIFFERENT 649 00:25:05,573 --> 00:25:07,108 WAYS COMBINING 2 OUT OF 3 PARTS 650 00:25:07,108 --> 00:25:10,611 MISSION ALONG WITH MOUD AND WE 651 00:25:10,611 --> 00:25:11,979 ARE RECRUITING FROM OUTPATIENT 652 00:25:11,979 --> 00:25:13,814 CLINICS IN SUPPORT PROGRAMS AND 653 00:25:13,814 --> 00:25:16,484 GOAL IS TO RECRUIT 1,000 PASH 654 00:25:16,484 --> 00:25:18,953 YOERNTS WITH 2 HUNDRED 655 00:25:18,953 --> 00:25:20,154 RANDOMIZED EACH CONDITION AND 656 00:25:20,154 --> 00:25:22,823 THESE TAKE PLACE AT BASELINE AND 657 00:25:22,823 --> 00:25:24,959 QUARTERLY THEREAFTER FOR ARY AND 658 00:25:24,959 --> 00:25:25,927 HIGH-LEVEL DESCRIPTION OF A 659 00:25:25,927 --> 00:25:28,062 STUDY AND I WILL TALK YOU TO FOR 660 00:25:28,062 --> 00:25:30,665 A MINUTE ABOUT PLANNED ECONOMIC 661 00:25:30,665 --> 00:25:31,566 ANALYSIS. 662 00:25:31,566 --> 00:25:33,134 FOR SHORT WE WILL USE 663 00:25:33,134 --> 00:25:35,603 TRADITIONAL COST EFFECTIVE 664 00:25:35,603 --> 00:25:36,270 ANALYSIS SPECIFICALLY TO COMPARE 665 00:25:36,270 --> 00:25:39,240 5 ARMS WE USE INCREMENTAL COST 666 00:25:39,240 --> 00:25:42,843 EFFECTIVENESS RATIOS DEFINED AS 667 00:25:42,843 --> 00:25:43,411 INCREMENTAL COST OF GIVEN 668 00:25:43,411 --> 00:25:45,379 TREATMENT AND COMPARED TO NEXT 669 00:25:45,379 --> 00:25:46,514 TREATMENT AND PAINTING 670 00:25:46,514 --> 00:25:50,952 ADDITIONAL UNIT OUTCOME AND 671 00:25:50,952 --> 00:25:52,153 [INDISCERNIBLE] AND ADDITIONAL 672 00:25:52,153 --> 00:25:55,356 DEPRESSION FREE DAY AND SO ON. 673 00:25:55,356 --> 00:25:57,258 NOW THIS IS POINT ESTIMATES YOU 674 00:25:57,258 --> 00:25:59,794 CAN THINK OF AS SINGLE BEST 675 00:25:59,794 --> 00:26:01,128 GUESS AND RELATIVE COST 676 00:26:01,128 --> 00:26:02,663 EFFECTIVENESS OF STUDY 677 00:26:02,663 --> 00:26:03,898 INTERVENTIONS AND DECISION 678 00:26:03,898 --> 00:26:05,499 MAKERS WE WILL GO FURTHER TO 679 00:26:05,499 --> 00:26:07,435 PROVIDE DECISION MAKERS WITH A 680 00:26:07,435 --> 00:26:09,971 SENSE OF STATISTICAL UNCERTAINTY 681 00:26:09,971 --> 00:26:12,607 BEHIND OUR POINT ESTIMATES WILL 682 00:26:12,607 --> 00:26:17,778 ALSO PROVIDE 95% COST INTERVALS 683 00:26:17,778 --> 00:26:20,014 AND COST EFFECTIVENESS 684 00:26:20,014 --> 00:26:20,848 SUSCEPTIBILITY CURVES IF YOU 685 00:26:20,848 --> 00:26:23,451 HAVE NOT HEARD OF THEM NICE 686 00:26:23,451 --> 00:26:25,786 INTUITIVE VISUAL TOOL TO 687 00:26:25,786 --> 00:26:27,655 SEPARATE REPORTING COST 688 00:26:27,655 --> 00:26:29,991 EFFECTIVENESS ANALYSIS AND FOR 689 00:26:29,991 --> 00:26:31,392 EXAMPLE EACH INTERVENTION 690 00:26:31,392 --> 00:26:34,028 SHOWING PROBABILITY OF Y AXIS 0 691 00:26:34,028 --> 00:26:35,997 AND 1 AND EACH INTERVENTION IS 692 00:26:35,997 --> 00:26:37,198 COST EFFECTIVE COMPARED TO 693 00:26:37,198 --> 00:26:39,634 OTHERS IN THE STUDY FOR RANGE OF 694 00:26:39,634 --> 00:26:42,169 DOLLAR VALUES HERE ON X AXIS AND 695 00:26:42,169 --> 00:26:44,438 RANGE OF DOLLAR VALUES DECISION 696 00:26:44,438 --> 00:26:46,874 MAKER IS WILLING TO PAY FOR 697 00:26:46,874 --> 00:26:49,744 ADDITIONAL UNIT OF OUTCOME AND 698 00:26:49,744 --> 00:26:51,846 WE WILL CALCULATE THESE AND 699 00:26:51,846 --> 00:26:53,280 ACCEPTABILITY CURVES FROM 700 00:26:53,280 --> 00:26:55,149 VARIETY OF PERSPECTIVES THAT IS 701 00:26:55,149 --> 00:26:57,218 VERY IMPORTANT WHEN CONDUCTING 702 00:26:57,218 --> 00:26:58,419 ECONOMIC EVALUATION AND I'M SURE 703 00:26:58,419 --> 00:27:00,254 WE WILL HEAR FROM OTHER 704 00:27:00,254 --> 00:27:03,090 PANELISTS THROUGHOUT THE DAY AND 705 00:27:03,090 --> 00:27:04,558 WHY IS THIS IMPORTANT? 706 00:27:04,558 --> 00:27:07,461 PERSPECTIVE LITERALLY DEFINES 707 00:27:07,461 --> 00:27:09,330 WHAT IS COST AND BENEFIT AND 708 00:27:09,330 --> 00:27:11,799 TRANSFER AND SO ON AND ECONOMIC 709 00:27:11,799 --> 00:27:14,602 EVALUATION AND FOLLOWING 710 00:27:14,602 --> 00:27:15,770 RECOMMENDATIONS ON SECOND PANEL 711 00:27:15,770 --> 00:27:17,738 WILL INCLUDE SOCIETAL AND HEALTH 712 00:27:17,738 --> 00:27:19,874 CARE SYSTEM PERSPECTIVES IN 713 00:27:19,874 --> 00:27:21,976 ANALYSIS IN ADDITION TO MAKE 714 00:27:21,976 --> 00:27:24,011 SURE RESULTS ARE MAXIMAL USEFUL 715 00:27:24,011 --> 00:27:26,180 TO WIDE RANGE OF DECISION MAKERS 716 00:27:26,180 --> 00:27:29,050 CONDUCTING ANALYSIS FROM PATIENT 717 00:27:29,050 --> 00:27:31,686 CLINIC AND TAXPAYER PERSPECTIVES 718 00:27:31,686 --> 00:27:33,821 AND RATIONALE FOR THESE 719 00:27:33,821 --> 00:27:35,489 ADDITIONAL PERSPECTIVES IS 720 00:27:35,489 --> 00:27:36,490 PATIENTS DETERMINE WHETHER TO 721 00:27:36,490 --> 00:27:38,359 ACCEPT TREATMENT BASED IN PART 722 00:27:38,359 --> 00:27:39,994 ON TIME ON TREATMENT AND 723 00:27:39,994 --> 00:27:41,662 TRANSPORTATION TIME AND COPAYS 724 00:27:41,662 --> 00:27:44,098 AND CLINICS DETERMINE WHETHER TO 725 00:27:44,098 --> 00:27:46,133 ADOPT TREATMENT AT LEAST IN PART 726 00:27:46,133 --> 00:27:47,301 ON SUSTAINABILITY AND RETURN ON 727 00:27:47,301 --> 00:27:51,605 INVESTMENT FOR EXAMPLE 728 00:27:51,605 --> 00:27:52,273 OFFSETTING IMPLEMENTATION COSTS 729 00:27:52,273 --> 00:27:54,709 AND TAXPAYERS AND GOVERNMENT ON 730 00:27:54,709 --> 00:27:58,045 BEHALF TREATMENTS ON REDUCTIONS 731 00:27:58,045 --> 00:27:59,113 AND MEDICAID EXPENDITURES 732 00:27:59,113 --> 00:28:00,781 CRIMINAL JUSTICE SYSTEM AND SO 733 00:28:00,781 --> 00:28:01,515 ON. 734 00:28:01,515 --> 00:28:03,784 FINALLY WE WILL CONDUCT 735 00:28:03,784 --> 00:28:06,420 SENSITIVITY ANALYSIS TO SHOW HOW 736 00:28:06,420 --> 00:28:08,989 ROBUST ANALYSIS IS AND UNIT COST 737 00:28:08,989 --> 00:28:11,692 AND ALTERNATIVE IMPLEMENTATION 738 00:28:11,692 --> 00:28:12,193 SCENARIOS. 739 00:28:12,193 --> 00:28:14,361 ALL RIGHT. NOW, OUTCOMES AND 740 00:28:14,361 --> 00:28:17,932 RUMOR OUTCOMES DENOMINATOR OF 741 00:28:17,932 --> 00:28:20,000 COST RATIOS AND OUTCOMES LOOKING 742 00:28:20,000 --> 00:28:23,037 AT QUALITY LIFE YEARS PATIENT 743 00:28:23,037 --> 00:28:26,440 ENGAGEMENT OPIOID USE AND MENTAL 744 00:28:26,440 --> 00:28:26,674 HEALTH. 745 00:28:26,674 --> 00:28:30,077 USING MULTIPLE OUTCOMES 746 00:28:30,077 --> 00:28:31,712 DETERMINE ROBUSTNESS OF FINDINGS 747 00:28:31,712 --> 00:28:34,315 AND FINE-GRAINED ECONOMIC 748 00:28:34,315 --> 00:28:35,416 ANALYSIS TO ADDRESS DECISION 749 00:28:35,416 --> 00:28:37,318 MAKING PRIORITIES. 750 00:28:37,318 --> 00:28:39,320 FINALLY, ON COST SIDE OF THINGS, 751 00:28:39,320 --> 00:28:41,622 WE WILL BE ESTIMATED 752 00:28:41,622 --> 00:28:42,356 IMPLEMENTATION COSTS INCLUDING 753 00:28:42,356 --> 00:28:45,760 ALL RESOURCES REQUIRED TO BOTH 754 00:28:45,760 --> 00:28:46,660 START-UP AND CONTINUE DELIVERING 755 00:28:46,660 --> 00:28:48,529 EACH OF THE INTERVENTIONS 756 00:28:48,529 --> 00:28:52,266 MEASURING COST OFFSETS HEALTH 757 00:28:52,266 --> 00:28:54,034 UTILIZATION MEDICATIONS ACTIVITY 758 00:28:54,034 --> 00:28:55,169 AND REPORTING THINGS LIKE 759 00:28:55,169 --> 00:28:57,938 EARNINGS MISSED DAYS AT WORK IN 760 00:28:57,938 --> 00:28:59,874 OFFICE AND HOME AND MENTAL 761 00:28:59,874 --> 00:29:02,409 HEALTH SUBSTANCE ABUSE DISORDERS 762 00:29:02,409 --> 00:29:04,245 AND LEGAL ISSUES INTERACTIONS 763 00:29:04,245 --> 00:29:06,747 WITH THE CRIMINAL JUSTICE SYSTEM 764 00:29:06,747 --> 00:29:09,016 AND THE DATA TO MEASURE COST 765 00:29:09,016 --> 00:29:11,952 SIDE OF THINGS COMING FROM A 766 00:29:11,952 --> 00:29:13,788 VARIETY OF DIFFERENT SOURCES 767 00:29:13,788 --> 00:29:16,891 STUDY INVOICES PARTICIPANT 768 00:29:16,891 --> 00:29:18,492 SURVEYS AND [INDISCERNIBLE]. 769 00:29:18,492 --> 00:29:20,261 THAT CONCLUDES A HIGH-LEVEL 770 00:29:20,261 --> 00:29:24,265 SUMMARY OF STUDY AND ECONOMIC 771 00:29:24,265 --> 00:29:26,300 ANALYSIS WE HAVE PLANNED AND THE 772 00:29:26,300 --> 00:29:28,202 DEVIL IS REALLY IN THE DETAILS I 773 00:29:28,202 --> 00:29:30,604 WOULD BE HAPPY TO TALK ABOUT 774 00:29:30,604 --> 00:29:32,273 AFTERWARDS. IF YOU WANT TO GET 775 00:29:32,273 --> 00:29:34,175 INTO NITTY GRITTY FEEL FREE TO 776 00:29:34,175 --> 00:29:38,112 SEND ME AN E-MAIL I'M AT CORNELL 777 00:29:38,112 --> 00:29:39,480 PUBLIC HEALTH AND CORNELL'S 778 00:29:39,480 --> 00:29:42,616 POLICY CENTER. 779 00:29:42,616 --> 00:29:44,084 WITH THAT, BACK OVER. 780 00:29:44,084 --> 00:29:47,454 >> THANK YOU SO MUCH. NEXT 781 00:29:47,454 --> 00:29:52,259 SPEAKER IS FREYA NEZIR FROM 782 00:29:52,259 --> 00:29:53,427 UNIVERSITY OF PENNSYLVANIA 783 00:29:53,427 --> 00:29:56,363 HIGHLIGHTING VARIETY OF ECONOMIC 784 00:29:56,363 --> 00:30:00,267 APPROACHES SUPPORTING REAL WORLD 785 00:30:00,267 --> 00:30:04,672 SCALE UP OF ECONOMIC BEST 786 00:30:04,672 --> 00:30:04,972 PRACTICES. 787 00:30:04,972 --> 00:30:09,677 TAKE IT AWAY. 788 00:30:09,677 --> 00:30:11,512 WE CANNOT HEAR YOU. MIGHT NEED 789 00:30:11,512 --> 00:30:12,913 TO UNMUTE. 790 00:30:12,913 --> 00:30:15,583 >> I WAS ABLE TO DELETE THAT. 791 00:30:15,583 --> 00:30:16,884 GOOD MORNING, EVERYONE. 792 00:30:16,884 --> 00:30:19,220 I'M FREYA NEZIR AND PLEASURE TO 793 00:30:19,220 --> 00:30:21,956 BE HERE AND CONTRIBUTE TO THIS 794 00:30:21,956 --> 00:30:22,223 WORKSHOP. 795 00:30:22,223 --> 00:30:24,091 TODAY I WILL TALK ABOUT THE 796 00:30:24,091 --> 00:30:26,627 PROMISE OF COLLABORATIVE CARE 797 00:30:26,627 --> 00:30:28,963 FOR PEOPLE WITH OPIOID USE AND 798 00:30:28,963 --> 00:30:30,464 MENTAL HEALTH DISORDERS AND 799 00:30:30,464 --> 00:30:31,665 ECONOMIC TOOLS AND SUPPORT THAT 800 00:30:31,665 --> 00:30:33,767 IS NEEDED TO MAKE IT WORK IN THE 801 00:30:33,767 --> 00:30:36,270 REAL WORLD. 802 00:30:36,270 --> 00:30:38,539 BEFORE WE DIVE IN, QUICK NOTE 803 00:30:38,539 --> 00:30:41,909 HOW I USE THE TERM ECONOMIC 804 00:30:41,909 --> 00:30:42,409 EVALUATION. 805 00:30:42,409 --> 00:30:44,979 IN OUR FIELD IT MEANS FORMAL 806 00:30:44,979 --> 00:30:46,480 STUDIES COMPARING COST OUTCOMES 807 00:30:46,480 --> 00:30:50,751 COST EFFECTIVENESS OR COST 808 00:30:50,751 --> 00:30:55,022 BENEFIT ANALYSIS HERE I'M USING 809 00:30:55,022 --> 00:30:59,660 IT BROADLY COST FINANCING 810 00:30:59,660 --> 00:31:01,362 STRATEGIES AND RESOURCE PLANNING 811 00:31:01,362 --> 00:31:05,266 WAND THAT IN MIND LET'S TURN TO 812 00:31:05,266 --> 00:31:08,302 COLLABORATIVE CARE. 813 00:31:08,302 --> 00:31:09,803 NEXT SLIDE, PLEASE. 814 00:31:09,803 --> 00:31:15,242 BIG PICTURE COLLABORATIVE CARE 815 00:31:15,242 --> 00:31:20,247 IS CLINICALLY EFFECTIVE BUT 816 00:31:20,247 --> 00:31:27,888 UNDERUSED. 817 00:31:27,888 --> 00:31:31,058 DO WE BREAK EVEN? MOST 818 00:31:31,058 --> 00:31:32,026 EVALUATIONS DON'T ANSWER THOSE. 819 00:31:32,026 --> 00:31:34,561 SO THE GAP IS NOT IN EVIDENCE. 820 00:31:34,561 --> 00:31:36,230 IT IS IN THE INFRASTRUCTURE THAT 821 00:31:36,230 --> 00:31:40,668 IS NEED TODAY MAKE MODELS 822 00:31:40,668 --> 00:31:41,268 SUSTAINABLE. 823 00:31:41,268 --> 00:31:51,612 NEXT SLIDE, PLEASE. 824 00:31:52,279 --> 00:31:55,816 SLIDE 3. A QUICK OVERVIEW AND 825 00:31:55,816 --> 00:31:57,217 COLLABORATIVE CARE STRUCTURE 826 00:31:57,217 --> 00:31:59,486 TEAM-BASED MODEL AND PRIMARY 827 00:31:59,486 --> 00:32:01,922 CARE PROVIDER BEHAVIORAL HEALTH 828 00:32:01,922 --> 00:32:03,557 MANAGER AND PSYCHIATRIC KWON 829 00:32:03,557 --> 00:32:06,293 SULTANT ON SHARED CASES 830 00:32:06,293 --> 00:32:10,998 COORDINATED MEASUREMENT-BASED 831 00:32:10,998 --> 00:32:12,399 REGULARLY REVEALING PROGRESS 832 00:32:12,399 --> 00:32:14,268 TRACKING AND ACCOUNTABILITY AND 833 00:32:14,268 --> 00:32:16,270 DESIGNED FOR DEPRESSION IT IS 834 00:32:16,270 --> 00:32:21,642 ADAPTED FOR OUDC PTAC AND OTHER 835 00:32:21,642 --> 00:32:21,942 CONDITIONS. 836 00:32:21,942 --> 00:32:24,178 NEXT SLIDE, PLEASE. 837 00:32:24,178 --> 00:32:28,649 WHY IT MATTERS FOR OUR SPECIFIC 838 00:32:28,649 --> 00:32:32,252 POPULATION, IT IS KEY FOR 839 00:32:32,252 --> 00:32:37,091 SPECIFIC POPULATION WITH WHICH 840 00:32:37,091 --> 00:32:40,561 OFTEN CALLED CURE MENTAL HEALTH 841 00:32:40,561 --> 00:32:43,330 DISORDERS OCCUR TOGETHER 60 TO 842 00:32:43,330 --> 00:32:48,268 80% THOSE WITH THIS HAVE MENTAL 843 00:32:48,268 --> 00:32:51,672 HEALTH DIAGNOSIS BUT TREAT THESE 844 00:32:51,672 --> 00:32:53,874 CONDITIONS SEPARATELY RELAPSE 845 00:32:53,874 --> 00:32:55,676 AND OVERDOSE AND COLLABORATIVE 846 00:32:55,676 --> 00:32:58,012 CARE BRINGS PHYSICAL MENTAL AND 847 00:32:58,012 --> 00:32:59,513 ADDICTION TREATMENT TO ONE 848 00:32:59,513 --> 00:33:00,981 COORDINATED SYSTEM WITH CLEAR 849 00:33:00,981 --> 00:33:04,251 ROLES AND SHARED PLANS AND BROAD 850 00:33:04,251 --> 00:33:06,387 OVERSIGHT. 851 00:33:06,387 --> 00:33:11,392 NEXT SLIDE, PLEASE. 852 00:33:11,392 --> 00:33:14,194 CLINICAL EVIDENCE KEEPS GROWING 853 00:33:14,194 --> 00:33:16,263 COLLABORATIVE CARE IMPROVES 854 00:33:16,263 --> 00:33:18,866 PSYCHIATRIC SYMPTOMS CARE 855 00:33:18,866 --> 00:33:20,634 ENGAGEMENT RETENTION FOLLOW UP 856 00:33:20,634 --> 00:33:23,370 CARE CONTINUITY AND MEDICATION 857 00:33:23,370 --> 00:33:26,273 ADHERENCE HELPING REDUCE 858 00:33:26,273 --> 00:33:28,308 SUBSTANCE ABUSE RELAPSE OVERDOSE 859 00:33:28,308 --> 00:33:31,412 RISK AND HOSPITAL AND ED VISIT 860 00:33:31,412 --> 00:33:32,179 AND EMERGENCY DEPARTMENT VISIT 861 00:33:32,179 --> 00:33:36,250 AND SOME OF THE RESULTS ARE IN 862 00:33:36,250 --> 00:33:36,550 DEPRESSION. 863 00:33:36,550 --> 00:33:38,085 AND MEDICATION-ASSISTED 864 00:33:38,085 --> 00:33:39,520 TREATMENT AND SUPPORT FOR 865 00:33:39,520 --> 00:33:41,522 BROADER CO-OCCURRING CONDITIONS 866 00:33:41,522 --> 00:33:44,958 IS EXPANDING. 867 00:33:44,958 --> 00:33:48,962 NEXT SLIDE, PLEASE. 868 00:33:48,962 --> 00:33:52,099 STRONG ECONOMIC VALUE AS WELL, 869 00:33:52,099 --> 00:33:56,303 STUDIES SHOW 3,000 TO 7,000 IN 870 00:33:56,303 --> 00:33:58,572 ANNUAL SAVINGS PER PATIENT 871 00:33:58,572 --> 00:34:01,542 MOSTLY FROM FEWER ED AND PATIENT 872 00:34:01,542 --> 00:34:03,444 VISITS AND SOME STUDY REPORTS 873 00:34:03,444 --> 00:34:06,947 RETURN AS HIGH AS ALMOST $6 PER 874 00:34:06,947 --> 00:34:10,417 1 DOLLAR INVESTED AND SYSTEMWIDE 875 00:34:10,417 --> 00:34:12,853 BENEFITS ACROSS MANY SIDES. 876 00:34:12,853 --> 00:34:14,788 HERE IS THE KEY. 877 00:34:14,788 --> 00:34:16,657 FINDINGS HAVEN'T BECOME USABLE 878 00:34:16,657 --> 00:34:19,026 TOOLS FOR DECISION MAKERS AND 879 00:34:19,026 --> 00:34:22,162 GIVE US DATA EVIDENCE AND NOT 880 00:34:22,162 --> 00:34:24,064 ANSWERS THAT PEOPLE NEED LIKE 881 00:34:24,064 --> 00:34:27,034 WHEN DO WE BREAK EVEN OR HOW DO 882 00:34:27,034 --> 00:34:30,070 COSTS CHANGE OVER TIME? 883 00:34:30,070 --> 00:34:33,474 NEXT SLIDE, PLEASE. 884 00:34:33,474 --> 00:34:35,242 SO WHAT DO CURRENTLY SUCH 885 00:34:35,242 --> 00:34:38,145 ECONOMIC STUDIES OFFER? 886 00:34:38,145 --> 00:34:42,216 MOSTLY RESEARCH-FOCUSED MODELS 887 00:34:42,216 --> 00:34:43,817 NOT TOOLS FOR REAL-WORLD 888 00:34:43,817 --> 00:34:47,087 DECISIONS AND WE SEE OFTEN COST 889 00:34:47,087 --> 00:34:48,388 EFFECTIVENESS AND DOLLAR PER 890 00:34:48,388 --> 00:34:50,991 COLLY COST BENEFIT ANALYSIS 891 00:34:50,991 --> 00:34:53,961 RETURN PER DOLLAR BUDGET IMPACT 892 00:34:53,961 --> 00:34:55,762 ANALYSIS SHORT TERM 893 00:34:55,762 --> 00:34:57,798 AFFORDABILITY AND DESCRIPTIVE 894 00:34:57,798 --> 00:34:59,666 COST ANALYSIS SIDE ENCOUNTER 895 00:34:59,666 --> 00:35:04,271 LEVEL COST ESTIMATES THAT GIVE 896 00:35:04,271 --> 00:35:05,906 BOTH INSIGHTS BUT RARELY GUIDE 897 00:35:05,906 --> 00:35:08,275 SIGHT LEVEL AND SPECIFIC SYSTEM 898 00:35:08,275 --> 00:35:11,378 LEVEL PLANNING. 899 00:35:11,378 --> 00:35:14,648 NEXT SLIDE, PLEASE. 900 00:35:14,648 --> 00:35:19,086 SO THE GAPS ARE NOT -- THESE 901 00:35:19,086 --> 00:35:22,389 GAPS ARE CLEAR, TRIAL DATA THAT 902 00:35:22,389 --> 00:35:25,125 DON'T TRANSLATE LOCALLY. NO 903 00:35:25,125 --> 00:35:28,295 GUIDANCE ON STAFFING, FUNDING OR 904 00:35:28,295 --> 00:35:29,463 BILLING. 905 00:35:29,463 --> 00:35:32,799 OUTPUTS THAT ARE NOT BUILT FOR 906 00:35:32,799 --> 00:35:34,868 REAL-WORLD USE. 907 00:35:34,868 --> 00:35:36,270 LONG-TIME STUDIES WITH LITTLE 908 00:35:36,270 --> 00:35:40,974 FOCUS ON SUSTAINABILITY AND 909 00:35:40,974 --> 00:35:41,241 SCALE-UP. 910 00:35:41,241 --> 00:35:42,809 NEXT SLIDE, PLEASE. 911 00:35:42,809 --> 00:35:45,846 THESE GAPS ARE NOT UNIQUE TO 912 00:35:45,846 --> 00:35:46,813 COLLABORATIVE CARE. 913 00:35:46,813 --> 00:35:48,115 THEY ARE TOUGHER TO SOLVE 914 00:35:48,115 --> 00:35:51,785 BECAUSE THE MODEL ITSELF IS 915 00:35:51,785 --> 00:35:52,252 COMPLEX. 916 00:35:52,252 --> 00:35:53,954 IT INVOLVES MULTIPLE STAFFING 917 00:35:53,954 --> 00:35:56,190 WITH DIFFERENT BILLING AND 918 00:35:56,190 --> 00:35:57,824 MULTIPLE CONDITIONS WITH SHARED 919 00:35:57,824 --> 00:36:00,527 COSTS AND OUTCOMES AND 920 00:36:00,527 --> 00:36:02,529 FRAGMENTED FUNDING ACROSS 921 00:36:02,529 --> 00:36:04,998 SYSTEMS AND DIFFERENT FINANCIAL 922 00:36:04,998 --> 00:36:07,935 PHASES THAT START-UP 923 00:36:07,935 --> 00:36:11,038 IMPLEMENTATION SUSTAINMENT 924 00:36:11,038 --> 00:36:13,707 MISALIGNED INCENTIVES, COMPLEX 925 00:36:13,707 --> 00:36:15,876 CPT BILLING AND COORDINATION 926 00:36:15,876 --> 00:36:19,313 ACROSS CLINICAL AND FINANCIAL 927 00:36:19,313 --> 00:36:19,646 TEAMS. 928 00:36:19,646 --> 00:36:22,382 NEXT SLIDE, PLEASE. 929 00:36:22,382 --> 00:36:25,319 SO WHAT DO DECISION MAKERS NEED 930 00:36:25,319 --> 00:36:28,455 FOR REAL-WORLD DECISIONS? 931 00:36:28,455 --> 00:36:30,991 THEY NEED TOOLS THAT MATCH REAL 932 00:36:30,991 --> 00:36:31,425 DECISIONS. 933 00:36:31,425 --> 00:36:33,860 FOR ADOPTION, BREAK EVEN AND 934 00:36:33,860 --> 00:36:37,831 RETURN ON INVESTMENT 935 00:36:37,831 --> 00:36:38,265 CALCULATORS. 936 00:36:38,265 --> 00:36:40,901 FOR PLANNING, STAFFING MODELS 937 00:36:40,901 --> 00:36:44,238 BUDGET PAMPHLETS AND SALARY TO 938 00:36:44,238 --> 00:36:47,741 PATIENT RATIOS. IMPLEMENTATION 939 00:36:47,741 --> 00:36:49,243 BILLING MAPPERS LINK TO 940 00:36:49,243 --> 00:36:53,847 WORKFLOWS AND CPT CODES AND 941 00:36:53,847 --> 00:36:55,749 SUSTAINMENT MULTI-YEAR BUDGET 942 00:36:55,749 --> 00:36:57,584 TRACKERS CASH FLOW TOOLS SCALE 943 00:36:57,584 --> 00:37:00,320 UP RETURN ON INVESTMENT 944 00:37:00,320 --> 00:37:03,790 DASHBOARDS AND FLEXIBLE SCENARIO 945 00:37:03,790 --> 00:37:04,124 PLANNERS. 946 00:37:04,124 --> 00:37:05,192 NEXT SLIDE, PLEASE. 947 00:37:05,192 --> 00:37:07,294 SO THESE ARE EXAMPLES OF THE 948 00:37:07,294 --> 00:37:09,963 TOOLS THAT WE SHOULD BE 949 00:37:09,963 --> 00:37:10,764 BUILDING. 950 00:37:10,764 --> 00:37:12,332 LOCAL COST TEMPLATES FOR 951 00:37:12,332 --> 00:37:14,968 BUDGETING AND FORECASTING AND 952 00:37:14,968 --> 00:37:17,671 BREAKEVEN CALCULATORS TIED TO 953 00:37:17,671 --> 00:37:20,240 SALARY AND PAYER MIX. 954 00:37:20,240 --> 00:37:23,110 SCENARIO PLANNERS FOR SCALING 955 00:37:23,110 --> 00:37:24,244 AND STAFFING. 956 00:37:24,244 --> 00:37:28,115 BILLING MAPPERS LINKED TO CPT 957 00:37:28,115 --> 00:37:30,851 CODES AND FINANCING VISUALIZERS 958 00:37:30,851 --> 00:37:33,086 FOR BRAIDED FUNDING AND 959 00:37:33,086 --> 00:37:33,987 DASHBOARDS COMPARING 960 00:37:33,987 --> 00:37:35,422 COLLABORATIVE CARE TO OTHER 961 00:37:35,422 --> 00:37:40,727 MODELS AND DECISION TREES FOR 962 00:37:40,727 --> 00:37:42,663 SIGHT-LEVEL SYSTEM LEVEL 963 00:37:42,663 --> 00:37:45,165 GUIDANCE AND TOOLKITS WITH 964 00:37:45,165 --> 00:37:47,301 TRAINING, RESOURCES AND EXPERT 965 00:37:47,301 --> 00:37:47,901 SUPPORT. 966 00:37:47,901 --> 00:37:51,204 THESE ARE TOOLS FOR ACTION NOT 967 00:37:51,204 --> 00:37:55,742 JUST JOURNAL PUBLICATION. 968 00:37:55,742 --> 00:37:59,046 NEXT SLIDE, PLEASE. 969 00:37:59,046 --> 00:38:00,213 MOST IN THE GROUP CAN'T BUILD 970 00:38:00,213 --> 00:38:01,515 THIS ALONE. 971 00:38:01,515 --> 00:38:04,217 THIS IS WHAT EACH ROLE CAN DO. 972 00:38:04,217 --> 00:38:06,687 ECONOMIC EVALUATORS AND 973 00:38:06,687 --> 00:38:08,922 CO-DESIGNED TOOLS WITHEND USERS 974 00:38:08,922 --> 00:38:12,292 FOCUS ON PRACTICAL TOOLS AND 975 00:38:12,292 --> 00:38:13,727 IMPLEMENTERS ASK FOR TOOLS AND 976 00:38:13,727 --> 00:38:18,131 SHARE LOCAL DATA AND PLAN FOR 977 00:38:18,131 --> 00:38:18,598 SUSTAINABILITY. 978 00:38:18,598 --> 00:38:20,267 FUNDERS SUPPORT TOOL BUILDING 979 00:38:20,267 --> 00:38:23,003 NOT JUST TRIALS THAT REQUIRE 980 00:38:23,003 --> 00:38:23,670 ECONOMIC PLANNING. 981 00:38:23,670 --> 00:38:27,474 POLICY MAKERS AND PAYERS SET 982 00:38:27,474 --> 00:38:29,076 SUSTAINABLE GOALS ALIGNING 983 00:38:29,076 --> 00:38:31,011 FUNDING WITH INTEGRATED CARE. 984 00:38:31,011 --> 00:38:32,713 I THINK THAT IS HOW WE START TO 985 00:38:32,713 --> 00:38:36,249 BUILD THIS INFRASTRUCTURE TO 986 00:38:36,249 --> 00:38:41,855 TURN PROVEN MODELS INTO 987 00:38:41,855 --> 00:38:42,789 REAL-WORLD PRACTICE. 988 00:38:42,789 --> 00:38:43,757 NEXT SLIDE. 989 00:38:43,757 --> 00:38:46,293 TO WRAP UP, COLLABORATIVE CARE 990 00:38:46,293 --> 00:38:48,261 DELIVERS REAL CLINICAL AND 991 00:38:48,261 --> 00:38:51,031 ECONOMIC VALUE. 992 00:38:51,031 --> 00:38:53,867 BUT UPTICK IS SLOW AND SEEMS NOT 993 00:38:53,867 --> 00:38:55,602 BECAUSE IT DOESN'T WORK BUT 994 00:38:55,602 --> 00:38:57,571 BECAUSE ECONOMIC INFRASTRUCTURE 995 00:38:57,571 --> 00:39:01,708 IS MISSING AND WHAT WE NEED ARE 996 00:39:01,708 --> 00:39:05,679 PRACTICAL DECISION RELATED TOOLS 997 00:39:05,679 --> 00:39:09,015 TO TURN EVIDENCE INTO ACTION. 998 00:39:09,015 --> 00:39:15,355 THANK YOU. 999 00:39:15,355 --> 00:39:20,527 >> THANK YOU, DR. NEZIR I 1000 00:39:20,527 --> 00:39:22,629 APPRECIATE THE NEW CALL TO 1001 00:39:22,629 --> 00:39:24,264 ACTION BILL. 1002 00:39:24,264 --> 00:39:27,734 NEXT SPEAKER IS LISA SALDANA 1003 00:39:27,734 --> 00:39:31,204 FROM CHESTNUT HEALTH SYSTEMS 1004 00:39:31,204 --> 00:39:33,473 INSTITUTE AND STRATEGIES THAT IS 1005 00:39:33,473 --> 00:39:35,575 CRITICAL TO FEASIBILITY AND 1006 00:39:35,575 --> 00:39:37,177 SUSTAINMENT CONSIDERATION AND 1007 00:39:37,177 --> 00:39:39,112 WILL SHOW YOU EXCEPTIONALLY 1008 00:39:39,112 --> 00:39:40,814 USEFUL COINS TOOL THAT HELPS 1009 00:39:40,814 --> 00:39:48,889 WITH DIRECT AND INDIRECT COSTS. 1010 00:39:48,889 --> 00:39:51,224 >> HELLO. GOOD MORNING. CAN 1011 00:39:51,224 --> 00:39:53,560 YOU HEAR ME? 1012 00:39:53,560 --> 00:39:56,129 >> WE CAN HEAR YOU. 1013 00:39:56,129 --> 00:39:57,731 >> GREAT. THANK YOU. I DON'T 1014 00:39:57,731 --> 00:39:59,666 BELIEVE I HAVE CONTROL OF THE 1015 00:39:59,666 --> 00:40:02,602 SLIDES YET. 1016 00:40:02,602 --> 00:40:04,838 THERE WE GO. 1017 00:40:04,838 --> 00:40:09,843 LET SEE IF I CAN ADVANCE. NOT 1018 00:40:09,843 --> 00:40:20,053 QUITE YET. 1019 00:40:37,804 --> 00:40:39,873 ABOUT THE IMPORTANCE OF COSTING 1020 00:40:39,873 --> 00:40:40,907 IMPLEMENTATION STRATEGIES. 1021 00:40:40,907 --> 00:40:43,610 THOSE ARE THE STRATEGIES WE 1022 00:40:43,610 --> 00:40:46,012 ACTUALLY USE TO MOVE THESE GREAT 1023 00:40:46,012 --> 00:40:47,481 INTERVENTIONS INTO PRACTICE. 1024 00:40:47,481 --> 00:40:50,383 AND TO TALK A LITTLE BIT ABOUT A 1025 00:40:50,383 --> 00:40:53,987 TOOL THAT WE USE TO COLLECT THAT 1026 00:40:53,987 --> 00:40:57,090 DATA THAT THEN INFORMS ECONOMIC 1027 00:40:57,090 --> 00:40:57,357 ANALYSIS. 1028 00:40:57,357 --> 00:40:59,359 BEFORE I GET STARTED I WANT TO 1029 00:40:59,359 --> 00:41:01,161 ACKNOWLEDGE THAT MUCH WORK WITH 1030 00:41:01,161 --> 00:41:03,330 THE COINS TOOL WAS DEVELOPED 1031 00:41:03,330 --> 00:41:05,899 ALONGSIDE STAGES OF 1032 00:41:05,899 --> 00:41:07,334 IMPLEMENTATION COMPLETION DURING 1033 00:41:07,334 --> 00:41:11,004 MY TIME WHEN I WAS AN EMPLOYEE 1034 00:41:11,004 --> 00:41:13,206 WITH OREGON SOCIAL LEARNING 1035 00:41:13,206 --> 00:41:15,208 CENTER WHO OWNS THE TRADEMARK TO 1036 00:41:15,208 --> 00:41:17,611 THIS AND STARTING TYPES OF TALKS 1037 00:41:17,611 --> 00:41:19,479 OUT WITH A DISCLAIMER AND I'M 1038 00:41:19,479 --> 00:41:21,615 NOT AN ECONOMIST FOR THOSE THAT 1039 00:41:21,615 --> 00:41:24,684 KNOW ME I'M AN IMPLEMENTATION 1040 00:41:24,684 --> 00:41:25,519 SCIENTIST AND CLINICAL 1041 00:41:25,519 --> 00:41:28,021 PSYCHOLOGIST AND WHAT I REALLY 1042 00:41:28,021 --> 00:41:29,523 DO IS EVERYTHING -- ALL RESEARCH 1043 00:41:29,523 --> 00:41:32,225 I DO CENTERS AND SITS ON 1044 00:41:32,225 --> 00:41:35,462 IMPORTANT VALUE OF ECONOMICS AND 1045 00:41:35,462 --> 00:41:36,997 BEING ABLE TO AFFORD ALL OF THE 1046 00:41:36,997 --> 00:41:39,266 GREAT INNOVATIONS THAT WE KNOW 1047 00:41:39,266 --> 00:41:42,202 WE WANT TO GET INTO THE HANDS OF 1048 00:41:42,202 --> 00:41:42,502 CONSUMERS. 1049 00:41:42,502 --> 00:41:44,638 TO BEGIN WITH, I ALSO WANT TO 1050 00:41:44,638 --> 00:41:46,239 JUST SORT OF SIT WEIGHT US TO 1051 00:41:46,239 --> 00:41:49,609 THE FACT AS I MENTIONED AS AN 1052 00:41:49,609 --> 00:41:50,810 IMPLEMENTATION SCIENTIST WE 1053 00:41:50,810 --> 00:41:52,312 ALWAYS START WITH AN 1054 00:41:52,312 --> 00:41:53,346 IMPLEMENTATION FRAMEWORK AND 1055 00:41:53,346 --> 00:41:55,282 THIS IS FOR THOSE WHO ARE -- 1056 00:41:55,282 --> 00:41:56,249 MANY OF YOU ARE PROBABLY 1057 00:41:56,249 --> 00:41:58,652 FAMILIAR WITH, THIS IS LAURA AND 1058 00:41:58,652 --> 00:42:00,820 COLLEAGUES AND WHAT WE CALL THE 1059 00:42:00,820 --> 00:42:04,257 C FOR MODEL WHICH IS A 1060 00:42:04,257 --> 00:42:06,059 CONSOLIDATED FRAMEWORK OF 1061 00:42:06,059 --> 00:42:06,893 IMPLEMENTATION RESEARCH THAT IS 1062 00:42:06,893 --> 00:42:08,795 A WIDELY USED MODEL AND POINT 1063 00:42:08,795 --> 00:42:11,064 BRINGING IT UP HERE IS WE SEE 1064 00:42:11,064 --> 00:42:12,299 ALL THESE DIFFERENT COMPONENTS 1065 00:42:12,299 --> 00:42:14,601 GOING INTO LOOKING AT 1066 00:42:14,601 --> 00:42:15,635 IMPLEMENTATION AND 1067 00:42:15,635 --> 00:42:17,137 IMPLEMENTATION FRAMEWORK. 1068 00:42:17,137 --> 00:42:19,105 WHEN WE ARE TYPICALLY TALKING 1069 00:42:19,105 --> 00:42:21,341 ABOUT COSTS AND COSTING 1070 00:42:21,341 --> 00:42:23,076 LITERATURE THAT REALLY FOCUSED 1071 00:42:23,076 --> 00:42:27,047 ON COST OF INTERORIGINAL 1072 00:42:27,047 --> 00:42:28,248 INTERVENTION OR ADAPTED 1073 00:42:28,248 --> 00:42:29,716 INTERVENTION IS WHERE FOLKS ARE 1074 00:42:29,716 --> 00:42:31,851 REALLY FOCUSED AND WE CONSIDER 1075 00:42:31,851 --> 00:42:33,153 THE INTERVENTION TO BE SORT OF 1076 00:42:33,153 --> 00:42:35,121 THE THING. THE THING WE ARE 1077 00:42:35,121 --> 00:42:36,122 TRYING TO IMPLEMENT. 1078 00:42:36,122 --> 00:42:38,592 WHAT I WILL TALK ABOUT TODAY IS 1079 00:42:38,592 --> 00:42:40,727 INSTEAD ON THE PROCESS. 1080 00:42:40,727 --> 00:42:41,227 OOPS. 1081 00:42:41,227 --> 00:42:43,463 SO THE PROCESS REALLY IS THE 1082 00:42:43,463 --> 00:42:45,365 UNDERLYING STRUCTURE. THIS IS 1083 00:42:45,365 --> 00:42:47,601 WHAT MOVES YOUR -- MOVES YOUR 1084 00:42:47,601 --> 00:42:49,369 INTERVENTION FROM A TO B AND 1085 00:42:49,369 --> 00:42:51,404 MOVES IT FROM AN IDEA AND 1086 00:42:51,404 --> 00:42:53,506 GETTING IT INTO PRACTICE. 1087 00:42:53,506 --> 00:42:55,375 THAT IS AN ESSENTIAL PART OF 1088 00:42:55,375 --> 00:42:58,311 COSTING THAT IS OFTEN TIMES 1089 00:42:58,311 --> 00:43:01,681 IGNORED AND IMPLEMENTATION 1090 00:43:01,681 --> 00:43:03,984 PROCESS IS AROUND ESSENTIAL PART 1091 00:43:03,984 --> 00:43:05,819 THINKING ABOUT WITH 1092 00:43:05,819 --> 00:43:06,419 IMPLEMENTATION. 1093 00:43:06,419 --> 00:43:08,955 THIS IS REALLY THE STEPS AND 1094 00:43:08,955 --> 00:43:11,057 SEQUENTIAL PACING THAT WE THINK 1095 00:43:11,057 --> 00:43:14,961 ABOUT IN TERMS OF HOW WE DO THE 1096 00:43:14,961 --> 00:43:15,629 ACTIVE IMPLEMENTING. 1097 00:43:15,629 --> 00:43:19,366 SO IT IS ONE THING TO HAVE 1098 00:43:19,366 --> 00:43:20,934 AMAZING INTERVENTIONS DEVELOPING 1099 00:43:20,934 --> 00:43:23,803 THESE THINGS WITH HEAL AND 1100 00:43:23,803 --> 00:43:25,338 DEVELOPING REALLY GREAT 1101 00:43:25,338 --> 00:43:28,274 PREVENTIVE INTERVENTIONS AND 1102 00:43:28,274 --> 00:43:31,244 RECOVERY SORT OF INTERVENTIONS 1103 00:43:31,244 --> 00:43:32,979 BUT WANTING TO REALLY THINK 1104 00:43:32,979 --> 00:43:34,481 ABOUT MOVING THESE INTO ACTION 1105 00:43:34,481 --> 00:43:39,519 WE WANT TO THINK ABOUT WHAT ARE 1106 00:43:39,519 --> 00:43:40,220 STEPS? 1107 00:43:40,220 --> 00:43:41,855 IN EACH OF THE STEPS ARE 1108 00:43:41,855 --> 00:43:46,359 STRATEGIES WE WANT TO CONSIDER. 1109 00:43:46,359 --> 00:43:47,961 THOSE -- I LOST CONTROL AGAIN 1110 00:43:47,961 --> 00:43:49,996 AND STRATEGIES THAT WE REFERRED 1111 00:43:49,996 --> 00:43:51,665 TO IS IMPLEMENTATION STRATEGIES 1112 00:43:51,665 --> 00:43:53,933 THAT ARE REALLY THE HOW OF 1113 00:43:53,933 --> 00:43:54,300 IMPLEMENTATION. 1114 00:43:54,300 --> 00:43:55,969 WHEN WE THINK ABOUT HOW, SO 1115 00:43:55,969 --> 00:43:57,637 THESE STEPS AND STRATEGIES THAT 1116 00:43:57,637 --> 00:44:00,240 WE ARE FOLLOWING, WE ALSO WANT 1117 00:44:00,240 --> 00:44:02,275 TO CONSIDER ESPECIALLY WHEN 1118 00:44:02,275 --> 00:44:06,179 THINKING ABOUT COSTS AND WHO THE 1119 00:44:06,179 --> 00:44:08,248 ACTOR IS AND WHO IS DOG THIS AND 1120 00:44:08,248 --> 00:44:10,417 SOMEBODY THAT IS AN EXECUTIVE 1121 00:44:10,417 --> 00:44:13,653 LEADER THAT OF COURSE HAS A ONE 1122 00:44:13,653 --> 00:44:14,921 THICK TYPE OF SALARY AND 1123 00:44:14,921 --> 00:44:16,723 SOMEBODY THAT IS AN 1124 00:44:16,723 --> 00:44:17,490 ADMINISTRATIVE ASSISTANT THAT IS 1125 00:44:17,490 --> 00:44:19,159 A DIFFERENT TYPE OF SALARY OR 1126 00:44:19,159 --> 00:44:20,460 VOLUNTEER THAT MIGHT NOT HAVE 1127 00:44:20,460 --> 00:44:22,696 ANY SALARY AT ALL AND THINKING 1128 00:44:22,696 --> 00:44:24,497 ABOUT HOW COMPLICATED THE THING 1129 00:44:24,497 --> 00:44:26,800 IS THAT IS BEING IMPLEMENTED AND 1130 00:44:26,800 --> 00:44:28,735 SOMETHING WHERE IT IS A 15 1131 00:44:28,735 --> 00:44:31,471 MINUTE EXERCISE ROUTINE FOR 1132 00:44:31,471 --> 00:44:32,906 OBESITY TYPES OF STUDIES AND IS 1133 00:44:32,906 --> 00:44:35,675 IT SOMETHING THAT WILL BE A VERY 1134 00:44:35,675 --> 00:44:36,543 COMPLEX INTERVENTION SUCH AS 1135 00:44:36,543 --> 00:44:39,813 MANY OF THE INTERVENTIONS BOTH 1136 00:44:39,813 --> 00:44:41,581 PREVENTIVE AND TREATMENT 1137 00:44:41,581 --> 00:44:43,550 INTERVENTIONS WE HAVE FOR 1138 00:44:43,550 --> 00:44:45,518 TREATMENT OF OPIOID USE AND WE 1139 00:44:45,518 --> 00:44:46,986 WANT TO ALSO THINK ABOUT WHO IS 1140 00:44:46,986 --> 00:44:49,489 BEING SERVED BY THIS AND IN THE 1141 00:44:49,489 --> 00:44:51,291 CONTEXT THAT IS VERY DIFFERENT 1142 00:44:51,291 --> 00:44:53,893 TO IMPLEMENT SOMETHING IN HIGH 1143 00:44:53,893 --> 00:44:55,929 RESOURCED VERSUS UNDERRESOURCED 1144 00:44:55,929 --> 00:44:56,262 ENVIRONMENT. 1145 00:44:56,262 --> 00:44:58,732 WHEN WE DO THAT WE THINK OF 1146 00:44:58,732 --> 00:45:00,133 IMPLEMENTATION PROCESS AND ONE 1147 00:45:00,133 --> 00:45:03,103 OF THE MOST UBIQUITOUS 1148 00:45:03,103 --> 00:45:05,205 IMPLEMENTATION PROCESS 1149 00:45:05,205 --> 00:45:07,674 FRAMEWORKS OUT THERE IS FS AND 1150 00:45:07,674 --> 00:45:10,410 GREG AND COLLEAGUES STANDING FOR 1151 00:45:10,410 --> 00:45:11,111 EXPLORATION PREPARATION 1152 00:45:11,111 --> 00:45:12,445 IMPLEMENTATION AND SUSTAINMENT 1153 00:45:12,445 --> 00:45:14,447 IS A FRAMEWORK THAT HAS BEEN 1154 00:45:14,447 --> 00:45:17,183 USED BY HUNDREDS OF DIFFERENT 1155 00:45:17,183 --> 00:45:18,651 RESEARCHERS BUT THEN ALSO REAL 1156 00:45:18,651 --> 00:45:20,754 WORLD IMPLEMENTERS WHO ARE 1157 00:45:20,754 --> 00:45:22,422 TRYING TO UNDERSTAND WHAT ARE -- 1158 00:45:22,422 --> 00:45:24,057 WHAT DO THEY -- WHAT ARE PHASES 1159 00:45:24,057 --> 00:45:26,359 THEY HAVE TO GO THROUGH WHEN 1160 00:45:26,359 --> 00:45:30,063 THEY DECIDE WHEN THEY WANT TO 1161 00:45:30,063 --> 00:45:32,866 IMPLEMENT A NEW INTERVENTION. 1162 00:45:32,866 --> 00:45:34,100 THIS FRAMEWORK MAPS WELL ON TO 1163 00:45:34,100 --> 00:45:35,969 THE WORK THAT MY COLLEAGUES AND 1164 00:45:35,969 --> 00:45:38,872 I HAVE DONE WITH STAGES OF 1165 00:45:38,872 --> 00:45:39,506 IMPLEMENTATION COMPLETION OR 1166 00:45:39,506 --> 00:45:41,941 SICK AND SICK IS A MEASURE OF 1167 00:45:41,941 --> 00:45:43,309 IMPLEMENTATION PROCESS THAT CAN 1168 00:45:43,309 --> 00:45:46,179 ALSO BE USED AS A MODEL OF 1169 00:45:46,179 --> 00:45:46,546 IMPLEMENTATION. 1170 00:45:46,546 --> 00:45:49,115 AND SO WHAT IT REALLY DOES IS IT 1171 00:45:49,115 --> 00:45:51,885 -- IT IS 8 STAGES. 1172 00:45:51,885 --> 00:45:53,753 THESE 8 STAGES OF IMPLEMENTATION 1173 00:45:53,753 --> 00:45:56,256 YOU CAN SEE SORT OF MAP ON TO 1174 00:45:56,256 --> 00:45:58,124 THIS FRAMEWORK THAT IS, AGAIN, 1175 00:45:58,124 --> 00:45:59,993 THAT PROCESS FRAMEWORK AND WHAT 1176 00:45:59,993 --> 00:46:02,195 WE THINK ABOUT IS THE FIRST 1177 00:46:02,195 --> 00:46:03,763 THREE STAGES THAT IS LIKE 1178 00:46:03,763 --> 00:46:05,031 ENGAGING AND DECIDE WLG OR NOT 1179 00:46:05,031 --> 00:46:06,733 YOU WANT TO DO THIS THING AND 1180 00:46:06,733 --> 00:46:08,268 DETERMINING WHETHER IT IS 1181 00:46:08,268 --> 00:46:09,569 FEASIBLE AND PREPARING YOUR 1182 00:46:09,569 --> 00:46:11,337 AGENCY OR ORGANIZATION TO DO IT 1183 00:46:11,337 --> 00:46:13,540 AND WE REFER TO THAT AS 1184 00:46:13,540 --> 00:46:14,607 PREIMPLEMENTATION AND WE MOVE 1185 00:46:14,607 --> 00:46:16,142 INTO ACTIVE IMPLEMENTATION WHERE 1186 00:46:16,142 --> 00:46:20,246 YOU ARE ACTUALLY HIRING AND 1187 00:46:20,246 --> 00:46:21,981 GETTING FIDELITY MONITORING SET 1188 00:46:21,981 --> 00:46:23,716 UP AND ACTUALLY DOG YOUR THING 1189 00:46:23,716 --> 00:46:26,319 AND WE ARE OBVIOUSLY MOVING 1190 00:46:26,319 --> 00:46:27,420 TOWARDS SUSTAINMENT AND WITHIN 1191 00:46:27,420 --> 00:46:29,656 EACH OF THE DIFFERENT STAGES, IT 1192 00:46:29,656 --> 00:46:32,125 IS NOT ADVANCING AGAIN. I'M 1193 00:46:32,125 --> 00:46:32,358 SORRY. 1194 00:46:32,358 --> 00:46:33,993 WITHIN EACH OF THE DIFFERENT 1195 00:46:33,993 --> 00:46:35,895 STAGES, THEY ARE POPULATED WITH 1196 00:46:35,895 --> 00:46:38,498 DIFFERENT IMPLEMENTATION 1197 00:46:38,498 --> 00:46:40,266 ACTIVITIES OR IMPLEMENTATION 1198 00:46:40,266 --> 00:46:42,001 STRATEGIES AND THINGS THAT FOLKS 1199 00:46:42,001 --> 00:46:43,236 OFTEN TIMES THINK ABOUT WHEN 1200 00:46:43,236 --> 00:46:45,305 THEY ARE THINKING ABOUT 1201 00:46:45,305 --> 00:46:46,272 IMPLEMENTING. 1202 00:46:46,272 --> 00:46:48,241 IF YOU LOOK IN THAT GOLD REGION 1203 00:46:48,241 --> 00:46:49,976 THERE, THAT IS WHAT FOLKS ARE 1204 00:46:49,976 --> 00:46:51,511 NORMALLY TALKING ABOUT, GETTING 1205 00:46:51,511 --> 00:46:53,012 THEIR STAFF TRAINED AND SERVING 1206 00:46:53,012 --> 00:46:55,281 YOUR PATIENTS AND GETTING 1207 00:46:55,281 --> 00:46:56,883 FIDELITY MONITORING IN PLACE. 1208 00:46:56,883 --> 00:47:00,954 WHAT IS OFTEN TIMES IGNORED ARE 1209 00:47:00,954 --> 00:47:01,621 PREIMPLEMENTATION PARTS OF THAT 1210 00:47:01,621 --> 00:47:03,523 PROCESS THAT WE HAVE FOUND IN 1211 00:47:03,523 --> 00:47:06,292 OUR WORK TO BE EXTREMELY 1212 00:47:06,292 --> 00:47:06,693 IMPORTANT. 1213 00:47:06,693 --> 00:47:09,128 ALSO, EXTREMELY COSTLY. THERE 1214 00:47:09,128 --> 00:47:11,764 ARE COSTS ASSOCIATED WITH THIS. 1215 00:47:11,764 --> 00:47:14,701 SO STRATEGIES, WE KNOW THEY ARE 1216 00:47:14,701 --> 00:47:16,402 ESSENTIAL TO IMPLEMENT 1217 00:47:16,402 --> 00:47:19,539 INNOVATION WITH SUCCESS AND HAVE 1218 00:47:19,539 --> 00:47:22,909 DONE LOTS OF WORK TO SHOW ALL 1219 00:47:22,909 --> 00:47:24,978 THOSE TYPES OF IMPLEMENTATION 1220 00:47:24,978 --> 00:47:26,379 STRATEGY ARE IMPORTANT AND 46 OF 1221 00:47:26,379 --> 00:47:28,615 THEM ARE ESSENTIAL FOR 1222 00:47:28,615 --> 00:47:30,650 IMPLEMENTING AN EVIDENCE-BASED 1223 00:47:30,650 --> 00:47:32,719 PRACTICE AND WORK OF OURS ABLE 1224 00:47:32,719 --> 00:47:35,989 TO PULL OUT 296 SITES ONLY THOSE 1225 00:47:35,989 --> 00:47:37,690 THAT ARE CONFIDENT AND ACHIEVE 1226 00:47:37,690 --> 00:47:39,559 ACTUALLY THAT POINT OF 1227 00:47:39,559 --> 00:47:40,593 SUSTAINMENT. IT TAKES WE CAN 1228 00:47:40,593 --> 00:47:43,429 SEE IT TAKES ABOUT 10.5 MONTHS 1229 00:47:43,429 --> 00:47:45,798 TO BE ABLE TO COMPLETE YOUR 1230 00:47:45,798 --> 00:47:46,466 PREIMPLEMENTATION PROCESS ABOUT 1231 00:47:46,466 --> 00:47:49,002 8 TA ENMONTHS TO BE ABLE TO 1232 00:47:49,002 --> 00:47:53,106 COMPLETE YOUR -- YOUR 1233 00:47:53,106 --> 00:47:54,240 IMPLEMENTATION, ACT OF 1234 00:47:54,240 --> 00:47:55,808 IMPLEMENTATION DURATION BEFORE 1235 00:47:55,808 --> 00:47:58,411 YOU ACHIEVE COMPETENCY AND 2.5 1236 00:47:58,411 --> 00:48:00,013 YEARS OF IMPLEMENTATION PROCESS 1237 00:48:00,013 --> 00:48:02,982 AND THINKING ABOUT THAT FROM A 1238 00:48:02,982 --> 00:48:05,151 SDIGS MAKER STANDPOINT IF THEY 1239 00:48:05,151 --> 00:48:06,953 SAY I WILL BUY THIS ONE 1240 00:48:06,953 --> 00:48:07,687 PARTICULAR INTERVENTION BUT WE 1241 00:48:07,687 --> 00:48:10,023 ARE NOT TELLING THEM THERE IS AN 1242 00:48:10,023 --> 00:48:12,292 ADDITIONAL 2.5 YEARS WORTH OF 1243 00:48:12,292 --> 00:48:13,559 WORK FOR THEM AND THEIR AGENCY 1244 00:48:13,559 --> 00:48:16,095 AND THEIR ADMINISTRATORS AND 1245 00:48:16,095 --> 00:48:18,431 PROVIDERS TO GO THROUGH, THAT IS 1246 00:48:18,431 --> 00:48:21,768 WHEN SDIGS MAKERS SOMETIMES FEEL 1247 00:48:21,768 --> 00:48:24,771 A LITTLE DUPED BY THE 1248 00:48:24,771 --> 00:48:26,472 EVIDENCE-BASED PRACTICE AND FEEL 1249 00:48:26,472 --> 00:48:29,275 IT IS MORE EXPENSIVE THAN WHAT 1250 00:48:29,275 --> 00:48:30,944 THEY WERE TOLD AND IS IMPORTANT 1251 00:48:30,944 --> 00:48:32,278 FOR US DEVELOPING INTERVENTIONS 1252 00:48:32,278 --> 00:48:34,614 TO BE VERY CLEAR ABOUT NOT JUST 1253 00:48:34,614 --> 00:48:36,883 INTERVENTION COSTS BUT 1254 00:48:36,883 --> 00:48:38,251 IMPLEMENTATION COSTS. 1255 00:48:38,251 --> 00:48:42,956 I'M SORRY IT KEEPS GETTING 1256 00:48:42,956 --> 00:48:53,099 STUCK. 1257 00:48:55,335 --> 00:48:59,005 THIS MAPS DIRECTLY ON TO THE 1258 00:48:59,005 --> 00:49:00,573 SIC. THAT MEANS AS YOU MOVE 1259 00:49:00,573 --> 00:49:02,141 THROUGH EACH OF THE STRATEGIES 1260 00:49:02,141 --> 00:49:04,243 YOU WORK THROUGH AS YOU 1261 00:49:04,243 --> 00:49:05,378 IMPLEMENT WHATEVER YOUR PROGRAM 1262 00:49:05,378 --> 00:49:07,947 IS WE WANT TO ASSESS WHAT ARE 1263 00:49:07,947 --> 00:49:09,882 DIRECT COSTS AND INDIRECT COSTS 1264 00:49:09,882 --> 00:49:11,017 GOING ALONG WITH IMPLEMENTING 1265 00:49:11,017 --> 00:49:14,654 THAT AND WE SOMETIMES HAVE 1266 00:49:14,654 --> 00:49:15,655 ACTUAL RECEIPTS. 1267 00:49:15,655 --> 00:49:17,423 WE ARE ALSO LOOKING REALLY AT 1268 00:49:17,423 --> 00:49:21,461 WHO ARE ACTORS INVOLVED IN THAT 1269 00:49:21,461 --> 00:49:22,895 PROCESS AND WHAT IS AMOUNT OF 1270 00:49:22,895 --> 00:49:26,399 EFFORT IT TAKES FOR THEM TO DO 1271 00:49:26,399 --> 00:49:28,868 THAT PROCESS. 1272 00:49:28,868 --> 00:49:30,803 THINKING OF CREATING COST 1273 00:49:30,803 --> 00:49:31,804 ANALYSIS, IT IS IMPORTANT TO 1274 00:49:31,804 --> 00:49:34,040 KNOW WHO IS COST AND WHO IS 1275 00:49:34,040 --> 00:49:34,841 BENEFIT AND THIS IS SOMETHING 1276 00:49:34,841 --> 00:49:36,609 THAT THE PAYER WILL BENEFIT FROM 1277 00:49:36,609 --> 00:49:40,680 AND PROVIDER IS PUTTING OUT ALL 1278 00:49:40,680 --> 00:49:42,315 OF THE COSTS IS WHEN WE HAVE A 1279 00:49:42,315 --> 00:49:43,816 LITTLE BIT OF A MISMATCH AND FOR 1280 00:49:43,816 --> 00:49:46,019 TYPE OF WORK WE ARE DOING WITH 1281 00:49:46,019 --> 00:49:47,186 IMPLEMENTATION WE WANT TO 1282 00:49:47,186 --> 00:49:53,659 CONSIDER ALL THESE DIFFERENT 1283 00:49:53,659 --> 00:49:54,060 PERSPECTIVES. 1284 00:49:54,060 --> 00:49:56,929 WORK WITH COINS IS A EXAMPLE 1285 00:49:56,929 --> 00:49:58,564 TABLE WHAT COMES OUT OF COINS 1286 00:49:58,564 --> 00:50:00,400 THAT IS NOT ROCKET SCIENCE AND 1287 00:50:00,400 --> 00:50:04,437 WHAT IT DOES IS ALLOWS US TO BE 1288 00:50:04,437 --> 00:50:07,340 ABLE TO LOOK AT WHO ARE ACTORS 1289 00:50:07,340 --> 00:50:11,477 INVOLVED IN IMPLEMENTATION 1290 00:50:11,477 --> 00:50:13,146 PROCESS WHERE IN PROCESS ACTORS 1291 00:50:13,146 --> 00:50:18,051 ARE ACTIVATED AND WHAT ARE COSTS 1292 00:50:18,051 --> 00:50:21,821 ASSOCIATED WITH THAT. IMAGINE 1293 00:50:21,821 --> 00:50:23,523 IF A SDIGS MAKER AND 1294 00:50:23,523 --> 00:50:27,193 EVIDENCE-BASED PRACTICE PART OF 1295 00:50:27,193 --> 00:50:28,795 THE SOLUTION YOU FEEL IT IS 1296 00:50:28,795 --> 00:50:30,596 EXPENSIVE AND IF YOU KNOW 1297 00:50:30,596 --> 00:50:32,131 STAGING OF EXPENSES AND STAGING 1298 00:50:32,131 --> 00:50:34,767 OF THE EFFORT AND ALLOWS YOU TO 1299 00:50:34,767 --> 00:50:35,935 MAKE A MORE INFORMED DECISION 1300 00:50:35,935 --> 00:50:37,970 ABOUT WHETHER OR NOT THIS IS 1301 00:50:37,970 --> 00:50:39,539 SOMETHING THAT THE ENTIRE 1302 00:50:39,539 --> 00:50:43,076 PACKAGE IS TOO MUCH OF STICKER 1303 00:50:43,076 --> 00:50:51,117 SHO 1304 00:50:51,117 --> 00:50:51,350 SHOCK. 1305 00:50:51,350 --> 00:50:53,553 WE CAN GET MONEY FOR THAT NOW 1306 00:50:53,553 --> 00:50:55,254 AND ACHIEVE GREATER MONEY IN THE 1307 00:50:55,254 --> 00:50:56,689 FUTURE AND NOW MAKES SOMETHING 1308 00:50:56,689 --> 00:50:59,525 THAT PREVIOUSLY FELL OUT OF 1309 00:50:59,525 --> 00:51:01,360 REACH WITHIN REACH FOR US TO 1310 00:51:01,360 --> 00:51:03,262 BRING INTO OUR COMMUNITIES. 1311 00:51:03,262 --> 00:51:08,234 WE CAN DO IT AT GLOBAL LEVELS OR 1312 00:51:08,234 --> 00:51:10,269 AN EXAMPLE FROM MY HEAL TRIAL 1313 00:51:10,269 --> 00:51:11,370 LOOKING AT INDIVIDUAL CLINIC 1314 00:51:11,370 --> 00:51:13,439 SORT OF I WON'T 2 INTO THE TRIAL 1315 00:51:13,439 --> 00:51:15,475 BUT AT THE CLINIC LEVEL WHAT WE 1316 00:51:15,475 --> 00:51:18,711 SEE HERE IS USING COINS TOOL WE 1317 00:51:18,711 --> 00:51:21,647 ARE ABLE TO SEE IN TERMS OF 1318 00:51:21,647 --> 00:51:24,183 EXPERT CONSULTATION THAT IS NEED 1319 00:51:24,183 --> 00:51:25,751 TODAY START UP TWO DIFFERENT 1320 00:51:25,751 --> 00:51:27,720 CLINICS IS THE SAME AND SIGNING 1321 00:51:27,720 --> 00:51:31,257 AGREEMENT COSTS AND READINESS 1322 00:51:31,257 --> 00:51:33,793 COSTS IS ABOUT THE SAME AND WHAT 1323 00:51:33,793 --> 00:51:35,895 IS DIFFERENT ABOUT THESE TWO 1324 00:51:35,895 --> 00:51:37,730 CLINICS IS AMOUNT OF STAFF HOURS 1325 00:51:37,730 --> 00:51:38,931 THEY PUT INTO IMPLEMENTATION 1326 00:51:38,931 --> 00:51:42,735 PROCESS AND THIS IS 1327 00:51:42,735 --> 00:51:43,603 PREIMPLEMENTATION PROCESS AND WE 1328 00:51:43,603 --> 00:51:48,541 SEE A $22,000 DIFFERENCE BETWEEN 1329 00:51:48,541 --> 00:51:50,743 THEM AND NOT SMALL 1330 00:51:50,743 --> 00:51:51,577 COMMUNITY-BASED ORGANIZATIONS 1331 00:51:51,577 --> 00:51:53,980 SEEING CLINIC PUTTING EFFORT AND 1332 00:51:53,980 --> 00:51:55,748 TIME IN UP FRONT STARTED TO 1333 00:51:55,748 --> 00:51:57,984 SERVE CLIENTS MORE QUICKLY AND 1334 00:51:57,984 --> 00:52:00,453 LONG STORY SHORT THIS CLINIC 1335 00:52:00,453 --> 00:52:03,956 ENDS UP RECOUPING COSTS MORE 1336 00:52:03,956 --> 00:52:04,257 QUICKLY. 1337 00:52:04,257 --> 00:52:06,726 HERE IS A EXAMPLE WHERE WE USED 1338 00:52:06,726 --> 00:52:10,163 COINS AND WE WERE ABLE TO 1339 00:52:10,163 --> 00:52:12,165 ACTUALLY SAY WHAT IS MORE 1340 00:52:12,165 --> 00:52:15,902 IMPORTANT IMPLEMENTING A 1341 00:52:15,902 --> 00:52:17,837 PARTICULAR INTERVENTION AND WAS 1342 00:52:17,837 --> 00:52:20,239 WORK WE DID WITH TFCO AND WITH 1343 00:52:20,239 --> 00:52:22,008 THIS WE WERE ABLE TO SAY 1344 00:52:22,008 --> 00:52:24,243 OPERATIONALIZE THIS SO THAT IN 1345 00:52:24,243 --> 00:52:28,814 THE FUTURE THERE IS TWO 1346 00:52:28,814 --> 00:52:31,284 DIFFERENT BLENDED IMPLEMENTATION 1347 00:52:31,284 --> 00:52:33,920 STRATEGIES YOU HAVE A BUNCH OF 1348 00:52:33,920 --> 00:52:34,754 STRATEGIES BUNDLED TOGETHER INTO 1349 00:52:34,754 --> 00:52:36,789 ONE AND ONE STRATEGY COSTS MORE 1350 00:52:36,789 --> 00:52:39,892 IN TERMS OF HOURS AND ANOTHER 1351 00:52:39,892 --> 00:52:41,627 STRATEGY COSTS MORE IN TERMS OF 1352 00:52:41,627 --> 00:52:43,329 DOLLARS AND DECISION MAKER COULD 1353 00:52:43,329 --> 00:52:47,200 BE ABLE TO THEN SAY WHAT IS IT 1354 00:52:47,200 --> 00:52:49,101 WE WANT INTERVENTION BUT DON'T 1355 00:52:49,101 --> 00:52:51,137 HAVE HOURS OR WANT INTERVENTION 1356 00:52:51,137 --> 00:52:53,873 BUT DON'T HAVE DOLLARS AND IS 1357 00:52:53,873 --> 00:52:56,275 DECISION TO MAKE INFORMED 1358 00:52:56,275 --> 00:52:59,111 STRATEGY THAT IS BEST TO BRING 1359 00:52:59,111 --> 00:53:00,279 EVIDENCE BASED PRACTICE BACK 1360 00:53:00,279 --> 00:53:02,014 INTO YOUR ORGANIZATION. ANOTHER 1361 00:53:02,014 --> 00:53:04,417 EXAMPLE HOW COINS HAS BEEN USED 1362 00:53:04,417 --> 00:53:06,652 LOOKING AT DIFFERENCE AND COSTS 1363 00:53:06,652 --> 00:53:09,188 ACROSS DIFFERENT STAGES FOR A 1364 00:53:09,188 --> 00:53:11,457 PROGRAM THAT ENDS UP BEING 1365 00:53:11,457 --> 00:53:13,993 COMPETENT AND THOSE ENDING UP 1366 00:53:13,993 --> 00:53:16,262 DELIVERING SERVICES WELL TO 1367 00:53:16,262 --> 00:53:18,164 PATIENTS VERSUS THOSE THAT ARE 1368 00:53:18,164 --> 00:53:20,132 NOT CONFIDENT AND THOSE THAT 1369 00:53:20,132 --> 00:53:20,866 DISCONTINUE ALL TOGETHER. THIS 1370 00:53:20,866 --> 00:53:22,435 IS ANOTHER WAY WE ARE ABLE TO 1371 00:53:22,435 --> 00:53:27,373 SEE HOW COSTS SORT OF ARE USED 1372 00:53:27,373 --> 00:53:28,174 ACROSS DIFFERENT PHASES TO 1373 00:53:28,174 --> 00:53:29,542 INFORM DECISION MAKERS AND I 1374 00:53:29,542 --> 00:53:31,611 WANT TO REALLY JUST SAY THAT I'M 1375 00:53:31,611 --> 00:53:33,746 HOPING WHAT I HAVE SHOWN IS THAT 1376 00:53:33,746 --> 00:53:35,548 WE DON'T JUST WANT TO CONSIDER 1377 00:53:35,548 --> 00:53:38,851 INTERVENTION COSTS WHEN THINKING 1378 00:53:38,851 --> 00:53:40,553 ABOUT IMPLEMENTING NEW PROGRAMS. 1379 00:53:40,553 --> 00:53:42,888 WE AS DEVELOPERS IT IS IMPORTANT 1380 00:53:42,888 --> 00:53:44,824 FOR US FROM THE VERY BEGINNING 1381 00:53:44,824 --> 00:53:46,759 AND FROM GET-GO AS WE DESIGN 1382 00:53:46,759 --> 00:53:48,794 THESE INTERVENTIONS FOR US TO BE 1383 00:53:48,794 --> 00:53:51,063 ABLE TO KNOW WHAT ARE THE COSTS 1384 00:53:51,063 --> 00:53:53,766 ALSO OF IMPLEMENTING THOSE 1385 00:53:53,766 --> 00:53:54,367 INTERVENTIONS. 1386 00:53:54,367 --> 00:53:56,769 SO IN CONCLUSION, IMPLEMENTATION 1387 00:53:56,769 --> 00:53:59,038 COSTS ARE REAL AND CAN HAVE A 1388 00:53:59,038 --> 00:53:59,972 VERY SIGNIFICANT DIFFERENCE ON 1389 00:53:59,972 --> 00:54:03,009 OVERALL SUCCESS OF AN 1390 00:54:03,009 --> 00:54:04,243 IMPLEMENTATION AND THEY ARE 1391 00:54:04,243 --> 00:54:06,946 NECESSARY AND FIGURE NORRED THAT 1392 00:54:06,946 --> 00:54:09,882 CAN LEAD TO MISTRUST BY DECISION 1393 00:54:09,882 --> 00:54:11,984 MAKERS AND QUEEN'S TOOL CAN 1394 00:54:11,984 --> 00:54:15,454 CAPTURE COST TO BE USED BY COST 1395 00:54:15,454 --> 00:54:17,256 ANALYSIS THAT THE COIN'S TOOL 1396 00:54:17,256 --> 00:54:19,525 ITSELF IS NOT A COST ANALYSIS 1397 00:54:19,525 --> 00:54:19,725 TOOL. 1398 00:54:19,725 --> 00:54:22,962 THANKS VERY MUCH AND APPRECIATE 1399 00:54:22,962 --> 00:54:24,697 YOUR TIME LISTENING. 1400 00:54:24,697 --> 00:54:35,241 >> >> THANK YOU. STARTING WITH 1401 00:54:38,110 --> 00:54:40,246 A FEW COMMENTS, DAVID YOUR 1402 00:54:40,246 --> 00:54:42,181 PRESENTATION WAS WONDERFUL AND 1403 00:54:42,181 --> 00:54:43,616 BACK TO A QUESTION FOR YOU ABOUT 1404 00:54:43,616 --> 00:54:46,385 MEDICAID ASPECT OF IT AND FOCUS 1405 00:54:46,385 --> 00:54:49,789 ON MEDICAID AND FOCUS ON USING 1406 00:54:49,789 --> 00:54:51,023 MEDICAID BILLING IS A CRITICAL 1407 00:54:51,023 --> 00:54:54,427 PIECE YOU HIGHLIGHTED AND TODD 1408 00:54:54,427 --> 00:54:56,429 BROUGHT IN FIVE PERSPECTIVES AND 1409 00:54:56,429 --> 00:54:58,864 ASKING A SPECIFIC QUESTION IN A 1410 00:54:58,864 --> 00:55:01,467 SECOND BUT THOSE FIVE 1411 00:55:01,467 --> 00:55:02,868 PERSPECTIVES MIGHT OR MIGHT NOT 1412 00:55:02,868 --> 00:55:04,503 ALIGN WITH EACH OTHER AND HAVE 1413 00:55:04,503 --> 00:55:07,840 TO FIGURE OUT HOW TO BRING INTO 1414 00:55:07,840 --> 00:55:10,443 ALIGNMENT AND FREYA TALKED ABOUT 1415 00:55:10,443 --> 00:55:12,945 TOOLS THAT NEED TO BE BUILT AND 1416 00:55:12,945 --> 00:55:14,780 HOW DO YOU ADAPT IT AND MAKE IT 1417 00:55:14,780 --> 00:55:17,550 EASY TO USE COMING TO LISA'S 1418 00:55:17,550 --> 00:55:19,218 DECISION ON INTERVENTION COSTS 1419 00:55:19,218 --> 00:55:20,553 AND ALSO TO THINK THROUGH ALL OF 1420 00:55:20,553 --> 00:55:24,256 THE DIFFERENT ASPECTS OF 1421 00:55:24,256 --> 00:55:26,292 IMPLEMENTATION COSTS. 1422 00:55:26,292 --> 00:55:28,661 A COUPLE OF GENERAL COMMENTS IS 1423 00:55:28,661 --> 00:55:30,096 I THINK THAT THE WHOLE 1424 00:55:30,096 --> 00:55:32,264 DISCUSSION IS NOT JUST ECONOMIC 1425 00:55:32,264 --> 00:55:34,867 EVALUATION OF INDIVIDUAL OR 1426 00:55:34,867 --> 00:55:37,636 MULTICOMPONENT INTERVENTION. 1427 00:55:37,636 --> 00:55:40,673 ALSO, TO FIGURE OUT HOW YOU 1428 00:55:40,673 --> 00:55:41,874 TRANSLATE IS INTO THE REAL WORLD 1429 00:55:41,874 --> 00:55:45,611 AND WHAT ARE BARRIERS AND HOW 1430 00:55:45,611 --> 00:55:48,247 YOU MAKE IT HAPPEN SERVING AS A 1431 00:55:48,247 --> 00:55:51,717 SYSTEM AND BOORS OF VALUE-BASED 1432 00:55:51,717 --> 00:55:52,685 ENTITIES TWO INTERESTING 1433 00:55:52,685 --> 00:55:53,886 ELEMENTS WE HAVE NOT TALKED 1434 00:55:53,886 --> 00:55:56,455 ABOUT AND ONE IS MOSTLY IMPACT 1435 00:55:56,455 --> 00:55:58,858 YOU WOULD SEE ON COST SAVING OR 1436 00:55:58,858 --> 00:56:00,393 LONGER TERM TREATING MENTAL 1437 00:56:00,393 --> 00:56:02,595 HEALTH OR OPIOID USE OR ALCOHOL 1438 00:56:02,595 --> 00:56:04,897 USE DISORDERS THAT IS MORE ON 1439 00:56:04,897 --> 00:56:06,432 MEDICAL COSTS AND SOCIAL COSTS 1440 00:56:06,432 --> 00:56:11,203 AND WHEN YOU ACTUALLY FIGURE OUT 1441 00:56:11,203 --> 00:56:12,872 INTERVENTIONS, BECAUSE THE 1442 00:56:12,872 --> 00:56:16,242 SECOND PART INCLUDES SOCIAL AND 1443 00:56:16,242 --> 00:56:19,478 FINANCIAL INTERVENTIONS YOU SEE 1444 00:56:19,478 --> 00:56:20,746 A DIFFERENT GAME. 1445 00:56:20,746 --> 00:56:23,582 HAVING BEEN INVOLVED IN PROGRAMS 1446 00:56:23,582 --> 00:56:26,252 TAKING ON ENTIRE COST OF CARE 1447 00:56:26,252 --> 00:56:28,220 AND HAVING ABILITY TO INCLUDE 1448 00:56:28,220 --> 00:56:30,423 SOCIAL ELEMENTS OF CARE SUCH AS 1449 00:56:30,423 --> 00:56:32,625 HOUSING, FOOD, MEDICATIONS, ET 1450 00:56:32,625 --> 00:56:35,694 CETERA, THERE IS SOMETHING TO 1451 00:56:35,694 --> 00:56:40,266 CONSIDER AS I MENTIONED AND NIDA 1452 00:56:40,266 --> 00:56:41,901 THINKING THROUGH HOW TO PLAY A 1453 00:56:41,901 --> 00:56:46,739 ROLE IN INFLUENCING CMS 1454 00:56:46,739 --> 00:56:49,775 [INDISCERNIBLE]. I WILL START 1455 00:56:49,775 --> 00:56:53,212 WITH QUESTIONS. 1456 00:56:53,212 --> 00:57:03,756 QUESTION DAIID -- AND ABOUT FIVE 1457 00:57:04,323 --> 00:57:05,291 PERSPECTIVES THAW DISCUSSED AND 1458 00:57:05,291 --> 00:57:07,460 HOW DO YOU TRY TO TAKE A LOOK AT 1459 00:57:07,460 --> 00:57:09,929 WHEN PERSPECTIVES DO NOT ALIGN? 1460 00:57:09,929 --> 00:57:12,765 LET ME START WITH THAT. ERIC 1461 00:57:12,765 --> 00:57:16,235 AND I WILL ASK QUESTIONS AS THEY 1462 00:57:16,235 --> 00:57:22,708 COME THROUGH FROM THE AUDIENCE. 1463 00:57:22,708 --> 00:57:25,411 >> TODD, WANT ME TO GO FIRST? 1464 00:57:25,411 --> 00:57:26,312 >> YES, PLEASE. 1465 00:57:26,312 --> 00:57:28,247 >> SOUNDS GREAT. GREAT 1466 00:57:28,247 --> 00:57:30,449 QUESTION. IT WASN'T TRIVIAL TO 1467 00:57:30,449 --> 00:57:32,284 WORK WITH MEDICAID AND TRY TO 1468 00:57:32,284 --> 00:57:34,653 FIGURE OUT HOW TO OPTIMIZE 1469 00:57:34,653 --> 00:57:35,154 BILLING CODES. 1470 00:57:35,154 --> 00:57:37,289 IT WOULD HAVE BEEN EASY IF WE 1471 00:57:37,289 --> 00:57:38,824 DIDN'T WANT TO REALLY DO THE 1472 00:57:38,824 --> 00:57:41,927 BEST THAT WE CAN TO OPTIMIZE 1473 00:57:41,927 --> 00:57:43,362 WHAT POSSIBLY PEOPLE COULD 1474 00:57:43,362 --> 00:57:46,799 RECEIVE. WE WANTED TO REALLY BE 1475 00:57:46,799 --> 00:57:49,535 COMPREHENSIVE ABOUT THAT. 1476 00:57:49,535 --> 00:57:54,373 NOT ONLY E SSSENTIAL LS AND WHA 1477 00:57:54,373 --> 00:57:57,042 WE WERE MISSING AND TOOK TIME 1478 00:57:57,042 --> 00:57:58,777 AND MASS HEALTH MEDICAID 1479 00:57:58,777 --> 00:58:00,246 AUTHORITY HUNG IN THERE WITH US 1480 00:58:00,246 --> 00:58:02,882 AND GAVE US LOTS OF TIME AND MY 1481 00:58:02,882 --> 00:58:06,619 ADVICE WOULD REALLY BE TO GO AND 1482 00:58:06,619 --> 00:58:07,720 SIT WITH YOUR MEDICAID AUTHORITY 1483 00:58:07,720 --> 00:58:09,488 AND GO THROUGH WHAT YOU ARE 1484 00:58:09,488 --> 00:58:12,291 DOING AND BACK INTO BILLING 1485 00:58:12,291 --> 00:58:12,525 CODES. 1486 00:58:12,525 --> 00:58:16,228 IF IT IS RELATED TO MISSION, 1487 00:58:16,228 --> 00:58:18,664 EASIEST WAY IS TO BRING BILLING 1488 00:58:18,664 --> 00:58:21,100 CODES OVER TO YOUR MEDICAID 1489 00:58:21,100 --> 00:58:22,334 AUTHORITY THAT THERE ARE BILLING 1490 00:58:22,334 --> 00:58:26,138 CODES THAT COULD BE POTENTIALLY 1491 00:58:26,138 --> 00:58:27,439 SOMEWHAT UNIVERSAL AND THERE 1492 00:58:27,439 --> 00:58:31,443 WOULD BE VARIATION AND HAVE THEM 1493 00:58:31,443 --> 00:58:38,150 WORK THROUGH THOSE CODES. 1494 00:58:38,150 --> 00:58:42,955 >> TODD TURNING IT TO YOU. 1495 00:58:42,955 --> 00:58:45,791 >> QUESTION AND ALIGNMENT OF 1496 00:58:45,791 --> 00:58:47,293 PERSPECTIVES TO SOLVE THAT ONE 1497 00:58:47,293 --> 00:58:54,433 AND WAY WE LOOK AT IT IS AS A 1498 00:58:54,433 --> 00:58:58,203 PRACTICAL MATTER. 1499 00:58:58,203 --> 00:59:00,239 PERHAPS MOST IMPORTANT 1500 00:59:00,239 --> 00:59:02,675 COMPARISON ACROSS STUDIES OF 1501 00:59:02,675 --> 00:59:04,243 DIFFERENT INTERVENTIONS AND 1502 00:59:04,243 --> 00:59:05,711 EVERYBODY ADOPTS A SIMILAR 1503 00:59:05,711 --> 00:59:08,080 PERSPECTIVE AND IS HELPFUL IN 1504 00:59:08,080 --> 00:59:10,115 TERMS OF COMPARING RELATIVE 1505 00:59:10,115 --> 00:59:13,519 PROCESS OF DIFFERENT TREATMENTS. 1506 00:59:13,519 --> 00:59:19,124 THAT SAID AS A PRACTICAL MATTER 1507 00:59:19,124 --> 00:59:20,759 IT IS IMPORTANT PATIENTS GOOD 1508 00:59:20,759 --> 00:59:25,164 DEAL FOR PATIENTS AND CLINIC AND 1509 00:59:25,164 --> 00:59:34,707 PAYERS WHOEVER THEY ARE. 1510 00:59:34,707 --> 00:59:38,711 THAT IS A BARRIER TO 1511 00:59:38,711 --> 00:59:44,283 IMPLEMENTATION THIS STAGE OF THE 1512 00:59:44,283 --> 00:59:47,019 GAME WE ARE TRYING TO SEE WHAT 1513 00:59:47,019 --> 00:59:47,987 POTENTIAL BARRIERS AND 1514 00:59:47,987 --> 00:59:48,654 PERSPECTIVE WILL BE 1515 00:59:48,654 --> 00:59:49,588 [INDISCERNIBLE] AND ONE MORE 1516 00:59:49,588 --> 00:59:51,991 THING ON THAT. MORE GENERALLY 1517 00:59:51,991 --> 00:59:58,063 IS A NOTION OF A [INDISCERNIBLE] 1518 00:59:58,063 --> 00:59:59,898 POC 1519 00:59:59,898 --> 01:00:03,335 POK PROBLEM AND WRONG POCKET 1520 01:00:03,335 --> 01:00:07,606 PROBLEM IS WHEN IMPLEMENTATION 1521 01:00:07,606 --> 01:00:13,379 COSTS DISPROPORTIONATELY BY BUN 1522 01:00:13,379 --> 01:00:15,748 ENTITY IS ENJOYED BY ANOTHER 1523 01:00:15,748 --> 01:00:17,750 ENTITY AND WHEN IT HAPPENS WE 1524 01:00:17,750 --> 01:00:19,752 HAVE LIKELIHOOD AND PROBLEM WILL 1525 01:00:19,752 --> 01:00:23,255 BE CHRONICALLY UNDERFUNDED THAT 1526 01:00:23,255 --> 01:00:28,260 HAPPENS ALL THE TIME PROGRAMS AT 1527 01:00:28,260 --> 01:00:29,762 INTERSECTION OF MEDICAL 1528 01:00:29,762 --> 01:00:31,363 SOCIALIZATIONS AND NO GREAT 1529 01:00:31,363 --> 01:00:34,466 SOLUTION FOR WRONG POCKET 1530 01:00:34,466 --> 01:00:37,436 PROBLEM I'M AWARE OF PUT OUT A 1531 01:00:37,436 --> 01:00:39,238 PROPOSAL A FEW YEARS AGO FOR 1532 01:00:39,238 --> 01:00:41,140 FOLKS TO EXAMINE THIS AND MAYBE 1533 01:00:41,140 --> 01:00:43,709 SOMEONE ON THE CALL OR PANELISTS 1534 01:00:43,709 --> 01:00:45,377 MIGHT KNOW WHAT THAT IS AND THAT 1535 01:00:45,377 --> 01:00:48,814 WOULD BE WONDERFUL IF WE COULD 1536 01:00:48,814 --> 01:00:51,417 MAKE THAT HAPPEN. THANK YOU. 1537 01:00:51,417 --> 01:00:56,255 >> WANT TO ASK THE NEXT 1538 01:00:56,255 --> 01:00:58,123 QUESTION? 1539 01:00:58,123 --> 01:01:00,159 DR. NEZIR, WE HAVE A QUESTION 1540 01:01:00,159 --> 01:01:01,927 FOR YOU ASKING HOW YOU ALIGN 1541 01:01:01,927 --> 01:01:07,232 INTEREST OF PAYERS PROVIDERS AND 1542 01:01:07,232 --> 01:01:13,572 PATIENTS IN THE LONG TERM. 1543 01:01:13,572 --> 01:01:15,474 TYPICALLY WE PRESENT IN 1544 01:01:15,474 --> 01:01:17,376 LITERATURE AND COST 1545 01:01:17,376 --> 01:01:20,946 EFFECTIVENESS ANALYSIS OF 1546 01:01:20,946 --> 01:01:24,116 ECONOMIC EVALUATION. 1547 01:01:24,116 --> 01:01:28,387 IT SEEMS IN REAL WORLD RETURN ON 1548 01:01:28,387 --> 01:01:29,922 INVESTMENT AND DECISION MAKERS 1549 01:01:29,922 --> 01:01:33,659 CARE MORE ABOUT RETURN ON 1550 01:01:33,659 --> 01:01:35,094 INVESTMENT AND MY 1551 01:01:35,094 --> 01:01:35,994 [INDISCERNIBLE] WHEN WE HAVE 1552 01:01:35,994 --> 01:01:39,631 CLEAR EVIDENCE ON SHARED RETURN 1553 01:01:39,631 --> 01:01:45,304 ON INVESTMENT PAYERS CARE ABOUT 1554 01:01:45,304 --> 01:01:47,239 REDUCED LONG TERM UTILIZATION 1555 01:01:47,239 --> 01:01:48,240 AMONG OTHER THINGS MAINLY AND 1556 01:01:48,240 --> 01:01:51,643 FOR PROVIDERS IT IS MORE 1557 01:01:51,643 --> 01:01:55,748 RELIABLE FUNDING AND PA PATIENT 1558 01:01:55,748 --> 01:02:00,018 WANT ACCESS RECOVERY OUTCOMES 1559 01:02:00,018 --> 01:02:03,756 AND ALIGNING THESE MIGHT BE LIKE 1560 01:02:03,756 --> 01:02:07,259 PAYMENT MODELS REFLECTING 1561 01:02:07,259 --> 01:02:09,161 TIME-BASED RETURN AS WELL AND UP 1562 01:02:09,161 --> 01:02:12,598 FRONT INVESTMENT THAT IS 1563 01:02:12,598 --> 01:02:18,637 PROVIDERS BEING MORE VOVED IN 1564 01:02:18,637 --> 01:02:20,239 THAT PHASE AND MIDTERM BREAK 1565 01:02:20,239 --> 01:02:24,243 EVEN FOR PROVIDERS AND PAYERS 1566 01:02:24,243 --> 01:02:28,580 AND LONG TERM SAVINGS FOR PAYERS 1567 01:02:28,580 --> 01:02:33,952 AND TOOLS LIKE THIS BREAK EVEN 1568 01:02:33,952 --> 01:02:38,457 CALCULATORS OR MULTIPAY ER RETUN 1569 01:02:38,457 --> 01:02:44,129 ON INVESTMENT MODELS THAT NEED 1570 01:02:44,129 --> 01:02:45,931 TO BE [INDISCERNIBLE] 1571 01:02:45,931 --> 01:02:46,899 TRANSPARENTLY SHARING WHAT COSTS 1572 01:02:46,899 --> 01:02:50,669 AND BENEFITS CAN BE IN EACH LYE 1573 01:02:50,669 --> 01:02:53,172 TIME OF A PROGRAM WHAT WE WOULD 1574 01:02:53,172 --> 01:02:57,376 EXPECT AND LATER ON COULD BE 1575 01:02:57,376 --> 01:02:58,844 NEGOTIATION POINTS BETWEEN 1576 01:02:58,844 --> 01:03:00,813 DIFFERENT DECISION MAKERS AND 1577 01:03:00,813 --> 01:03:05,751 AGAIN IS A VERY YOU KNOW 1578 01:03:05,751 --> 01:03:11,223 DIFFICULT QUESTION THAT IS A 1579 01:03:11,223 --> 01:03:15,294 START TO THINKING ABOUT WHO IS 1580 01:03:15,294 --> 01:03:18,030 INTERESTED AND MOSTLY AT 1581 01:03:18,030 --> 01:03:18,764 OUTFRONT OF DECISION OF 1582 01:03:18,764 --> 01:03:20,666 DIFFERENT PHASES AND INTRODUCING 1583 01:03:20,666 --> 01:03:24,236 A PROGRAM AND WHAT ARE PROVIDERS 1584 01:03:24,236 --> 01:03:25,871 NEEDING AND HOW CAN WE LET'S 1585 01:03:25,871 --> 01:03:28,073 LOOK AT PAYMENT MODELS TO 1586 01:03:28,073 --> 01:03:30,142 ADDRESS THEM VERSUS IN LONG TERM 1587 01:03:30,142 --> 01:03:32,244 PAYERS MIGHT BE MORE INTERESTED 1588 01:03:32,244 --> 01:03:34,379 AND RETURN ON INVESTMENT AND 1589 01:03:34,379 --> 01:03:36,682 SHARED RETURN ON INVESTMENT 1590 01:03:36,682 --> 01:03:38,550 MODELS MIGHT BE A WAY TO START 1591 01:03:38,550 --> 01:03:39,852 TO LOOK INTO THAT. 1592 01:03:39,852 --> 01:03:40,686 WE DON'T HAVE IT. 1593 01:03:40,686 --> 01:03:43,989 I MEAN, WHICH WE -- ECONOMIC 1594 01:03:43,989 --> 01:03:45,457 LITERATURE, NOT MUCH, I WOULD 1595 01:03:45,457 --> 01:03:45,924 SAY. 1596 01:03:45,924 --> 01:03:48,861 WE HAVE SOCIETAL PERSPECTIVE WE 1597 01:03:48,861 --> 01:03:51,129 USE IN COST EFFECTIVENESS 1598 01:03:51,129 --> 01:03:52,798 ANALYSIS THAT I THINK AS I TRIED 1599 01:03:52,798 --> 01:03:55,534 TO DESCRIBE IN THE PRESENTATION 1600 01:03:55,534 --> 01:03:59,171 REAL WORLD DECISIONS THAT WE 1601 01:03:59,171 --> 01:04:03,775 STILL ARE TOO DEVELOPMENTS TO 1602 01:04:03,775 --> 01:04:07,112 LOOK INTO. 1603 01:04:07,112 --> 01:04:10,916 >> I THINK YOU BROUGHT UP A 1604 01:04:10,916 --> 01:04:13,085 CRITICAL POINT AND DECISION 1605 01:04:13,085 --> 01:04:14,953 MAKER HAVING TO MAKE CHOICES 1606 01:04:14,953 --> 01:04:16,588 TOOLS DON'T EXIST AND YOU HAVE 1607 01:04:16,588 --> 01:04:19,124 TO OFTEN WORK OUT BASED ON LOCAL 1608 01:04:19,124 --> 01:04:21,426 CONTEXT AND KEEP ADAPTING AND 1609 01:04:21,426 --> 01:04:23,629 THINK THAT YOU ARE BRINGING UP A 1610 01:04:23,629 --> 01:04:25,130 CRITICAL POINT THAT WE HAVE TO 1611 01:04:25,130 --> 01:04:27,599 FIGURE OUT HOW TO CREATE THESE 1612 01:04:27,599 --> 01:04:29,534 TOOLS THAT I THINK ALSO CONNECTS 1613 01:04:29,534 --> 01:04:33,472 TO THE TYPE OF STRATEGY THAT WAS 1614 01:04:33,472 --> 01:04:34,973 -- TODD WAS CONDUCTING. 1615 01:04:34,973 --> 01:04:37,276 YOU NEED DATA TO RUN THE TOOLS 1616 01:04:37,276 --> 01:04:38,777 SO YOU CAN PROPERLY MAKE 1617 01:04:38,777 --> 01:04:40,579 DECISIONS AND THINK THAT BOTH OF 1618 01:04:40,579 --> 01:04:42,881 YOU HAVE BROUGHT UP CRITICAL 1619 01:04:42,881 --> 01:04:43,215 POINTS. 1620 01:04:43,215 --> 01:04:47,052 IF YOU WANT TO ASK THE NEXT 1621 01:04:47,052 --> 01:04:48,987 QUESTION, ERIKA, OR -- 1622 01:04:48,987 --> 01:04:51,523 >> SURE. GREAT POINTS ALL 1623 01:04:51,523 --> 01:04:52,925 AROUND. I WOULDN'T MENTION YOU 1624 01:04:52,925 --> 01:04:54,526 KNOW THESE PRESENTATIONS 1625 01:04:54,526 --> 01:04:56,728 HIGHLIGHTED SEVERAL ECONOMIC 1626 01:04:56,728 --> 01:04:58,463 TOOLS TO USE DURING DIFFERENT 1627 01:04:58,463 --> 01:04:59,965 PHASES OF IMPLEMENTATION 1628 01:04:59,965 --> 01:05:01,733 PLANNING AND SUSTAINMENT AND 1629 01:05:01,733 --> 01:05:03,869 SCALE-UP AND WONDERING IF 1630 01:05:03,869 --> 01:05:05,270 PANELISTS CAN COLLECTIVELY SPEAK 1631 01:05:05,270 --> 01:05:07,039 TO HOW YOU WORK WITH LOCAL 1632 01:05:07,039 --> 01:05:09,675 DECISION MAKERS AND MORE NITTY 1633 01:05:09,675 --> 01:05:11,610 GRITTY DETAILS TO THINK ABOUT 1634 01:05:11,610 --> 01:05:14,413 HOW TO SELECT THE RIGHT TOOL OR 1635 01:05:14,413 --> 01:05:15,881 ECONOMIC EVALUATION APPROACH FOR 1636 01:05:15,881 --> 01:05:17,582 LOCAL CONTEXT OR END GOAL NEEDS 1637 01:05:17,582 --> 01:05:19,618 AND IF YOU WANT TO TALK ABOUT 1638 01:05:19,618 --> 01:05:22,054 HOW THAT APPROACH DIFFERS AND IF 1639 01:05:22,054 --> 01:05:23,422 YOU ARE WORKING WITH 1640 01:05:23,422 --> 01:05:26,725 ORGANIZATIONS AND HEALTH SYSTEM 1641 01:05:26,725 --> 01:05:28,193 DECISION MAKERS AND STATE AGENCY 1642 01:05:28,193 --> 01:05:30,562 DECISION MAKERS WE WELCOME THAT 1643 01:05:30,562 --> 01:05:31,363 DETAIL AS WELL. 1644 01:05:31,363 --> 01:05:33,565 >> I WOULD LIKE TO CHIME IN WITH 1645 01:05:33,565 --> 01:05:34,032 THAT. 1646 01:05:34,032 --> 01:05:35,167 MY WHOLE PRESENTATION I THINK 1647 01:05:35,167 --> 01:05:36,969 WAS ABOUT THAT. 1648 01:05:36,969 --> 01:05:39,104 TOOLS I MENTIONED ARE NOT THERE. 1649 01:05:39,104 --> 01:05:41,139 THEY ARE NOT THERE FOR US 1650 01:05:41,139 --> 01:05:43,308 RESEARCHERS TO USE AND WERE 1651 01:05:43,308 --> 01:05:44,977 SUGGESTIONS TO BUILD THESE 1652 01:05:44,977 --> 01:05:46,712 TOOLS. THEY SEEM TO BE MORE 1653 01:05:46,712 --> 01:05:48,480 RELEVANT FOR DECISION MAKERS. 1654 01:05:48,480 --> 01:05:50,615 WE DON'T HAVE THE TWO AS FAR AS 1655 01:05:50,615 --> 01:05:53,385 I KNOW TO PICK FROM AND GENERAL 1656 01:05:53,385 --> 01:05:55,554 APPROACH IS COST EFFECTIVENESS 1657 01:05:55,554 --> 01:05:59,524 ANALYSIS FOR MOSTLY I MEAN 1658 01:05:59,524 --> 01:06:00,158 PUBLICATION PURPOSES. 1659 01:06:00,158 --> 01:06:03,996 IT IS LIKE DATA BUT NOT LOCALLY 1660 01:06:03,996 --> 01:06:05,831 TRANSFERABLE AND LOCALLY USABLE 1661 01:06:05,831 --> 01:06:07,899 FOR DECISION MAKING AND THOSE 1662 01:06:07,899 --> 01:06:11,636 TOOLS WE ARE TO DEVELOP, I 1663 01:06:11,636 --> 01:06:14,439 THINK. 1664 01:06:14,439 --> 01:06:16,008 I THINK THAT PRETTY MUCH IS 1665 01:06:16,008 --> 01:06:19,311 IMPORTANT AND WE DON'T HAVE THAT 1666 01:06:19,311 --> 01:06:20,245 INFRASTRUCTURE AND CALL TO 1667 01:06:20,245 --> 01:06:23,315 ACTION WAS LET'S WORK ON 1668 01:06:23,315 --> 01:06:27,185 BUILDING THIS INFRASTRUCTURE AND 1669 01:06:27,185 --> 01:06:30,022 COST EFFECTIVENESS NORMAL 1670 01:06:30,022 --> 01:06:31,823 ECONOMIC EVALUATION WE HAVE 1671 01:06:31,823 --> 01:06:34,526 DOESN'T SEEM TO FIT TO SO-CALLED 1672 01:06:34,526 --> 01:06:36,028 REAL WORLD DECISIONS. 1673 01:06:36,028 --> 01:06:38,130 >> ERIKA, IF YOU DON'T MIND, IF 1674 01:06:38,130 --> 01:06:40,165 I CAN JUMP IN FOLLOWING FREYA 1675 01:06:40,165 --> 01:06:45,504 THERE. I THI THINK THAT IS RIG 1676 01:06:45,504 --> 01:06:48,073 AND HOPE TO HINT A LITTLE OF 1677 01:06:48,073 --> 01:06:50,575 THAT IN MY PRESENTATION AND 1678 01:06:50,575 --> 01:06:51,309 BELIEVE WAY WE PRESENT 1679 01:06:51,309 --> 01:06:53,245 INFORMATION AND INFORMATION THAT 1680 01:06:53,245 --> 01:06:55,447 IS USEFUL TO DIFFERENT 1681 01:06:55,447 --> 01:06:56,581 CONSTITUENTS ARE QUITE 1682 01:06:56,581 --> 01:06:56,882 DIFFERENT. 1683 01:06:56,882 --> 01:06:58,683 SO JUST LIKE FREYA WAS SAYING, 1684 01:06:58,683 --> 01:07:01,653 WHEN I'M GOING AND MEETING AN 1685 01:07:01,653 --> 01:07:02,888 INDIVIDUAL ORGANIZATIONAL LEADER 1686 01:07:02,888 --> 01:07:04,222 OR EXECUTIVE DIRECTOR, THEY ARE 1687 01:07:04,222 --> 01:07:07,559 NOT INTERESTED IN THE OVERALL 1688 01:07:07,559 --> 01:07:08,760 COST EFFECTIVENESS WE MIGHT 1689 01:07:08,760 --> 01:07:10,162 MENTION THAT AND WHAT CATCHES 1690 01:07:10,162 --> 01:07:12,164 OUR ATTENTION AND WHAT STARTS 1691 01:07:12,164 --> 01:07:14,499 THE CONVERSATION AND IN TERMS OF 1692 01:07:14,499 --> 01:07:15,634 ACTUALLY DECIDING WHETHER OR NOT 1693 01:07:15,634 --> 01:07:17,135 THEY ARE GOING TO IMPLEMENT 1694 01:07:17,135 --> 01:07:18,804 SOMETHING, THEY ARE REALLY 1695 01:07:18,804 --> 01:07:21,506 INTERESTED IN WHAT IS SORT OF 1696 01:07:21,506 --> 01:07:23,341 THE BEAR BONES NEEDS TO LIKE 1697 01:07:23,341 --> 01:07:24,643 WHAT ARE THE STRATEGIES THAT 1698 01:07:24,643 --> 01:07:27,646 WILL BE NEEDED TO IMPLEMENT THIS 1699 01:07:27,646 --> 01:07:29,781 PROGRAM TO BE ABLE TO IMPLEMENT 1700 01:07:29,781 --> 01:07:31,016 IT WITH FIDELITY AND THINK THAT 1701 01:07:31,016 --> 01:07:34,920 IS WHERE I HAVE A LOT OF 1702 01:07:34,920 --> 01:07:36,254 CONVERSATIONS SOMETIMES FOLKS 1703 01:07:36,254 --> 01:07:38,723 ARE ASKING IF THERE ARE PARTS OF 1704 01:07:38,723 --> 01:07:39,858 THE INTERVENTION THEY MIGHT BE 1705 01:07:39,858 --> 01:07:42,594 ABLE TO CUT CORNERS ON OR 1706 01:07:42,594 --> 01:07:44,229 DECREASE AMOUNT OF TIME THEY 1707 01:07:44,229 --> 01:07:46,131 HAVE FACILITATION MAYBE OR 1708 01:07:46,131 --> 01:07:48,200 COACHING IN A PARTICULAR MODEL. 1709 01:07:48,200 --> 01:07:50,202 ONE THING I OFTEN TIMES AM 1710 01:07:50,202 --> 01:07:52,204 TALKING TO THEM ABOUT IS YES WE 1711 01:07:52,204 --> 01:07:54,339 CAN DO THOSE COST CUTTING 1712 01:07:54,339 --> 01:07:56,308 MEASURES UP FRONT. THAT IS THEN 1713 01:07:56,308 --> 01:08:00,245 GOING TO PRODUCE A PROGRAM LESS 1714 01:08:00,245 --> 01:08:01,880 LIKELY TO SUSTAIN INTO THE 1715 01:08:01,880 --> 01:08:03,715 FUTURE AND AT THAT POINT THOSE 1716 01:08:03,715 --> 01:08:05,484 ARE LOST COSTS; RIGHT? 1717 01:08:05,484 --> 01:08:08,153 WE START TO HAVE CONVERSATIONS 1718 01:08:08,153 --> 01:08:10,689 WHAT IT TAKES SORT OF IN THAT 1719 01:08:10,689 --> 01:08:12,324 BASIC WAY AND WHAT WE CAN DO NOW 1720 01:08:12,324 --> 01:08:14,426 AND PLAN FOR THAT ALONG THAT 1721 01:08:14,426 --> 01:08:16,027 PINNUM OF THE IMPLEMENTATION 1722 01:08:16,027 --> 01:08:19,264 PROCESS FOR THEM TO BE ABLE TO 1723 01:08:19,264 --> 01:08:20,966 DELIVER SOMETHING WITH FIDELITY 1724 01:08:20,966 --> 01:08:22,667 AND WHAT WE ARE ABLE TO SHOW 1725 01:08:22,667 --> 01:08:24,736 WITH COINS IS WE CAN SHOW THEM 1726 01:08:24,736 --> 01:08:26,238 HOW LONG IT TAKES FOR THEM TO 1727 01:08:26,238 --> 01:08:29,641 START TO BE ABLE TO RECOUP UP 1728 01:08:29,641 --> 01:08:31,376 FRONT AND WHAT OFTEN TIMES 1729 01:08:31,376 --> 01:08:33,545 PEOPLE REFER TO AS SUNK COST AND 1730 01:08:33,545 --> 01:08:35,547 DON'T LIKE TO REFER TO THEM AS 1731 01:08:35,547 --> 01:08:38,283 SUNK KOCHTS THAT ARE VERY REAL 1732 01:08:38,283 --> 01:08:39,518 COSTS TO THE AGENCY LAND OR NOT 1733 01:08:39,518 --> 01:08:41,386 THEY ARE COSTS IN THE FUTURE, IT 1734 01:08:41,386 --> 01:08:42,787 DOESN'T MATTER. 1735 01:08:42,787 --> 01:08:44,122 IN THAT MOMENT, IT WILL 1736 01:08:44,122 --> 01:08:45,524 DETERMINE WHETHER OR NOT THEY 1737 01:08:45,524 --> 01:08:47,125 CAN MAKE IT IN THEIR BUDGET AND 1738 01:08:47,125 --> 01:08:49,594 HOW I THINK ABOUT COINS SORT OF. 1739 01:08:49,594 --> 01:08:52,297 YES. IT CAN BE USED TO INFORM 1740 01:08:52,297 --> 01:08:53,398 ECONOMIC ANALYSIS. 1741 01:08:53,398 --> 01:08:58,637 IT CAN ALSO BE USED IN EVERY-DAY 1742 01:08:58,637 --> 01:09:00,505 DISCUSSIONS WITH DECISIONMAKERS. 1743 01:09:00,505 --> 01:09:02,507 >> I THINK THAT THIS APPROACH IS 1744 01:09:02,507 --> 01:09:03,175 REALLY INTERESTING. 1745 01:09:03,175 --> 01:09:04,876 IT COULD BE VERY VALUABLE IN 1746 01:09:04,876 --> 01:09:06,344 MANY INSTANCES. 1747 01:09:06,344 --> 01:09:10,515 THANK YOU FOR TALKING ABOUT IT. 1748 01:09:10,515 --> 01:09:17,088 I HAVE ONE QUESTION COX K FROM 1749 01:09:17,088 --> 01:09:18,657 AUDIENCE WORKING IN RURAL AREA 1750 01:09:18,657 --> 01:09:20,892 MIGHT NOT HAVE RESOURCES TO 1751 01:09:20,892 --> 01:09:22,928 PROVIDE THOSE. ANY SUGGESTIONS 1752 01:09:22,928 --> 01:09:24,729 FROM ANY PANEL MEMBERS HOW TO GO 1753 01:09:24,729 --> 01:09:25,297 ABOUT IT? 1754 01:09:25,297 --> 01:09:27,899 IT WAS RAISED IN CONTEXT OF 1755 01:09:27,899 --> 01:09:29,501 COLLABORATIVE CARE THAT I THINK 1756 01:09:29,501 --> 01:09:32,237 IS APPLICABLE TO EVERYTHING 1757 01:09:32,237 --> 01:09:33,805 RAISED WHEN YOU DON'T HAVE THE 1758 01:09:33,805 --> 01:09:35,106 RIGHT KIND OF PEOPLE AND IS 1759 01:09:35,106 --> 01:09:36,875 PROBABLY TRUE FOR A GOOD PART OF 1760 01:09:36,875 --> 01:09:37,909 THE COUNTRY. 1761 01:09:37,909 --> 01:09:42,814 WHAT DO YOU DO? 1762 01:09:42,814 --> 01:09:46,384 >> PSYCHIATRY SEEMS TO BE ONE 1763 01:09:46,384 --> 01:09:48,253 WAY TO GO. 1764 01:09:48,253 --> 01:09:54,893 SHARED CARE MANAGERS ASICROSS 1765 01:09:54,893 --> 01:09:55,126 SITES. 1766 01:09:55,126 --> 01:09:59,130 >> YEAH. I WOULD ADD THIS IS 1767 01:09:59,130 --> 01:09:59,364 DAVID. 1768 01:09:59,364 --> 01:10:02,234 FOR MISSION, WE STARTED TO TEST 1769 01:10:02,234 --> 01:10:04,502 TELEHEALTH MODEL AND THEN IN THE 1770 01:10:04,502 --> 01:10:06,805 DEPARTMENT OF VETERAN AFFAIRS 1771 01:10:06,805 --> 01:10:08,773 AND NOW HAVE A VIRTUAL CARE HUB 1772 01:10:08,773 --> 01:10:10,342 THAT IS OPERATING IN A NUMBER OF 1773 01:10:10,342 --> 01:10:12,310 DIFFERENT RURAL AREAS THAT SEEMS 1774 01:10:12,310 --> 01:10:15,180 OWE BE WORKING REASONABLY WELL 1775 01:10:15,180 --> 01:10:16,748 AND REAL QUESTION FOR US, YOU 1776 01:10:16,748 --> 01:10:18,950 KNOW, WHAT POPULATIONS IS IT 1777 01:10:18,950 --> 01:10:20,118 REASONABLE ENOUGH? 1778 01:10:20,118 --> 01:10:22,454 AND YOU KNOW WHEN DO YOU NEED 1779 01:10:22,454 --> 01:10:23,855 IN-PERSON CARE AND HOW TO DO 1780 01:10:23,855 --> 01:10:24,222 THAT? 1781 01:10:24,222 --> 01:10:26,524 WE ARE STARTING TO LOOK AT IT 1782 01:10:26,524 --> 01:10:26,725 NOW. 1783 01:10:26,725 --> 01:10:29,261 >> I WOULD ALSO SAY MY TEAM AND 1784 01:10:29,261 --> 01:10:30,895 I HAD THE GREAT PRIVILEGE BEING 1785 01:10:30,895 --> 01:10:34,366 ABLE TO WORK WITH A NUMBER OF 1786 01:10:34,366 --> 01:10:35,767 DIFFERENT COLLABORATIVE CARE 1787 01:10:35,767 --> 01:10:36,001 GROUPS. 1788 01:10:36,001 --> 01:10:37,802 SO DIFFERENT PLACES AROUND THE 1789 01:10:37,802 --> 01:10:39,371 COUNTRY AND DIFFERENT CONTEXTS 1790 01:10:39,371 --> 01:10:43,975 AND PARTICULAR POPULATIONS THAT 1791 01:10:43,975 --> 01:10:45,844 THEY MIGHT BE WORKING WITH AND 1792 01:10:45,844 --> 01:10:47,812 WHAT WE FOUND IN ECONOMIC 1793 01:10:47,812 --> 01:10:49,981 ANALYSIS IS THAT IF YOU CAN 1794 01:10:49,981 --> 01:10:52,217 DEVELOP A COHORT MODEL OF 1795 01:10:52,217 --> 01:10:54,052 IMPLEMENTATION WHERE YOU ARE 1796 01:10:54,052 --> 01:10:56,254 IMPLEMENTING WITH A REAL SET OF 1797 01:10:56,254 --> 01:10:57,489 DIFFERENT COLLABORATIVE CARE 1798 01:10:57,489 --> 01:10:59,491 TEAMS AT THE SAME TIME THAT CAN 1799 01:10:59,491 --> 01:11:01,226 REALLY HELP TO REDUCE COSTS. 1800 01:11:01,226 --> 01:11:04,129 SO THAT REALLY CUTS DOWN ON 1801 01:11:04,129 --> 01:11:06,765 TRAINING COSTS MAKING THEN 1802 01:11:06,765 --> 01:11:09,901 COLLABORATIVE CARE MORE OPEN OR 1803 01:11:09,901 --> 01:11:11,169 MORE AVAILABLE TO A GREATER PART 1804 01:11:11,169 --> 01:11:12,404 OF THE POPULATION. 1805 01:11:12,404 --> 01:11:15,173 IT IS NOT THAT THE MODEL ITSELF 1806 01:11:15,173 --> 01:11:18,143 CHANGES BUT MODEL ITSELF STILL 1807 01:11:18,143 --> 01:11:20,445 HAS FIXED COSTS OF THE THING AND 1808 01:11:20,445 --> 01:11:23,148 HOW WE IMPLEMENT IT IS -- CAN 1809 01:11:23,148 --> 01:11:24,783 MAKE AN IMPACT ON NUMBER OF 1810 01:11:24,783 --> 01:11:26,985 FOLKS THAT WE ARE ABLE TO REACH 1811 01:11:26,985 --> 01:11:29,054 WITH THAT MODEL. 1812 01:11:29,054 --> 01:11:31,056 >> THANK YOU, ERIC. 1813 01:11:31,056 --> 01:11:33,391 WANT TO ASK THE LAST QUESTION? 1814 01:11:33,391 --> 01:11:36,194 WE ARE RUNNING OUT OF TIME AND 1815 01:11:36,194 --> 01:11:38,330 VERY GOOD DISCUSSION SO FAR. 1816 01:11:38,330 --> 01:11:39,898 >> YEAH. GREAT DISCUSSION. 1817 01:11:39,898 --> 01:11:42,033 EARLY THANK YOU TO OUR 1818 01:11:42,033 --> 01:11:42,867 PANELISTS. 1819 01:11:42,867 --> 01:11:43,902 LAST AUDIENCE QUESTION WE HAVE 1820 01:11:43,902 --> 01:11:45,603 IS WONDERING ABOUT DIFFERENT 1821 01:11:45,603 --> 01:11:48,239 BENEFITS TO THINKING ABOUT 1822 01:11:48,239 --> 01:11:49,874 IMPLEMENTATION COSTS BY 1823 01:11:49,874 --> 01:11:50,742 DIFFERENT PHASES OF 1824 01:11:50,742 --> 01:11:52,243 IMPLEMENTATION VERSUS THINKING 1825 01:11:52,243 --> 01:11:55,547 ABOUT IMPLEMENTATION COSTS 1826 01:11:55,547 --> 01:11:57,949 ACROSS ALL PHASES TOGETHER. 1827 01:11:57,949 --> 01:11:59,684 >> YEAH. THANK YOU. I WILL 1828 01:11:59,684 --> 01:12:02,554 TAKE THAT. THAT IS PRETTY MUCH 1829 01:12:02,554 --> 01:12:04,522 ON PAR WITH WHAT WE HAVE BEEN 1830 01:12:04,522 --> 01:12:06,558 TALKING ABOUT THUS FAR AND JUST 1831 01:12:06,558 --> 01:12:07,992 IN TERMS OF BEING ABLE AND FACT 1832 01:12:07,992 --> 01:12:09,561 THAT WE ARE ABLE TO SAY THIS IS 1833 01:12:09,561 --> 01:12:13,431 WHAT IT LOOKS LIKE IN 1834 01:12:13,431 --> 01:12:14,766 PREIMPLEMENTATION AND WHAT 1835 01:12:14,766 --> 01:12:17,302 AVERAGE COSTS ARE FOR PARTICULAR 1836 01:12:17,302 --> 01:12:19,404 INTERVENTION AND EVIDENCE-BASED 1837 01:12:19,404 --> 01:12:20,939 PRACTICE ARE AVERAGE COST FOR 1838 01:12:20,939 --> 01:12:22,340 ACTIVE IMPLEMENTATION STAGE AND 1839 01:12:22,340 --> 01:12:25,043 IF YOU RECALL IN MY PRESENTATION 1840 01:12:25,043 --> 01:12:26,544 THAT THOSE PHASES ARE QUITE LONG 1841 01:12:26,544 --> 01:12:29,781 TO BE ABLE TO ACCOMPLISH. 1842 01:12:29,781 --> 01:12:32,250 WITH SIC PART OF COINS PROCESS 1843 01:12:32,250 --> 01:12:34,152 WE CAN BREAK IT DOWN FURTHER 1844 01:12:34,152 --> 01:12:34,552 INTO STAGES. 1845 01:12:34,552 --> 01:12:36,287 AS I MENTIONED, ONE THING THAT 1846 01:12:36,287 --> 01:12:39,457 IS REALLY IMPORTANT IS THE WHO 1847 01:12:39,457 --> 01:12:41,693 THAT IS AVAILABLE NEEDING TO 1848 01:12:41,693 --> 01:12:43,395 ACTIVATE STAGES AND IS ANOTHER 1849 01:12:43,395 --> 01:12:45,130 WAY WE CAN REALLY THINK ABOUT 1850 01:12:45,130 --> 01:12:48,967 COSTS IS IF WE ARE ABLE TO 1851 01:12:48,967 --> 01:12:51,069 DEPLOY A LESS EXPENSIVE 1852 01:12:51,069 --> 01:12:52,070 WORKFORCE WITHIN ORGANIZATIONS 1853 01:12:52,070 --> 01:12:55,039 TO HELP WITH IMPLEMENTATION AND 1854 01:12:55,039 --> 01:12:56,241 MIGHT BE APPROPRIATE AT ONE 1855 01:12:56,241 --> 01:13:00,178 PHASE OF THE IMPLEMENTATION 1856 01:13:00,178 --> 01:13:01,446 PROCESS UNLESS INAPPROPRIATE AT 1857 01:13:01,446 --> 01:13:03,281 ANOTHER PHASE AND THINK A NICE 1858 01:13:03,281 --> 01:13:05,884 THING AND REALIZE I'M BIAS AND 1859 01:13:05,884 --> 01:13:07,485 ANOTHER THING TO BASIC APPROACH 1860 01:13:07,485 --> 01:13:10,622 IS IT ALLOWS US TO PLAN AND 1861 01:13:10,622 --> 01:13:11,790 FORECAST AND BE REALLY 1862 01:13:11,790 --> 01:13:13,358 DELIBERATE WITH USE OF DOLLARS 1863 01:13:13,358 --> 01:13:16,728 IN THAT IMPLEMENTATION PROCESS. 1864 01:13:16,728 --> 01:13:18,763 >> THANK YOU. I THINK WE HAVE 1865 01:13:18,763 --> 01:13:22,767 RUN OUT OF TIME AND WE WANT TO 1866 01:13:22,767 --> 01:13:25,537 THANK ERIKA AND DAVID AND FREYA 1867 01:13:25,537 --> 01:13:28,239 AND LISA FOR A VERY GOOD 1868 01:13:28,239 --> 01:13:29,507 DISCUSSION AND CLEAR 1869 01:13:29,507 --> 01:13:29,841 PRESENTATION. 1870 01:13:29,841 --> 01:13:30,542 THANK YOU ALL. 1871 01:13:30,542 --> 01:13:33,278 >> YES. THANK YOU ALL AND TO 1872 01:13:33,278 --> 01:13:35,914 ERIKA AND RANGA FOR RUNNING THE 1873 01:13:35,914 --> 01:13:36,214 DISCUSSION. 1874 01:13:36,214 --> 01:13:38,149 WE HAVE LEARNED WHAT WE ARE 1875 01:13:38,149 --> 01:13:40,518 ADAPTING TO THE NEW TEAMS 1876 01:13:40,518 --> 01:13:42,220 ENVIRONMENT THAT SOME OF US 1877 01:13:42,220 --> 01:13:44,689 PARTICULARLY ON NIH SIDE ARE 1878 01:13:44,689 --> 01:13:46,057 HAVING DIFFICULTY ACCESSING THE 1879 01:13:46,057 --> 01:13:48,226 Q & A AND WILL LEAVE IT UP HERE 1880 01:13:48,226 --> 01:13:50,094 FOR A MINUTE IF YOU WANT TO 1881 01:13:50,094 --> 01:13:51,663 WRITE DOWN THE E-MAIL ADDRESS 1882 01:13:51,663 --> 01:13:54,132 AND SEND QUESTIONS TO CLAIRE, 1883 01:13:54,132 --> 01:13:54,833 OUR CONTRACTOR. 1884 01:13:54,833 --> 01:13:57,101 WE -- FOR ANYONE FOLLOWING ALONG 1885 01:13:57,101 --> 01:14:00,038 THROUGH NIH TELECAST THIS IS THE 1886 01:14:00,038 --> 01:14:02,740 E-MAIL ADDRESS PROVIDED THROUGH 1887 01:14:02,740 --> 01:14:05,009 NIH VIDEO CAST FOR SUBMITTING 1888 01:14:05,009 --> 01:14:07,078 QUESTIONS AND IF YOU HAVE 1889 01:14:07,078 --> 01:14:09,080 FUNCTIONALITIES IN THE Q & A USE 1890 01:14:09,080 --> 01:14:11,516 THAT. WITH THAT TURNING IT TO 1891 01:14:11,516 --> 01:14:14,219 MARY FROM MENTAL HEALTH AMERICA 1892 01:14:14,219 --> 01:14:15,653 COORDINATING OUR DISCUSSION ON 1893 01:14:15,653 --> 01:14:16,888 FINANCING AND PAYMENT MODELS. 1894 01:14:16,888 --> 01:14:19,624 >> GOOD MORNING, EVERYONE. I'M 1895 01:14:19,624 --> 01:14:22,160 ECSTATIC TO BE HERE TODAY. I'M 1896 01:14:22,160 --> 01:14:24,262 PASSIONATE ABOUT PAYMENT POLICY 1897 01:14:24,262 --> 01:14:26,431 BECAUSE AS YOU WILL SEE FROM 1898 01:14:26,431 --> 01:14:27,665 THESE PRESENTATIONS IT MAKES A 1899 01:14:27,665 --> 01:14:29,400 DIFFERENCE IN ABILITY OF PEOPLE 1900 01:14:29,400 --> 01:14:32,237 WITH MENTAL HEALTH AND SUBSTANCE 1901 01:14:32,237 --> 01:14:34,405 USE CONDITIONS TO ACCESS OFTEN 1902 01:14:34,405 --> 01:14:35,106 LIFE-SAVING CARE. 1903 01:14:35,106 --> 01:14:37,075 YOU WILL HEAR ABOUT A VARIETY OF 1904 01:14:37,075 --> 01:14:39,177 PAYMENT MODELS WHETHER 1905 01:14:39,177 --> 01:14:40,979 FEE-FOR-SERVICE OR BUNDLED 1906 01:14:40,979 --> 01:14:44,115 PACKAGES OR VALUE-BASED PAMENT. 1907 01:14:44,115 --> 01:14:45,917 IN ADDITION YOU WILL HEAR ABOUT 1908 01:14:45,917 --> 01:14:47,685 SIGNIFICANT FACTORS THAT CAN 1909 01:14:47,685 --> 01:14:50,822 EFFECT OUTCOMES AND THINGS LIKE 1910 01:14:50,822 --> 01:14:53,191 HOW SEVERE IS THE ILLNESS AND IS 1911 01:14:53,191 --> 01:14:56,928 IT SERIOUS MENTAL ILLNESS FOR 1912 01:14:56,928 --> 01:15:00,064 EXAMPLE WHERE DOES THE PERSON 1913 01:15:00,064 --> 01:15:02,200 LIVE AND HOW DO RURAL PARTS GET 1914 01:15:02,200 --> 01:15:05,303 ACCESS TO CARE AND END OF LIFE 1915 01:15:05,303 --> 01:15:06,738 PERINATAL CARE IS IMPORTANT TO 1916 01:15:06,738 --> 01:15:09,107 WOMEN AND TO CHILDREN; RIGHT? 1917 01:15:09,107 --> 01:15:10,542 THROUGH THIS ALL THINK THAT THE 1918 01:15:10,542 --> 01:15:11,676 MESSAGE I CAME FROM IN TALKING 1919 01:15:11,676 --> 01:15:13,745 TO PRESENTERS THAT I KNOW I HOPE 1920 01:15:13,745 --> 01:15:15,513 YOU WILL TOO IS WE HAVE SO MUCH 1921 01:15:15,513 --> 01:15:17,615 TO LEARN. OF COURSE, THE BEST 1922 01:15:17,615 --> 01:15:19,083 WAY TO LEARN THAT IS THERE YOU 1923 01:15:19,083 --> 01:15:21,185 RESEARCH AND WE NEED TO REALLY 1924 01:15:21,185 --> 01:15:23,121 LEARN MORE TO UNDERSTAND HOW DO 1925 01:15:23,121 --> 01:15:26,424 WE FINANCIALLY INCENTIVIZE WHAT 1926 01:15:26,424 --> 01:15:28,259 WE WANT TO SEE WHICH IS STRONG 1927 01:15:28,259 --> 01:15:30,562 HEALTH OUTCOMES IN MENTAL HEALTH 1928 01:15:30,562 --> 01:15:33,231 AND SUBSTANCE USE AREA NOT JUST 1929 01:15:33,231 --> 01:15:35,166 AVOIDING BAD OUTCOMES LIKE 1930 01:15:35,166 --> 01:15:36,534 EMERGENCY USE OR EMERGENCY ROOM 1931 01:15:36,534 --> 01:15:38,836 USE OR HOSPITALIZATIONS BUT ALSO 1932 01:15:38,836 --> 01:15:40,505 POSITIVE THINGS; RIGHT? 1933 01:15:40,505 --> 01:15:42,540 HOW WILL WE FINANCIALLY 1934 01:15:42,540 --> 01:15:43,808 INCENTIVIZE WHAT WE WANT TO SEE 1935 01:15:43,808 --> 01:15:46,578 AND MAKE IT EASY FOR PEOPLE AND 1936 01:15:46,578 --> 01:15:47,712 FOR PROVIDERS? 1937 01:15:47,712 --> 01:15:52,150 WITH THAT, I AM REALLY EXCITED 1938 01:15:52,150 --> 01:15:53,451 ABOUT PRESENTATIONS THAT WE WILL 1939 01:15:53,451 --> 01:15:56,254 DIVE INTO SOME OF THE IMPORTANT 1940 01:15:56,254 --> 01:15:56,487 ISSUES. 1941 01:15:56,487 --> 01:15:58,489 AS WAS PREVIOUSLY NOTED WE ARE 1942 01:15:58,489 --> 01:15:59,457 REALLY INTERESTED IN THE 1943 01:15:59,457 --> 01:16:01,659 QUESTIONS AND WILL GET TO THEM 1944 01:16:01,659 --> 01:16:01,960 AT THE END. 1945 01:16:01,960 --> 01:16:05,330 AND YOU HAVE BEEN ASKED TO 1946 01:16:05,330 --> 01:16:13,671 E-MAIL THEM AT CLAIRE 1947 01:16:13,671 --> 01:16:16,240 CLAIRE.BARED AT DUKE.EDU. 1948 01:16:16,240 --> 01:16:17,208 E-MAIL QUESTIONS THERE AND SEND 1949 01:16:17,208 --> 01:16:19,110 THEM TO BE ME AND GET TO THE END 1950 01:16:19,110 --> 01:16:20,478 OF THE PRESENTATION AND NOW 1951 01:16:20,478 --> 01:16:23,848 LET'S GET STARTED WITH THE FIRST 1952 01:16:23,848 --> 01:16:26,884 SPEAKER DR. BETH MCGINTY FROM 1953 01:16:26,884 --> 01:16:28,886 WILD CORNELL MEDICINE. 1954 01:16:28,886 --> 01:16:29,687 DR. MCBEGINTY. 1955 01:16:29,687 --> 01:16:34,392 >> THANK YOU SO MUCH FOR THE 1956 01:16:34,392 --> 01:16:35,126 FANTASTIC INTRODUCTION. 1957 01:16:35,126 --> 01:16:36,894 EVERYBODY OKAY? 1958 01:16:36,894 --> 01:16:37,962 >> YES. YES. 1959 01:16:37,962 --> 01:16:40,965 >> AH SMCHLT THANK YOU. I'M 1960 01:16:40,965 --> 01:16:42,500 GOING TO KICK OFF THIS SECTION 1961 01:16:42,500 --> 01:16:44,769 WITH AN OVERVIEW OF A PROJECT 1962 01:16:44,769 --> 01:16:48,539 THAT WE COMPLETED ABOUT A YEAR 1963 01:16:48,539 --> 01:16:48,840 AGO. 1964 01:16:48,840 --> 01:16:54,112 IT DID A LANDSCAPE ANALYSIS AND 1965 01:16:54,112 --> 01:16:57,415 QUALITY OF WORK WITH EXPERTS IN 1966 01:16:57,415 --> 01:16:59,817 PAYMENT POLICY TO UNDERSTAND THE 1967 01:16:59,817 --> 01:17:04,255 LANDSCAPE AND PERCEIVED 1968 01:17:04,255 --> 01:17:08,826 OPPORTUNITIES AROUND PAYMENT 1969 01:17:08,826 --> 01:17:15,800 OPTIONS AND HIGH LEVEL OVERVIEW 1970 01:17:15,800 --> 01:17:16,868 TO TEE UP COMING EXPERT 1971 01:17:16,868 --> 01:17:19,904 PRESENTATIONS NICELY. NEXT 1972 01:17:19,904 --> 01:17:28,312 SLI 1973 01:17:28,312 --> 01:17:28,946 SLIDE. 1974 01:17:28,946 --> 01:17:30,581 THIS IS WHERE I'M HEADED NEXT 1975 01:17:30,581 --> 01:17:33,951 AND DISCUSSING PROJECT AND 1976 01:17:33,951 --> 01:17:35,720 JUMPING INTO PRIMER AROUND KEY 1977 01:17:35,720 --> 01:17:38,356 POLICY PAYMENT CONCEPTS WE WORK 1978 01:17:38,356 --> 01:17:40,725 TO CHARACTERIZE IN LANDSCAPE 1979 01:17:40,725 --> 01:17:42,994 ANALYSIS AND GIVING A HIGH-LEVEL 1980 01:17:42,994 --> 01:17:46,597 OVERVIEW OF MOUD POLICY 1981 01:17:46,597 --> 01:17:48,232 LANDSCAPE AS IT CURRENTLY STANDS 1982 01:17:48,232 --> 01:17:49,667 WARNING YOU IT IS NOT 1983 01:17:49,667 --> 01:17:50,768 STRAIGHTFORWARD AND THERE IS A 1984 01:17:50,768 --> 01:17:53,604 LOT OF IT DEPENDS ON A, B, OR C. 1985 01:17:53,604 --> 01:17:57,308 I WILL GIVE YOU PROBABLY MORE OF 1986 01:17:57,308 --> 01:17:59,277 A SNAPSHOT THAN A COMPREHENSIVE 1987 01:17:59,277 --> 01:18:01,979 VIEW AND WILL TEE US UP FOR 1988 01:18:01,979 --> 01:18:03,648 IN-DEPTH LOOKS AT SPECIFIC 1989 01:18:03,648 --> 01:18:07,485 ISSUES IN REMAINING SECTIONS OF 1990 01:18:07,485 --> 01:18:08,519 THIS PANEL. 1991 01:18:08,519 --> 01:18:10,655 I'LL SHARE WHAT EXPERTS VIEWED 1992 01:18:10,655 --> 01:18:12,256 AS KEY OPPORTUNITIES IN PAYMENT 1993 01:18:12,256 --> 01:18:16,461 POLICIES FOR MOUD MEDICATION FOR 1994 01:18:16,461 --> 01:18:17,762 OPIOID USE DISORDER AND 1995 01:18:17,762 --> 01:18:19,130 HIGHLIGHT THAT WORK HAS BEEN 1996 01:18:19,130 --> 01:18:20,898 PUBLISHED IN HEALTH AFFAIRS 1997 01:18:20,898 --> 01:18:22,100 SCHOLAR AND IT WOULDN'T HAVE 1998 01:18:22,100 --> 01:18:23,267 BEEN POSSIBLE WITHOUT MY 1999 01:18:23,267 --> 01:18:27,739 FANTASTIC COLLABORATORS AND 2000 01:18:27,739 --> 01:18:31,576 WHITE MATTISE ENBERG AND 2001 01:18:31,576 --> 01:18:37,849 BRENDAN. NEXT SLIDE, PLEASE. 2002 01:18:37,849 --> 01:18:38,950 MOTIVATION HERE IS UNDERSTANDING 2003 01:18:38,950 --> 01:18:41,352 HOW MOUD SERVICES ARE PAID FOR 2004 01:18:41,352 --> 01:18:43,588 AND HOW WE MIGHT DO A BETTER JOB 2005 01:18:43,588 --> 01:18:47,258 AT DESIGNING PAYMENT POLICY. 2006 01:18:47,258 --> 01:18:49,694 IN PRACTICE, THIS IS MOSTLY 2007 01:18:49,694 --> 01:18:50,828 ABOUT INSURANCE PAYMENT DESIGN. 2008 01:18:50,828 --> 01:18:53,131 THAT IS WHERE WE FOCUSED IN THE 2009 01:18:53,131 --> 01:18:54,432 PROJECT AND WHERE I WILL FOCUS 2010 01:18:54,432 --> 01:18:56,634 IN THE TALK. 2011 01:18:56,634 --> 01:18:58,302 THERE ARE OTHER FUNDING 2012 01:18:58,302 --> 01:19:00,238 MECHANISMS LIKE BLOCK GRANTS 2013 01:19:00,238 --> 01:19:02,340 THAT ARE RELEVANT. IMPORTANT 2014 01:19:02,340 --> 01:19:04,909 CONCEPTS OUTSIDE OF SCOPE FOR 2015 01:19:04,909 --> 01:19:06,010 PURPOSES OF OUR TIME HERE 2016 01:19:06,010 --> 01:19:07,411 TOGETHER THIS MORNING. 2017 01:19:07,411 --> 01:19:09,313 WHY DO WE CARE? 2018 01:19:09,313 --> 01:19:11,115 THIS IS PERHAPS OBVIOUS AND 2019 01:19:11,115 --> 01:19:13,985 THINK IT IS USEFUL TO MOTIVATE A 2020 01:19:13,985 --> 01:19:14,185 BIT. 2021 01:19:14,185 --> 01:19:16,821 FIRST OF ALL, ADEQUATE PAYMENT 2022 01:19:16,821 --> 01:19:18,489 IS A NECESSARY CONDITION OF 2023 01:19:18,489 --> 01:19:20,758 SERVICE DELIVERY AND IF 2024 01:19:20,758 --> 01:19:22,160 PROVIDERS ARE NOT PAID ENOUGH 2025 01:19:22,160 --> 01:19:23,895 TREATMENT IS NOT DELIVERED. 2026 01:19:23,895 --> 01:19:26,063 PAYMENT DESIGN INTRODUCES 2027 01:19:26,063 --> 01:19:27,665 INCENTIVES THAT INFLUENCE VOLUME 2028 01:19:27,665 --> 01:19:30,635 AND QUALITY OF THE SERVICES 2029 01:19:30,635 --> 01:19:32,036 DELIVERED. HOW WE DESIGN 2030 01:19:32,036 --> 01:19:36,073 PAYMENT IS A KEY POLICY WEAVER 2031 01:19:36,073 --> 01:19:37,542 TO SCALE EFFECTIVE TREATMENTS 2032 01:19:37,542 --> 01:19:38,976 LIKE MOUD. 2033 01:19:38,976 --> 01:19:41,979 OF COURSE WE HAVE A MAJOR MOUD 2034 01:19:41,979 --> 01:19:43,848 TREATMENT GAP WHERE WE KNOW IT 2035 01:19:43,848 --> 01:19:45,616 IS A HIGHLY EFFECTIVE TREATMENT 2036 01:19:45,616 --> 01:19:48,119 THAT MANY PEOPLE ARE NOT OFFERED 2037 01:19:48,119 --> 01:19:51,923 OR WHO HAVE DIFFICULTY ACCESSING 2038 01:19:51,923 --> 01:19:54,158 IT EVEN WHEN INTERESTED AND 2039 01:19:54,158 --> 01:19:57,528 PAYMENT POLICY IS, ONE, 2040 01:19:57,528 --> 01:19:58,963 CERTAINLY NOT ONLY LEVER TO HELP 2041 01:19:58,963 --> 01:20:02,366 CLOSE THAT GAP. NEXT SLIDE, 2042 01:20:02,366 --> 01:20:05,837 PLE 2043 01:20:05,837 --> 01:20:06,103 PLEASE. 2044 01:20:06,103 --> 01:20:08,206 BRIEFLY AND IN A NUTSHELL TO 2045 01:20:08,206 --> 01:20:09,473 HELP TEE UP LANDSCAPE I WILL 2046 01:20:09,473 --> 01:20:15,146 SHOW IN A MINUTE WE HAVE THREE 2047 01:20:15,146 --> 01:20:16,247 PREDOMINANT INSURANCE PAYERS IN 2048 01:20:16,247 --> 01:20:19,917 THE US AND THREE GROUPS WE 2049 01:20:19,917 --> 01:20:22,320 FOCUSED ON IN LANDSCAPE ANALYSIS 2050 01:20:22,320 --> 01:20:24,155 AND MEDICARE AND OLDER ADULTS 2051 01:20:24,155 --> 01:20:27,058 AND THOSE YOUNGER EXPERIENCING 2052 01:20:27,058 --> 01:20:29,894 DISABILITY TRADITIONAL MEDICARE 2053 01:20:29,894 --> 01:20:31,996 AND MEDICARE ADVANTAGE AND 2054 01:20:31,996 --> 01:20:34,165 MEDICAID AND PROGRAM FOR LOW 2055 01:20:34,165 --> 01:20:35,666 INCOME AMERICANS AND AGAIN WE 2056 01:20:35,666 --> 01:20:38,002 HAVE TWO FLAVORS FEE-FOR-SERVICE 2057 01:20:38,002 --> 01:20:41,539 AND MEDICAID MANAGED CARE AND 2058 01:20:41,539 --> 01:20:43,107 THAT LANDSCAPE IS COMPLEX WITH 2059 01:20:43,107 --> 01:20:45,943 MANY STATE MEDICAID PROGRAMS 2060 01:20:45,943 --> 01:20:47,645 CONTRACTING WITH MULTIPLE MCOS 2061 01:20:47,645 --> 01:20:49,714 AND MA N AGED CARE ORGANIZATIONS 2062 01:20:49,714 --> 01:20:53,050 THAT THERE ARE OVER 280 MEDICAID 2063 01:20:53,050 --> 01:20:54,352 MANAGED CARE ORGANIZATIONS IN 2064 01:20:54,352 --> 01:20:57,154 THE US AND IS RELEVANT. THEY 2065 01:20:57,154 --> 01:21:00,224 MIGHT EACH HAVE OWN MOUD PAYMENT 2066 01:21:00,224 --> 01:21:01,859 POLICIES AND PRIVATE HEALTH 2067 01:21:01,859 --> 01:21:04,161 PLANS EMPLOYER SPONSORED PLANS 2068 01:21:04,161 --> 01:21:06,430 AND PLANS ON SMALL GROUP AND 2069 01:21:06,430 --> 01:21:08,866 INDIVIDUAL MARKET. 2070 01:21:08,866 --> 01:21:16,240 NEXT SLIDE. CONTINUING WITH OUR 2071 01:21:16,240 --> 01:21:17,808 PRIMER AND HIGH-LEVEL OVERVIEW 2072 01:21:17,808 --> 01:21:21,445 OF PAYMENT MODELS THAT WE USE TO 2073 01:21:21,445 --> 01:21:24,248 CATEGORIZE OUR FINDINGS IN THE 2074 01:21:24,248 --> 01:21:26,217 LANDSCAPE ANALYSIS. 2075 01:21:26,217 --> 01:21:27,485 FEE-FOR-SERVICE IN A NUTSHELL 2076 01:21:27,485 --> 01:21:29,420 FOR EACH BILLABLE SERVICE AND 2077 01:21:29,420 --> 01:21:31,789 CLINICIAN IS PAID A FEE AND 2078 01:21:31,789 --> 01:21:33,457 CAPITIATED PAYMENT IS WHEN WE 2079 01:21:33,457 --> 01:21:35,793 HAVE A LUMP SUM PAYMENT FROM 2080 01:21:35,793 --> 01:21:37,094 INSURER TO PROVIDER OR 2081 01:21:37,094 --> 01:21:39,430 ORGANIZATION AND OWE FRN IN A 2082 01:21:39,430 --> 01:21:41,966 PER MEMBER PER MONTH TYPE OF 2083 01:21:41,966 --> 01:21:44,936 FORMAT AND BUNDLED PAYMENT IS 2084 01:21:44,936 --> 01:21:47,271 WHEN INSURER PAYS PROVIDER A 2085 01:21:47,271 --> 01:21:48,806 WEEKLY OR MONTHLY FEE FOR 2086 01:21:48,806 --> 01:21:52,510 DELIVERING A GROUP OR BUNDLE OF 2087 01:21:52,510 --> 01:21:52,910 SERVICES. 2088 01:21:52,910 --> 01:21:56,247 AND VALU-BASED PAYMENT IS MODEL 2089 01:21:56,247 --> 01:21:58,783 THAT TIES PAYMENT TO PERFORMANCE 2090 01:21:58,783 --> 01:22:01,485 AND PAYMENT DESIGNS ABOVE CAN BE 2091 01:22:01,485 --> 01:22:04,155 TECHNICALLY VALUE-BASED IF TYING 2092 01:22:04,155 --> 01:22:07,124 SOMEHOW THAT PAYMENT DESIGN TO 2093 01:22:07,124 --> 01:22:07,591 PERFORMANCE METRICS. 2094 01:22:07,591 --> 01:22:10,795 EACH OF THE DESIGNS INTRODUCES 2095 01:22:10,795 --> 01:22:11,395 DIFFERENT INCENTIVES AROUND 2096 01:22:11,395 --> 01:22:14,398 VOLUME AND KWALET THAT IS A 2097 01:22:14,398 --> 01:22:17,301 WHOEP SEPARATE TALK AND AT A 2098 01:22:17,301 --> 01:22:19,370 VERY HIGH LEVEL FEE-FOR-SERVICE 2099 01:22:19,370 --> 01:22:22,606 ALONE CAN INCENTIVIZE VOLUME 2100 01:22:22,606 --> 01:22:23,140 OVER QUALITY. 2101 01:22:23,140 --> 01:22:25,710 MORE -- GREATER NUMBER OF 2102 01:22:25,710 --> 01:22:29,747 SERVICES YOU PROVIDE, MORE 2103 01:22:29,747 --> 01:22:32,216 REIMBURSEMENT YOU GET. 2104 01:22:32,216 --> 01:22:34,618 CAPITIATED PAYMENT CAN 2105 01:22:34,618 --> 01:22:35,553 INCENTIVIZE SKIMPING ON CARE. 2106 01:22:35,553 --> 01:22:38,689 YOU ARE GETTING A LUMP SUM 2107 01:22:38,689 --> 01:22:42,693 PAYMENT AND LESS SERVICES THAT 2108 01:22:42,693 --> 01:22:48,199 YOU DELIVER, THE MORE MONEY THE 2109 01:22:48,199 --> 01:22:51,268 INSURER MAKES. 2110 01:22:51,268 --> 01:22:53,871 NEXT SLIDE. 2111 01:22:53,871 --> 01:22:56,841 SO OUR FINAL PRIENLER ELEMENTS 2112 01:22:56,841 --> 01:22:59,176 HERE, PAYMENT POLICY DESIGN 2113 01:22:59,176 --> 01:23:01,379 ELEMENTS THAT WE CHARACTERIZE. 2114 01:23:01,379 --> 01:23:04,582 DEDUCTIBLES AND AMOUNT PAID BY 2115 01:23:04,582 --> 01:23:07,051 PATIENT INSURANCE COVERAGE 2116 01:23:07,051 --> 01:23:09,687 BEFORE IT BEGINS. COPAYMENTS, 2117 01:23:09,687 --> 01:23:11,555 SET AMOUNT PAID OUT OF POCKET 2118 01:23:11,555 --> 01:23:13,758 FOR SERVICE AND COINSURANCE IS 2119 01:23:13,758 --> 01:23:15,393 SIMILAR TO COPAYMENT BUT 2120 01:23:15,393 --> 01:23:17,061 PERCENTAGE OF COSTS OF A SERVICE 2121 01:23:17,061 --> 01:23:20,231 AND WE ALSO HAVE UTILIZATION 2122 01:23:20,231 --> 01:23:21,699 MANAGEMENT STRATEGIES AT PLAY 2123 01:23:21,699 --> 01:23:24,668 THAT ARE STRATEGIES THAT 2124 01:23:24,668 --> 01:23:27,772 ENSURERS USE LIKE PRIOR 2125 01:23:27,772 --> 01:23:28,606 AUTHORIZATION OR STEPPED 2126 01:23:28,606 --> 01:23:30,941 TREATMENT OR VISIT LIMITS TO 2127 01:23:30,941 --> 01:23:33,878 MANAGE CARE AND IN PRACTICE THAT 2128 01:23:33,878 --> 01:23:36,580 MEANS PAYMENT FOR GIVEN SERVICE 2129 01:23:36,580 --> 01:23:37,715 LIKE THIS PRESCRIPTION IS 2130 01:23:37,715 --> 01:23:40,251 PREDICATED ON USE OF ONE OF THE 2131 01:23:40,251 --> 01:23:41,852 STRATEGIES LIKE CLINICIAN MUST 2132 01:23:41,852 --> 01:23:44,255 OBTAIN PRIOR AUTHORIZATION FROM 2133 01:23:44,255 --> 01:23:46,424 THE INSURER BEFORE PRESCRIBING 2134 01:23:46,424 --> 01:23:48,626 AN MOUD. 2135 01:23:48,626 --> 01:23:51,095 WE HAVE ALSO GOOD EVIDENCE FROM 2136 01:23:51,095 --> 01:23:54,265 THE PRIOR LITERATURE THAT 2137 01:23:54,265 --> 01:23:55,866 GENERALLY SPEAKING GREATER COST 2138 01:23:55,866 --> 01:23:58,302 SHARING AND UTILIZATION 2139 01:23:58,302 --> 01:24:00,237 MANAGEMENT INCREASE -- EXCUSE 2140 01:24:00,237 --> 01:24:02,139 ME. DECREASES USE OF THAT KIND 2141 01:24:02,139 --> 01:24:05,076 OF TREATMENT. 2142 01:24:05,076 --> 01:24:06,444 NEXT SLIDE. 2143 01:24:06,444 --> 01:24:09,780 ALL RIGHT. NOW, JUMPING INTO 2144 01:24:09,780 --> 01:24:11,882 THE LANDSCAPE AND I TRIED TO 2145 01:24:11,882 --> 01:24:14,118 SIMPLIFY WHAT ARE GIANT TABLES 2146 01:24:14,118 --> 01:24:16,187 PRODUCED IN LANDSCAPE ANALYSIS 2147 01:24:16,187 --> 01:24:18,189 AND SOMETHING DIGESTIBLE IN A 2148 01:24:18,189 --> 01:24:19,924 SLIDE FORMAT AND DO JOB TO 2149 01:24:19,924 --> 01:24:23,794 WHETHER WE SUCCEEDED AND FIRST 2150 01:24:23,794 --> 01:24:27,765 THING WE LOOKED AT IS MOUD 2151 01:24:27,765 --> 01:24:29,467 COVERAGE ACROSS DIFFERENT 2152 01:24:29,467 --> 01:24:32,670 INSURANCE TYPES THAT WE 2153 01:24:32,670 --> 01:24:32,937 EXAMINED. 2154 01:24:32,937 --> 01:24:34,605 AND THE HIGH-LEVEL QUESTION WAS 2155 01:24:34,605 --> 01:24:37,575 DO EACH OF THE INSURANCE 2156 01:24:37,575 --> 01:24:38,776 CATEGORIES COVER AT LEAST ONE 2157 01:24:38,776 --> 01:24:42,546 FORMULATION OF ALL OF THE FDA 2158 01:24:42,546 --> 01:24:45,316 APPROVED MEDICATIONS FOR OPIOID 2159 01:24:45,316 --> 01:24:47,218 USE DISORDER. THE ANSWER IS 2160 01:24:47,218 --> 01:24:48,219 YES. 2161 01:24:48,219 --> 01:24:50,221 FOR TRADITIONAL MEDICARE AND 2162 01:24:50,221 --> 01:24:52,189 MEDICARE ADVANTAGE AND IT IS YES 2163 01:24:52,189 --> 01:24:54,158 FOR MEDICAID AND QUALIFICATION 2164 01:24:54,158 --> 01:24:57,995 THAT THE FEDERAL LAW AND SUPPORT 2165 01:24:57,995 --> 01:25:01,799 ACT THAT REQUIRED STATES TO 2166 01:25:01,799 --> 01:25:03,868 OFFER AND COVER AT LEAST ONE 2167 01:25:03,868 --> 01:25:05,302 FORMULAITION THAT PROVISION 2168 01:25:05,302 --> 01:25:09,206 EXPIRED IN SEPTEMBER OF 2025 AND 2169 01:25:09,206 --> 01:25:12,276 PRIVATE INSURANCE VARIES BY PLAN 2170 01:25:12,276 --> 01:25:14,078 AND METHO DON'T IN PARTICULAR IS 2171 01:25:14,078 --> 01:25:17,848 LEAST LIKELY TO BE COVERED. 2172 01:25:17,848 --> 01:25:21,018 NEXT SLIDE. 2173 01:25:21,018 --> 01:25:26,957 SO HERE, WE LOOKED AT 2174 01:25:26,957 --> 01:25:28,225 REIMBURSEMENT MODEL AND PRIOR 2175 01:25:28,225 --> 01:25:29,260 AUTHORIZATION REQUIREMENTS AND 2176 01:25:29,260 --> 01:25:31,495 LOOKED AT THINGS I INTRODUCED IN 2177 01:25:31,495 --> 01:25:35,466 THE PRIMER AND I'M SHOWING 2178 01:25:35,466 --> 01:25:36,934 REIMBURSEMENT MODEL AND PRIOR 2179 01:25:36,934 --> 01:25:38,502 REQUIREMENTS ACROSS VARYING 2180 01:25:38,502 --> 01:25:42,606 INSURANCE GROUPS THAT IS FOR 2181 01:25:42,606 --> 01:25:43,574 OFFICE-BASED MEDICATION FOR 2182 01:25:43,574 --> 01:25:46,343 OPIOID USE DISORDER NOT OPIOID 2183 01:25:46,343 --> 01:25:48,078 TREATMENT PROGRAM BASED AS 2184 01:25:48,078 --> 01:25:49,480 DIFFERENCES IN PAYMENT POLICY IN 2185 01:25:49,480 --> 01:25:50,781 THE TWO SETTINGS. 2186 01:25:50,781 --> 01:25:52,616 I WON'T TALK YOU THROUGH EVERY 2187 01:25:52,616 --> 01:25:54,552 SINGLE BOX ON THE SLIDE HERE. 2188 01:25:54,552 --> 01:25:56,820 I WILL HIGHLIGHT A COUPLE OF 2189 01:25:56,820 --> 01:25:58,355 RELEVANT THINGS AND AGAIN MAKE 2190 01:25:58,355 --> 01:26:02,226 THE POINT IF THERE IS A LOT OF 2191 01:26:02,226 --> 01:26:04,228 VARIATION ACROSS PAYERS AND 2192 01:26:04,228 --> 01:26:06,497 DEPENDING ON THINGS LIKE THE 2193 01:26:06,497 --> 01:26:08,699 FORMULATION OF THE MEDICATION 2194 01:26:08,699 --> 01:26:12,069 FOR OPIOID USE DISORDER. RIGHT? 2195 01:26:12,069 --> 01:26:16,240 FOR EXAMPLE, I WILL WALK THROUGH 2196 01:26:16,240 --> 01:26:18,542 MEDICAID. MEDICAID USES MOST 2197 01:26:18,542 --> 01:26:21,545 WILL I UNBUNDLED FEE-FOR-SERVICE 2198 01:26:21,545 --> 01:26:24,081 MODEL TO REIMBURSE PROVIDERS FOR 2199 01:26:24,081 --> 01:26:27,685 DELIVERING MOUD AND OFFICE-BASED 2200 01:26:27,685 --> 01:26:29,954 SCIENCE AND PRESCRIBING 2201 01:26:29,954 --> 01:26:31,889 NOREPINEPHRINE FOR EXAMPLE THAT 2202 01:26:31,889 --> 01:26:34,892 DIFFERS FOR FEDERALLY QUALIFIED 2203 01:26:34,892 --> 01:26:37,795 CENTERS AND RURAL HEALTH CENTERS 2204 01:26:37,795 --> 01:26:40,064 USING PROSPECTIVE PAYMENT AND 2205 01:26:40,064 --> 01:26:42,533 MEDICAID FEE-FOR-SERVICE AND 2206 01:26:42,533 --> 01:26:44,134 MANAGED CARE, THERE ARE SOME 2207 01:26:44,134 --> 01:26:45,402 EXCEPTIONS WHERE SOME STATES 2208 01:26:45,402 --> 01:26:48,239 MIGHT BE USING WAIVERS TO USE 2209 01:26:48,239 --> 01:26:51,475 DIFFERENT VALUE-BASED PAYMENT 2210 01:26:51,475 --> 01:26:54,178 MODELS OR CAPITIATED PAYMENT 2211 01:26:54,178 --> 01:26:57,915 MODELS AND SOME MEDICAID MANAGED 2212 01:26:57,915 --> 01:27:00,451 CARE ORGANIZATIONS MIGHT BE ALSO 2213 01:27:00,451 --> 01:27:01,518 USING ALTERNATIVE PAYMENT MODELS 2214 01:27:01,518 --> 01:27:05,356 AND MCO SIDE THAT IS NOT TOTALLY 2215 01:27:05,356 --> 01:27:07,558 TRANSPARENT AND WHAT OTHERS 2216 01:27:07,558 --> 01:27:10,294 PRIOR AUTHORIZATION FOR 2217 01:27:10,294 --> 01:27:12,263 NOREPINEPHRINE AND NAL TRECHLONE 2218 01:27:12,263 --> 01:27:15,132 AND MEDICAID PROGRAM DESIGN AND 2219 01:27:15,132 --> 01:27:18,235 FAE FOR SERVICE NCO AND 2220 01:27:18,235 --> 01:27:18,769 FORMULAITION AND EXAMPLE 2221 01:27:18,769 --> 01:27:21,038 IMMEDIATE RELEASE NOREPINEPHRINE 2222 01:27:21,038 --> 01:27:24,241 AND PRIOR OFFICE REQUIRED BY 37% 2223 01:27:24,241 --> 01:27:27,378 FEE-FOR-SERVICE PROGRAMS AND 37% 2224 01:27:27,378 --> 01:27:29,847 IN MOST OF RECENT DATA AVAILABLE 2225 01:27:29,847 --> 01:27:31,548 WE FOUND IN LANDSCAPE ANALYSIS 2226 01:27:31,548 --> 01:27:34,485 THAT I BELIEVE IS FROM 2021 AND 2227 01:27:34,485 --> 01:27:38,455 SIMILAR VARIATION FOR NAL 2228 01:27:38,455 --> 01:27:38,756 TRECHLONE. 2229 01:27:38,756 --> 01:27:41,592 NEXT SLIDE. 2230 01:27:41,592 --> 01:27:43,794 FOR OPIOID TREATMENT PROGRAMS, 2231 01:27:43,794 --> 01:27:45,629 PAYMENT POLICY FOR MOUD DIFFERS 2232 01:27:45,629 --> 01:27:48,232 AND MODELS ARE DIFFERENT AND 2233 01:27:48,232 --> 01:27:51,535 RELATIVE TO OFFICE-BASED MOUD. 2234 01:27:51,535 --> 01:27:56,073 FOR EXAMPLE, AGAIN, IN MEDICAID 2235 01:27:56,073 --> 01:27:58,375 CONTEXT, IT IS POSTALLY 2236 01:27:58,375 --> 01:28:00,110 UNBUNDLED FEE-FOR-SERVICE 2237 01:28:00,110 --> 01:28:02,780 PAYMENTS AND AGAIN WITH BUNDLED 2238 01:28:02,780 --> 01:28:04,648 CAPTATED AND VALUE-BASED 2239 01:28:04,648 --> 01:28:07,751 PAYMENTS BEING USED ACROSS 2240 01:28:07,751 --> 01:28:09,620 PROGRAMS THROUGH LEVERS AND 2241 01:28:09,620 --> 01:28:11,221 MANAGED CARE ORGANIZATION 2242 01:28:11,221 --> 01:28:15,159 POLICIES AND MEDICARE ON OTHER 2243 01:28:15,159 --> 01:28:16,193 HAND USES A BUNDLED PAYMENT 2244 01:28:16,193 --> 01:28:18,729 USING VALUE-BASED PAYMENT AND IS 2245 01:28:18,729 --> 01:28:20,764 ENDED WAS USING VALUE-BASED 2246 01:28:20,764 --> 01:28:23,734 PAYMENT IN VALUE AND OPIOID USE 2247 01:28:23,734 --> 01:28:25,235 DISORDER TREATMENT AND PRIOR 2248 01:28:25,235 --> 01:28:26,704 AUTHORIZATION AGAIN IS 2249 01:28:26,704 --> 01:28:29,239 FEE-FOR-SERVICE AND MCO AND 2250 01:28:29,239 --> 01:28:32,576 FORMULAITION AND BY SPECIFIC 2251 01:28:32,576 --> 01:28:33,110 PLAN. 2252 01:28:33,110 --> 01:28:34,778 NEXT SLIDE. 2253 01:28:34,778 --> 01:28:37,147 ALL RIGHT. TO CONCLUDE HERE, WE 2254 01:28:37,147 --> 01:28:40,117 DID INTERVIEWS WITH 21 EXPERTS 2255 01:28:40,117 --> 01:28:44,221 IN PAYMENT POLICIES FOR MOUD. 2256 01:28:44,221 --> 01:28:46,223 ALSO, FOLLOW UP SURVEYS THAT 2257 01:28:46,223 --> 01:28:48,859 BUILT ON INTERVIEWS AND GOAL WAS 2258 01:28:48,859 --> 01:28:49,626 TO UNDERSTAND AFTER THE 2259 01:28:49,626 --> 01:28:52,229 LAPPEDSCAPE ANALYSIS THAT HAS 2260 01:28:52,229 --> 01:28:55,632 ALL OF THE VARIATION THAT WHAT 2261 01:28:55,632 --> 01:28:57,401 THEIR PERSPECTIVE WAS ON THE 2262 01:28:57,401 --> 01:28:59,570 BEST MOUD PAYMENT POLICY AND 2263 01:28:59,570 --> 01:29:01,338 WHERE WE SHOULD HEAD IN THE 2264 01:29:01,338 --> 01:29:03,440 FUTURE AND WHAT ARE THE 2265 01:29:03,440 --> 01:29:04,775 OPPORTUNITIES AND WHAT I HEARD 2266 01:29:04,775 --> 01:29:09,580 IS LACK OF CONSENSUS ON A BEST 2267 01:29:09,580 --> 01:29:12,116 MODEL AND A CAUTION AGAINST 2268 01:29:12,116 --> 01:29:14,518 RIGID ONE-SIZE FITS ALL 2269 01:29:14,518 --> 01:29:15,786 APPROACHES THAT I THINK PERHAPS 2270 01:29:15,786 --> 01:29:17,588 HELPS TO EXPLAIN AT LEAST IN 2271 01:29:17,588 --> 01:29:18,922 PART A BUNCH OF THE VARIATION 2272 01:29:18,922 --> 01:29:22,326 THAT I SHOWED IN THE LANDSCAPE 2273 01:29:22,326 --> 01:29:22,960 ANALYSIS. 2274 01:29:22,960 --> 01:29:24,928 ONE EXAMPLE OF CAUTION AGAINST 2275 01:29:24,928 --> 01:29:27,431 THE ONE-SIZE FITS ALL 2276 01:29:27,431 --> 01:29:29,133 APPROACHES, FOR EXAMPLE, WAS 2277 01:29:29,133 --> 01:29:31,068 THAT DIFFERENT PAYMENT MODELS 2278 01:29:31,068 --> 01:29:32,936 MIGHT BE BETTER FOR LARGE 2279 01:29:32,936 --> 01:29:36,240 PRACTICES WITH HIGH VOLUMES OF 2280 01:29:36,240 --> 01:29:37,408 PATIENTS WITH OPIOID USE 2281 01:29:37,408 --> 01:29:38,942 DISORDER VERSUS SMALL PRACTICES 2282 01:29:38,942 --> 01:29:41,311 WITH LOW FOLLOW UP AND VALUE 2283 01:29:41,311 --> 01:29:43,180 BASED PAYMENT WAS CONSISTENTLY 2284 01:29:43,180 --> 01:29:46,884 RECOGNIZED AS A PRIORITY AND NOT 2285 01:29:46,884 --> 01:29:49,052 WIDELY USED AND CONSENSUS AMONG 2286 01:29:49,052 --> 01:29:51,088 EXPERTS IS IT WASN'T READY FOR 2287 01:29:51,088 --> 01:29:53,056 PRIME TIME FOR TWO MAIN REASONS 2288 01:29:53,056 --> 01:29:56,593 TO IMPROVE CAPACITY AND TRACK 2289 01:29:56,593 --> 01:29:59,329 AND REPORT DATA AND NEED FOR 2290 01:29:59,329 --> 01:30:05,169 VALIDATED PERFORMANCE METRIC. 2291 01:30:05,169 --> 01:30:06,937 NEXT SLIDE. SUMMING UP WHAT I 2292 01:30:06,937 --> 01:30:09,373 SAID AND I WILL STOP HERE IN 2293 01:30:09,373 --> 01:30:10,874 INTEREST OF TIME. THANKS. 2294 01:30:10,874 --> 01:30:15,145 >> THANKS, BETH. NEXT SPEAKER 2295 01:30:15,145 --> 01:30:19,416 IS DR. MARCELA HORVITZ-LENNON 2296 01:30:19,416 --> 01:30:23,353 FROM HEALTH EVALUATION RESEARCH 2297 01:30:23,353 --> 01:30:26,323 LAB AND HEALTH ALLIANCE AND 2298 01:30:26,323 --> 01:30:27,124 RAND. 2299 01:30:27,124 --> 01:30:30,761 >> HELLO, EVERYONE. CAN 2300 01:30:30,761 --> 01:30:33,964 EVERYONE HEAR ME WELL? 2301 01:30:33,964 --> 01:30:34,932 >> YES. 2302 01:30:34,932 --> 01:30:37,334 >> GREAT. 2303 01:30:37,334 --> 01:30:40,704 GOOD MORNING AND DELIGHTED TO BE 2304 01:30:40,704 --> 01:30:43,974 HERE TO PRESENT NEW IMPACTS ON 2305 01:30:43,974 --> 01:30:45,976 MEDICAID VALUE BASED PAYMENT AND 2306 01:30:45,976 --> 01:30:47,644 POLICIES YOU HEARD ABOUT AMONG 2307 01:30:47,644 --> 01:30:49,480 ADULTS WITH SERIOUS MENTAL 2308 01:30:49,480 --> 01:30:52,382 ILLNESS AND ACKNOWLEDGING 2309 01:30:52,382 --> 01:30:55,853 SUPPORT FROM RESEARCH FROM NIMH. 2310 01:30:55,853 --> 01:30:58,388 AND MULTIPLE COLLABORATORS AND 2311 01:30:58,388 --> 01:30:59,022 VARIOUS INSTITUTIONS LISTED 2312 01:30:59,022 --> 01:31:01,191 THERE OF WHICH I WILL HIGHLIGHT 2313 01:31:01,191 --> 01:31:02,926 NEW YORK STATE DEPARTMENT OF 2314 01:31:02,926 --> 01:31:05,496 HEALTH WHO PROVIDED INVALUABLE 2315 01:31:05,496 --> 01:31:08,232 INSIGHT AND CREDIBLE DATA FOR 2316 01:31:08,232 --> 01:31:09,933 RESEARCH. 2317 01:31:09,933 --> 01:31:12,269 NEXT SLIDE, PLEASE. 2318 01:31:12,269 --> 01:31:13,770 BEFORE PRESENTING OUR RESEARCH 2319 01:31:13,770 --> 01:31:17,007 AND FINDINGS, I WILL BRIEFLY 2320 01:31:17,007 --> 01:31:21,979 REVIEW WHAT MOTIVATED OUR 2321 01:31:21,979 --> 01:31:23,914 RESEARCH DESCRIBED BRIEFLY WITH 2322 01:31:23,914 --> 01:31:25,516 POLICIES IN MEDICAID AND SPEND A 2323 01:31:25,516 --> 01:31:29,720 BIT MORE TIME ON THE NEW YORK 2324 01:31:29,720 --> 01:31:32,222 STAGE, MEDICAID VALUE-BASED 2325 01:31:32,222 --> 01:31:35,692 POLICY. NEXT SLIDE, PLEASE. 2326 01:31:35,692 --> 01:31:39,530 SO MEDICAID IS VERY, VERY 2327 01:31:39,530 --> 01:31:41,532 IMPORTANT PAYER FOR PEOPLE WITH 2328 01:31:41,532 --> 01:31:45,068 VERY SERIOUS MENTAL ILLNESS AND 2329 01:31:45,068 --> 01:31:48,238 WE NEED INDIVIDUALS 2330 01:31:48,238 --> 01:31:49,006 SCHIZOPHRENIA BIPOLAR DISORDER 2331 01:31:49,006 --> 01:31:52,776 AND SERIOUS MAJOR DEPRESSIVE 2332 01:31:52,776 --> 01:31:54,344 DISORDER. DESPITE AVAILABILITY 2333 01:31:54,344 --> 01:31:56,246 OF EFFECTIVE TREATMENTS AND 2334 01:31:56,246 --> 01:31:57,915 EVIDENCE-BASED PRACTICES AND 2335 01:31:57,915 --> 01:32:01,952 HIGH COSTS TO MEDICAID PROGRAMS 2336 01:32:01,952 --> 01:32:03,887 AROUND THE COUNTRY OUTCOMES FOR 2337 01:32:03,887 --> 01:32:09,826 POPULATIONS ARE GENERALLY PRETTY 2338 01:32:09,826 --> 01:32:11,728 [INDISCERNIBLE]. AMONG DRIVERS, 2339 01:32:11,728 --> 01:32:14,031 KEY ACTIONABLE DRIVERS ARE IN 2340 01:32:14,031 --> 01:32:16,466 ADEQUATE ACCESS AND QUALITY OF 2341 01:32:16,466 --> 01:32:18,969 MEDICAID FINANCED SERIOUS MENTAL 2342 01:32:18,969 --> 01:32:21,638 ILLNESS CARE. 2343 01:32:21,638 --> 01:32:23,473 NEXT SLIDE, PLEASE. 2344 01:32:23,473 --> 01:32:26,843 VARIETY OF STRATEGIES THAT CAN 2345 01:32:26,843 --> 01:32:29,913 BE BROUGHT TO BEAR TO ADDRESS 2346 01:32:29,913 --> 01:32:31,315 FOUR OUTCOMES INCLUDE FINANCING 2347 01:32:31,315 --> 01:32:34,184 POLICY THAT WE ARE HERE TO TALK 2348 01:32:34,184 --> 01:32:34,551 ABOUT. 2349 01:32:34,551 --> 01:32:36,954 AND OUR FOCUS FOR THIS RESEARCH 2350 01:32:36,954 --> 01:32:45,362 WAS VALUE-BASED PAYMENT, BPP FOR 2351 01:32:45,362 --> 01:32:46,863 SHORT AND CORNERSTONE AND 2352 01:32:46,863 --> 01:32:50,167 LINKING OF QUALITY AND SPENDING 2353 01:32:50,167 --> 01:32:53,337 GOALS AND POLICIES TEND TO 2354 01:32:53,337 --> 01:32:54,605 INCLUDE EXPECTATIONS AND 2355 01:32:54,605 --> 01:32:57,307 PERFORMANCE STANDARDS INTO 2356 01:32:57,307 --> 01:33:01,278 CONTRACTS THAT BUILD THOSE 2357 01:33:01,278 --> 01:33:03,080 INTERCONTRACTS AND SHOULD 2358 01:33:03,080 --> 01:33:04,715 REQUIRE THAT THE STATE HAS 2359 01:33:04,715 --> 01:33:07,017 CAPACITY TO MEASURE AND MONITOR 2360 01:33:07,017 --> 01:33:11,455 PERFORMANCE AND IN WILLINGNESS 2361 01:33:11,455 --> 01:33:12,255 TO ENFORCE PENALTIES AND 2362 01:33:12,255 --> 01:33:14,057 MEDICAID PROGRAMS VARIOUS MODELS 2363 01:33:14,057 --> 01:33:16,226 MIGHT BE IDENTIFIED AND ONE OF 2364 01:33:16,226 --> 01:33:18,228 WHICH FOCUSES ON HEALTH PLAN 2365 01:33:18,228 --> 01:33:20,230 PAYMENTS TO PROVIDERS. 2366 01:33:20,230 --> 01:33:24,034 ONE OF THE MODELS IS THAT. 2367 01:33:24,034 --> 01:33:28,238 THOSE TEND TO BE GUIDED USING AS 2368 01:33:28,238 --> 01:33:31,408 A ROADMAP A FRAMEWORK PUT FORTH 2369 01:33:31,408 --> 01:33:35,078 BY THE HEALTH CARE PAYMENT 2370 01:33:35,078 --> 01:33:38,515 LEARNING AND ACTION NETWORK. 2371 01:33:38,515 --> 01:33:42,285 AN ORGANIZATION THAT HAS CMS 2372 01:33:42,285 --> 01:33:42,619 SPONSORSHOP. 2373 01:33:42,619 --> 01:33:44,554 DESPITE THE FACT THAT SEVERAL 2374 01:33:44,554 --> 01:33:47,724 MEDICAID PROGRAMS HAVE 2375 01:33:47,724 --> 01:33:50,394 IMPLEMENTED POLICIES INCLUDING 2376 01:33:50,394 --> 01:33:52,896 FOR PEOPLE WITH SERIOUS MENTAL 2377 01:33:52,896 --> 01:33:56,199 ILLNESS, LITTLE WAS KNOWN BY THE 2378 01:33:56,199 --> 01:33:59,703 TIME THAT WE SUBMITTED OUR GRANT 2379 01:33:59,703 --> 01:34:01,038 APPLICATION TO NIMH. 2380 01:34:01,038 --> 01:34:05,142 ON IMPACTS AMONG ENROLLEES WITH 2381 01:34:05,142 --> 01:34:08,245 SERIOUS MENTAL ILLNESS AND KEY 2382 01:34:08,245 --> 01:34:13,150 GAPS INCLUDE NO EVIDENCE ON 2383 01:34:13,150 --> 01:34:15,285 ACCESS AND NO EVIDENCE ON 2384 01:34:15,285 --> 01:34:16,053 HEALTHCARE QUALITY. 2385 01:34:16,053 --> 01:34:18,488 NEXT SLIDE, PLEASE. 2386 01:34:18,488 --> 01:34:21,658 SO THE NEW YORK STATE MEDICAID 2387 01:34:21,658 --> 01:34:23,260 VALUE-BASED POLICY WAS 2388 01:34:23,260 --> 01:34:28,231 IMPLEMENTED IN 2017 AS PART OF A 2389 01:34:28,231 --> 01:34:32,536 LARGER WAIVER, SECTIONS 11-15 2390 01:34:32,536 --> 01:34:38,075 DEMONSTRATION AND BPP POLICY WAS 2391 01:34:38,075 --> 01:34:39,443 FOCUSED ON HEALTH PLAN PAYMENTS 2392 01:34:39,443 --> 01:34:46,316 TO PROVIDERS MODELED ON HCP LAND 2393 01:34:46,316 --> 01:34:47,417 FRAMEWORK AND POLICY INCLUDED 2394 01:34:47,417 --> 01:34:50,654 SEVERAL TYPES WITH OWN 2395 01:34:50,654 --> 01:34:51,188 PERFORMANCE MEASURES. 2396 01:34:51,188 --> 01:34:54,124 HOWEVER, MOST PLANS ADOPTED 2397 01:34:54,124 --> 01:34:56,660 GENERAL POPULATION CONTRACTS FOR 2398 01:34:56,660 --> 01:35:00,230 INDIVIDUALS WITH AVERAGE NEEDS. 2399 01:35:00,230 --> 01:35:03,800 THE MEASURES INCLUDED INDICATORS 2400 01:35:03,800 --> 01:35:06,336 THAT WERE ARC PREVENTION QUALITY 2401 01:35:06,336 --> 01:35:08,238 INDICATORS AND CMS AND OTHERS 2402 01:35:08,238 --> 01:35:10,974 WITH HIGHER QUALITY MEASURES 2403 01:35:10,974 --> 01:35:13,477 DESIGNATED AS PAY FOR 2404 01:35:13,477 --> 01:35:15,812 PERFORMANCE MEASURES AND 2405 01:35:15,812 --> 01:35:18,081 PROVIDERS SHARED SAVINGS AND 2406 01:35:18,081 --> 01:35:20,917 LOSSES BASED ON PERFORMANCE ON 2407 01:35:20,917 --> 01:35:24,321 THOSE P FOR P MEASURES INCLUDED 2408 01:35:24,321 --> 01:35:26,590 IN CONTRACTS AND REFERRED TO 2409 01:35:26,590 --> 01:35:30,127 ALSO AS INCENTIVE METRICS AND 2410 01:35:30,127 --> 01:35:31,828 RELATIONSHIP BETWEEN ACTUAL AND 2411 01:35:31,828 --> 01:35:35,565 BUDGETED AGGREGATE COSTS. 2412 01:35:35,565 --> 01:35:40,137 NEXT SLIDE, PLEASE. 2413 01:35:40,137 --> 01:35:44,241 OUR RESEARCH, AS I SAID, FOCUSED 2414 01:35:44,241 --> 01:35:47,677 ON THOSE IMPACTS OF POLICIES AND 2415 01:35:47,677 --> 01:35:50,213 BPP POLICIES IN THIS POPULATION 2416 01:35:50,213 --> 01:35:55,786 AND HERE WE ARE REPRESENTING OUR 2417 01:35:55,786 --> 01:35:59,856 RESEARCH FOCUSED ON THE NEW YORK 2418 01:35:59,856 --> 01:36:01,825 STAGE POLICY. 2419 01:36:01,825 --> 01:36:04,161 OUR STUDY PERIOD COVERED 2420 01:36:04,161 --> 01:36:07,798 PROCEEDING AND FOLLOWING 2421 01:36:07,798 --> 01:36:13,804 IMPLEMENTATION OF POLICY WITH 2422 01:36:13,804 --> 01:36:14,671 POST IMPLEMENTATION PERIOD AND 2423 01:36:14,671 --> 01:36:18,341 POST BPP PERIOD AND DATA SOURCE 2424 01:36:18,341 --> 01:36:20,644 INCLUDED A DATA SOURCE ASSEMBLED 2425 01:36:20,644 --> 01:36:23,146 BY THE STATE THAT PERMITTED 2426 01:36:23,146 --> 01:36:25,015 IDENTIFYING INDIVIDUALS COVERED 2427 01:36:25,015 --> 01:36:30,954 BY BPP CONTRACTS AND OUR STUDY 2428 01:36:30,954 --> 01:36:34,291 POPULATION WAS ADULTS MEDICAID 2429 01:36:34,291 --> 01:36:35,592 ADULT ENROLLEES AND VARIOUS 2430 01:36:35,592 --> 01:36:39,830 OUTCOMES INCLUDED ACCESS AND 2431 01:36:39,830 --> 01:36:41,765 QUALITY AND EXPOSURE WAS DEFINED 2432 01:36:41,765 --> 01:36:44,801 AS COVERAGE UNDER BPP CONTRACT 2433 01:36:44,801 --> 01:36:48,238 EVERY YEAR OF POST BPP PERIOD. 2434 01:36:48,238 --> 01:36:52,242 OUR APPROACH WAS A DIFFERENCE IN 2435 01:36:52,242 --> 01:36:55,312 DIFFERENCE ANALYSIS THAT USED 2436 01:36:55,312 --> 01:36:57,814 INTERACTION TERM BETWEEN BPP 2437 01:36:57,814 --> 01:36:59,349 EXPOSURE AND POST PERIOD 2438 01:36:59,349 --> 01:37:02,118 INDICATORS AS KEY INDEPENDENT 2439 01:37:02,118 --> 01:37:04,087 VARIABLE. 2440 01:37:04,087 --> 01:37:08,024 NEXT SLIDE, PLEASE. 2441 01:37:08,024 --> 01:37:12,262 SO WE -- AS I SAID, WE HAD 2442 01:37:12,262 --> 01:37:16,233 VARIOUS OUTCOMES AND HEALTH 2443 01:37:16,233 --> 01:37:18,535 ACCESS ANALYSIS FOCUSED ON 2444 01:37:18,535 --> 01:37:21,037 AMCRESS TO MENTAL HEALTH CARE 2445 01:37:21,037 --> 01:37:23,106 FOR SERIOUS MENTAL ILLNESS. 2446 01:37:23,106 --> 01:37:27,177 WE IDENTIFIED INITIATION OF CARE 2447 01:37:27,177 --> 01:37:30,547 AS HAVING PARTICULAR POLICY AND 2448 01:37:30,547 --> 01:37:32,616 CLINICAL RELEVANCE AND OUR STUDY 2449 01:37:32,616 --> 01:37:35,585 COHORT WAS VERY LARGE THAT YOU 2450 01:37:35,585 --> 01:37:37,587 CAN SEE THERE OVER 5 MILLION 2451 01:37:37,587 --> 01:37:42,259 YEARS WITH 18% BPP EXPOSED. 2452 01:37:42,259 --> 01:37:44,861 NEXT SLIDE, MREZ. 2453 01:37:44,861 --> 01:37:47,564 MAIN FINDING FROM THIS ANALYSIS 2454 01:37:47,564 --> 01:37:51,167 WAS BPP EXPOSURE WAS ASSOCIATED 2455 01:37:51,167 --> 01:37:53,036 WITH HALF PERCENTAGE INCREASE IN 2456 01:37:53,036 --> 01:37:55,305 ACCESS RELATIVE TO NO EXPOSURE 2457 01:37:55,305 --> 01:38:00,243 OVER A BASE RATE OF 22.5%. 2458 01:38:00,243 --> 01:38:04,047 THAT WAS A SIGNIFICANT FINDING. 2459 01:38:04,047 --> 01:38:07,817 NEXT SLIDE. 2460 01:38:07,817 --> 01:38:14,057 IN TERMS OF QUALITY ANALYSIS OUR 2461 01:38:14,057 --> 01:38:15,692 OUTCOME WAS QUALITY OF HEALTH 2462 01:38:15,692 --> 01:38:18,628 CARE RECEIVED BY ENROLLEES WITH 2463 01:38:18,628 --> 01:38:20,463 SERIOUS MENTAL ILLNESS 2464 01:38:20,463 --> 01:38:21,865 PRESCRIBING QUALITY WITH 18 2465 01:38:21,865 --> 01:38:25,936 MEASURES AND ADULTS WITH SERIOUS 2466 01:38:25,936 --> 01:38:27,570 MENTAL ILLNESS AND BOTH 2467 01:38:27,570 --> 01:38:29,205 PREVENTION QUALITY INDICATORS 2468 01:38:29,205 --> 01:38:31,641 DESCRIBING MENTAL, PHYSICAL, AND 2469 01:38:31,641 --> 01:38:33,310 OVERALL HEALTH CARE QUALITY. 2470 01:38:33,310 --> 01:38:38,114 OUR STUDY COHORT WAS ALSO VERY 2471 01:38:38,114 --> 01:38:39,582 LARGE GIVEN THAT THESE WOULD 2472 01:38:39,582 --> 01:38:42,485 ONLY INCLUDE INDIVIDUALS WITH 2473 01:38:42,485 --> 01:38:45,889 SERIOUS MENTAL ILLNESS AND 19% 2474 01:38:45,889 --> 01:38:49,125 OF WHOM WERE EXPOSE TODAY BPP. 2475 01:38:49,125 --> 01:38:50,327 NEXT SLIDE, PLEASE. 2476 01:38:50,327 --> 01:38:52,028 MAIN FINDING WAS THAT EXPOSURE 2477 01:38:52,028 --> 01:38:58,835 TO BPP WAS ASSOCIATED TO REDUCED 2478 01:38:58,835 --> 01:39:01,137 OR UNCHANGED QUALITY VERSUS NO 2479 01:39:01,137 --> 01:39:02,505 EXPOSURE AND IMPORTANTLY A THIRD 2480 01:39:02,505 --> 01:39:06,476 OF MEASURES 6 OUT OF 18 SHOWED 2481 01:39:06,476 --> 01:39:09,980 LOWER PERFORMANCE UNDER BPP AND 2482 01:39:09,980 --> 01:39:12,148 INCLUDED PAY FOR PERFORMANCE 2483 01:39:12,148 --> 01:39:14,551 METRICS USED AS INCENTIVE 2484 01:39:14,551 --> 01:39:16,219 METRICS YOU CAN SEE THERE AND 2485 01:39:16,219 --> 01:39:17,520 LARGEST REDUCTIONS WERE OBSERVED 2486 01:39:17,520 --> 01:39:20,090 FOR MENTAL HEALTH AND PHYSICAL 2487 01:39:20,090 --> 01:39:23,793 HEALTH AND OVERALL HEALTH 2488 01:39:23,793 --> 01:39:26,029 QUALITY METRICS. NEXT SLIDE, 2489 01:39:26,029 --> 01:39:26,663 PLEASE. 2490 01:39:26,663 --> 01:39:28,231 IN SUMMARY FINDINGS FROM OUR 2491 01:39:28,231 --> 01:39:32,235 FIRST -- FROM THE FIRST YEAR, 2492 01:39:32,235 --> 01:39:35,872 TWO YEARS OF POST IMPLEMENTATION 2493 01:39:35,872 --> 01:39:38,008 SUCH AS POSITIVE IMPACTS ON 2494 01:39:38,008 --> 01:39:39,976 ACCESS AND NEGATIVE OR NO 2495 01:39:39,976 --> 01:39:42,846 IMPACTS ON QUALITY IS DIFFICULT 2496 01:39:42,846 --> 01:39:46,549 FOR US TO DETERMINE WHAT MAY BE 2497 01:39:46,549 --> 01:39:48,284 DRIVING DIVERGENT RESULTS. 2498 01:39:48,284 --> 01:39:50,954 WAIVER THAT BPP POLICY WAS PART 2499 01:39:50,954 --> 01:39:53,490 OF SOUGHT TO IMPROVE ACCESS AND 2500 01:39:53,490 --> 01:39:56,092 QUALITY OF HEALTHCARE AND 2501 01:39:56,092 --> 01:39:58,895 TARGETED ENROLLEES WITH HIGH 2502 01:39:58,895 --> 01:39:59,562 BEHAVIORAL NEEDS . 2503 01:39:59,562 --> 01:40:03,366 WE SPECULATE THAT SOME DRIVERS 2504 01:40:03,366 --> 01:40:04,801 OF DISAPPOINTING QUALITY RESULTS 2505 01:40:04,801 --> 01:40:06,903 INCLUDE THAT. MOST ENROLLEES 2506 01:40:06,903 --> 01:40:09,239 WITH SERIOUS MENTAL ILLNESS IS 2507 01:40:09,239 --> 01:40:11,941 INCLUDED IN GENERAL POPULATION 2508 01:40:11,941 --> 01:40:14,778 CONTRACTS AND PERMITTING THIS 2509 01:40:14,778 --> 01:40:16,880 POTENTIALLY WORSE PERFORMANCE 2510 01:40:16,880 --> 01:40:19,549 AND GIVEN THAT THEY ARE A 2511 01:40:19,549 --> 01:40:20,683 RELATIVELY SMALL PROPORTION OF 2512 01:40:20,683 --> 01:40:24,921 THOSE CONTRACTS, NOT ALL OF THE 2513 01:40:24,921 --> 01:40:26,890 MEASURES THAT WERE RELEVANT TO 2514 01:40:26,890 --> 01:40:28,224 THE POPULATION WERE DESIGNATED 2515 01:40:28,224 --> 01:40:31,061 AS PAY FOR PERFORMANCE AND SOME 2516 01:40:31,061 --> 01:40:34,764 THAT WERE WERE INFREQUENTLY 2517 01:40:34,764 --> 01:40:36,499 SELECTED AS INCENTIVE METRICS. 2518 01:40:36,499 --> 01:40:39,035 YOU CAN SEE SOME OF THEM THERE 2519 01:40:39,035 --> 01:40:40,003 NEXT SLIDE, MREZ. 2520 01:40:40,003 --> 01:40:43,740 SO FINALLY, IN TERMS OF POLICY 2521 01:40:43,740 --> 01:40:46,709 POTENTIAL POLICY IMPLICATIONS WE 2522 01:40:46,709 --> 01:40:49,646 THINK BPP POLICIES SHOULD 2523 01:40:49,646 --> 01:40:51,748 EXPLICITLY INCENTIVIZE IMPROVING 2524 01:40:51,748 --> 01:40:53,950 ACCESS AND KWALET FOR VULNERABLE 2525 01:40:53,950 --> 01:40:56,719 POPULATIONS WITH HIGHER RATES OF 2526 01:40:56,719 --> 01:40:59,522 UNMET NEEDS DELIVERING FULLY 2527 01:40:59,522 --> 01:41:00,623 INTEGRATED CARE WITH SPECIAL 2528 01:41:00,623 --> 01:41:04,227 FOCUS ON INTEGRATING BEHAVIORAL 2529 01:41:04,227 --> 01:41:05,428 HEALTH PROVIDERS AND LARGE 2530 01:41:05,428 --> 01:41:07,397 GENERAL HEALTH PROVIDERS 2531 01:41:07,397 --> 01:41:09,265 ENSURING TIMELY ACCESS TO 2532 01:41:09,265 --> 01:41:11,134 PATIENT CARE FOLLOWING ACUTE 2533 01:41:11,134 --> 01:41:13,436 CARE AND IMPROVING WORKFORCE 2534 01:41:13,436 --> 01:41:14,671 AVAILABILITY AND COMPETENCIES 2535 01:41:14,671 --> 01:41:16,706 AND FOR OUTCOMES OF ENROLLEES 2536 01:41:16,706 --> 01:41:20,243 WITH SMI AND HONESTLY IMPROVING 2537 01:41:20,243 --> 01:41:22,078 CONTRACTS, THEY SHOULD REQUIRE A 2538 01:41:22,078 --> 01:41:24,681 MINIMUM OF SMI RELEVANT QUALITY 2539 01:41:24,681 --> 01:41:27,450 MEASURES THAT ARE USED IN SHARED 2540 01:41:27,450 --> 01:41:30,753 SAVINGS CALCULATION AND 2541 01:41:30,753 --> 01:41:32,055 PERFORMANCE REPORTING VULNERABLE 2542 01:41:32,055 --> 01:41:35,758 GROUPS INCLUDING THOSE WITH SMI. 2543 01:41:35,758 --> 01:41:36,326 ADDITIONALLY PAYERS SHOULD 2544 01:41:36,326 --> 01:41:38,361 STRUCTURE PAYMENT FORMULAS TO 2545 01:41:38,361 --> 01:41:40,096 PROTECT SAFETY NET PROVIDERS AND 2546 01:41:40,096 --> 01:41:42,298 I WILL END HERE AND I HAVE 2547 01:41:42,298 --> 01:41:44,567 REFERENCES ALSO. 2548 01:41:44,567 --> 01:41:46,569 THANKS VERY MUCH. 2549 01:41:46,569 --> 01:41:57,013 >> THANK YOU SO MUCH, DR. 2550 01:41:58,414 --> 01:42:01,417 HORVITZ LENNON AND NEXT UP IS 2551 01:42:01,417 --> 01:42:05,054 YUHUA BAO FROM CORNELL MEDICINE. 2552 01:42:05,054 --> 01:42:08,491 THANK YOU DR. BAO. 2553 01:42:08,491 --> 01:42:19,035 >> OKAY. NEXT SLIDE IF YOU CAN 2554 01:42:20,937 --> 01:42:21,604 ADVANCE, PLEASE. 2555 01:42:21,604 --> 01:42:26,743 >> I DIDN'T GET CONTROL. I WILL 2556 01:42:26,743 --> 01:42:30,446 DO THIS AGAIN. 2557 01:42:30,446 --> 01:42:33,316 >> YOU SHOULD HAVE CONTROL NOW, 2558 01:42:33,316 --> 01:42:34,217 DR. BAO. 2559 01:42:34,217 --> 01:42:37,820 >> SOMETIMES IT TAKE AZ SECOND 2560 01:42:37,820 --> 01:42:44,861 TO WORK. 2561 01:42:44,861 --> 01:42:47,030 THERE YOU ARE. 2562 01:42:47,030 --> 01:42:50,466 >> GREAT. THANK YOU. MR. BAO 2563 01:42:50,466 --> 01:42:52,602 FROM CORNELL MEDICINE WAS 2564 01:42:52,602 --> 01:42:54,370 PREVIOUS TWO WONDERFUL 2565 01:42:54,370 --> 01:42:55,672 PRESENTATIONS, THANK YOU. I 2566 01:42:55,672 --> 01:42:58,875 WILL TAKE YOU ALL INTO A 2567 01:42:58,875 --> 01:42:59,842 RELATIVELY MICROSETTING THAT IS 2568 01:42:59,842 --> 01:43:02,745 OPIOID TREATMENT PROGRAMS FOR 2569 01:43:02,745 --> 01:43:04,214 METHO DON'T SERVICES. 2570 01:43:04,214 --> 01:43:07,116 I WANT TO ACKNOWLEDGE FUNDING 2571 01:43:07,116 --> 01:43:10,887 FROM NIDA AND ESPECIALLY POST 2572 01:43:10,887 --> 01:43:15,491 DATA TO ACTION NETWORK FOR A 2573 01:43:15,491 --> 01:43:16,226 WONDERFULLY COLLABORATIVE TEAM 2574 01:43:16,226 --> 01:43:19,028 AT MULTIPLE INSTITUTIONS AND UY 2575 01:43:19,028 --> 01:43:22,565 CORNELL AND UCONN AND GOVERNMENT 2576 01:43:22,565 --> 01:43:26,169 PARTNER IN OFFICE OF MEDICAID 2577 01:43:26,169 --> 01:43:29,372 SERVICES AND SUPPORTS AND FROM 2578 01:43:29,372 --> 01:43:31,174 12OTP ORGANIZATIONS IN NEW YORK 2579 01:43:31,174 --> 01:43:33,743 STATE PARTICIPATING IN INTERVIEW 2580 01:43:33,743 --> 01:43:33,977 STUDY. 2581 01:43:33,977 --> 01:43:36,679 BIG PICTURE PROBLEM IS 2582 01:43:36,679 --> 01:43:38,748 SUSTAINING EVIDENCE-BASED HOST 2583 01:43:38,748 --> 01:43:40,817 PROGRAMS IS CHALLENGING FOR MANY 2584 01:43:40,817 --> 01:43:44,220 DIFFERENT REASONS AND ONE OF THE 2585 01:43:44,220 --> 01:43:46,956 MAJOR BARRIERS COULD BE LACK OF 2586 01:43:46,956 --> 01:43:49,459 MISALIGNMENT OF PROVIDER PAYMENT 2587 01:43:49,459 --> 01:43:51,794 AND SO PER SERVICE PAYMENT THAT 2588 01:43:51,794 --> 01:43:54,197 IS ALSO KNOWN AS FEE-FOR-SERVICE 2589 01:43:54,197 --> 01:43:57,133 PAYMENT MIGHT BE INADEQUATE OR 2590 01:43:57,133 --> 01:44:01,604 PROVIDE THE INCENTIVES FOR DOING 2591 01:44:01,604 --> 01:44:04,040 WHAT IS RIGHT FOR PATIENTS AND 2592 01:44:04,040 --> 01:44:06,109 FAMILIES AND BUNDLE PAYMENT IS A 2593 01:44:06,109 --> 01:44:07,377 PROMISING APPROACH THAT IS BEING 2594 01:44:07,377 --> 01:44:09,279 INCREASINGLY USED AND SOMETIMES 2595 01:44:09,279 --> 01:44:12,815 COULD BE DIFFICULT TO DESIGN AND 2596 01:44:12,815 --> 01:44:13,182 OPERATIONALIZE. 2597 01:44:13,182 --> 01:44:15,518 HOST PROVIDER ORGANIZATIONS ARE 2598 01:44:15,518 --> 01:44:18,021 NO DOUBT A MAJOR STAKEHOLDER AND 2599 01:44:18,021 --> 01:44:21,824 MAY LACK EXPERTISE TO ADEQUATELY 2600 01:44:21,824 --> 01:44:24,994 ENGAGE IN FINANCIAL SDIGS MAKING 2601 01:44:24,994 --> 01:44:30,033 AND TAKE ADVANTAGE OF PAYMENT 2602 01:44:30,033 --> 01:44:30,700 INNOVATIONS. 2603 01:44:30,700 --> 01:44:32,268 BIG PICTURE PROBLEM THAT TEAM 2604 01:44:32,268 --> 01:44:35,705 HAS BEEN WRESTLING WITH IN 2605 01:44:35,705 --> 01:44:37,440 RECENT YEARS IS CAN WE DEVELOP 2606 01:44:37,440 --> 01:44:42,178 SUPPORT TOOLS TO BENEFIT DIVERSE 2607 01:44:42,178 --> 01:44:43,446 DATA AND ORGANIZATIONS AND IN 2608 01:44:43,446 --> 01:44:45,448 THAT PROCESS YOU SEE IMMEDIATELY 2609 01:44:45,448 --> 01:44:49,352 ENGAGEMENT OF TARGET USERS COULD 2610 01:44:49,352 --> 01:44:59,595 BE CRITICAL. 2611 01:44:59,796 --> 01:45:02,899 METHO DON'T FOR OPIOID USE IS 2612 01:45:02,899 --> 01:45:05,134 AVAILABLE FOR FEDERALLY 2613 01:45:05,134 --> 01:45:09,005 CERTIFIED PROGRAMS OR OTPS. 2614 01:45:09,005 --> 01:45:10,206 PATIENTS BECAUSE OF VERY 2615 01:45:10,206 --> 01:45:11,908 STRINGENT FEDERAL AND STATE 2616 01:45:11,908 --> 01:45:13,509 REGULATIONS TYPICALLY HAVE TO 2617 01:45:13,509 --> 01:45:17,280 VISIT OTPS ON DAILY OR NEAR 2618 01:45:17,280 --> 01:45:19,716 DAILY BASIS TO RECEIVE DOSES 2619 01:45:19,716 --> 01:45:22,352 WHILE BEING OBSERVED THAT IS 2620 01:45:22,352 --> 01:45:23,986 MEDICATION ADMINISTRATION. 2621 01:45:23,986 --> 01:45:25,355 DURING COVID, FEDERAL 2622 01:45:25,355 --> 01:45:30,059 REGULATIONS ARE RELAXED TO ALLOW 2623 01:45:30,059 --> 01:45:32,995 PATIENTS TO TAKE DOSES HOME. 2624 01:45:32,995 --> 01:45:34,731 SUCH FLEXIBILITY WAS MADE 2625 01:45:34,731 --> 01:45:38,401 PERMANENT IN APRIL OF 2024 2626 01:45:38,401 --> 01:45:41,671 SAMHSA FINAL RULE FOR OTPS AND 2627 01:45:41,671 --> 01:45:44,073 EXISTING DATA SUGGESTS THAT 2628 01:45:44,073 --> 01:45:46,242 UPTAKE OF TAKE-HOME METHO DON'T 2629 01:45:46,242 --> 01:45:48,544 WAS LOW AND VARIED ACROSS OTPS 2630 01:45:48,544 --> 01:45:50,346 AND ACROSS STATES AND PRIOR TO 2631 01:45:50,346 --> 01:45:53,549 THE PANDEMIC, IT WAS TYPICALLY 2632 01:45:53,549 --> 01:45:57,019 PAID AT LEAST IN MEDICAID WITH A 2633 01:45:57,019 --> 01:46:00,957 PER SERVICE BILLING OF MEANING 2634 01:46:00,957 --> 01:46:02,992 THAT CLINICS COULD ONLY BILL FOR 2635 01:46:02,992 --> 01:46:04,460 SERVICES EVERY TIME PATIENT 2636 01:46:04,460 --> 01:46:06,963 COMES ON SITE FOR DOSING AND 2637 01:46:06,963 --> 01:46:08,998 THAT PAYMENT WAS PREVALENT 2638 01:46:08,998 --> 01:46:12,668 BEFORE THE -- BEFORE COVID AND 2639 01:46:12,668 --> 01:46:14,871 CHANCES ARE THAT TO OUR EXISTING 2640 01:46:14,871 --> 01:46:16,239 KNOWLEDGE IT MAY STILL BE 2641 01:46:16,239 --> 01:46:20,143 PREVALENT THESE DAYS AND THAT 2642 01:46:20,143 --> 01:46:21,944 COULD CONSTITUTE A SERIOUS 2643 01:46:21,944 --> 01:46:25,415 BARRIER TO TAKE-HOME DOSES IF 2644 01:46:25,415 --> 01:46:27,150 THEY ARE NOT COVERED AND 2645 01:46:27,150 --> 01:46:28,451 ANTICIPATING AND REALLY 2646 01:46:28,451 --> 01:46:31,120 ADDRESSING THAT ISSUE, NEW YORK 2647 01:46:31,120 --> 01:46:35,491 STATE MEDICAID EARLY ON IN THE 2648 01:46:35,491 --> 01:46:37,326 PANDEMIC THAT IS MARCH 2020 2649 01:46:37,326 --> 01:46:39,862 IMPLEMENTED A BUNDLED PAYMENT 2650 01:46:39,862 --> 01:46:41,731 FOR METHO DON'T AS AN 2651 01:46:41,731 --> 01:46:44,133 ALTERNATIVE TO PER SERVICE 2652 01:46:44,133 --> 01:46:45,535 PAYMENT AND ALTERNATIVE PER 2653 01:46:45,535 --> 01:46:51,541 SERVICE PAYMENT IS CALLED APG OR 2654 01:46:51,541 --> 01:46:52,241 AGGREGATE PROVIDER PAYMENT GROUP 2655 01:46:52,241 --> 01:46:55,044 AND PAYMENT AS I WILL REFER TO 2656 01:46:55,044 --> 01:46:57,380 IT AS LPG AND HERE IS HOW THE 2657 01:46:57,380 --> 01:46:59,816 BUNDLE PAYMENT WORKS AND IN ANY 2658 01:46:59,816 --> 01:47:03,986 GIVEN WEEK IF THE PATIENT 2659 01:47:03,986 --> 01:47:08,024 RECEIVES ANY SERVICES, 2660 01:47:08,024 --> 01:47:09,959 ADMINISTRATION TOXICOLOGY OR 2661 01:47:09,959 --> 01:47:11,427 MEDICATION MANAGEMENT WITH OR 2662 01:47:11,427 --> 01:47:13,763 WITHOUT TAKE-HOME DOSES CLINIC 2663 01:47:13,763 --> 01:47:18,701 IS ELIGIBLE FOR FULL BUNDLE THAT 2664 01:47:18,701 --> 01:47:20,203 NOWADAYS IN NEW YORK IT IS 2665 01:47:20,203 --> 01:47:22,905 ALMOST 20 OR 50 DOLLARS AND SO 2666 01:47:22,905 --> 01:47:25,041 AS I MENTIONED THAT THIS BUNDLE 2667 01:47:25,041 --> 01:47:28,211 PAYMENT IS AN ALTERNATIVE TO THE 2668 01:47:28,211 --> 01:47:30,480 PRE-EXISTING A P. G PAYMENT 2669 01:47:30,480 --> 01:47:32,248 MEANING THAT IN ANY GIVEN WEEK 2670 01:47:32,248 --> 01:47:35,451 THE CLINIC HAS THE OPTION TO 2671 01:47:35,451 --> 01:47:37,153 SUBMIT A BUNDLED BILLING OR 2672 01:47:37,153 --> 01:47:39,722 STILL BILL WITH A P. G AND 2673 01:47:39,722 --> 01:47:42,592 GIVEN THAT IF A PATIENT COMES ON 2674 01:47:42,592 --> 01:47:44,494 SITE IN A WEEK TO RECEIVE A DOSE 2675 01:47:44,494 --> 01:47:46,229 AND THAT IS THE ONLY SERVICE 2676 01:47:46,229 --> 01:47:49,198 THEY RECEIVE, YOU KNOW, CLINIC 2677 01:47:49,198 --> 01:47:52,001 WILL RECEIVE 247 BASED ON BUNDLE 2678 01:47:52,001 --> 01:47:54,303 BILLING AND BASED ON APG AND IS 2679 01:47:54,303 --> 01:47:57,840 ONLY THE PAYMENT FOR ONE 2680 01:47:57,840 --> 01:48:00,142 CLINIC-BASED ON SITE MEDICATION 2681 01:48:00,142 --> 01:48:03,179 ADMINISTRATION THAT IS $49. 2682 01:48:03,179 --> 01:48:05,181 THE PAYMENT HAS A SECOND TIER 2683 01:48:05,181 --> 01:48:06,983 MEDICATION ONLY BUNDLE THAT 2684 01:48:06,983 --> 01:48:09,819 MEANS THAT IN THAT WEEK IF THE 2685 01:48:09,819 --> 01:48:11,454 PATIENT HAS TAKE-HOME MEDICATION 2686 01:48:11,454 --> 01:48:13,723 WITH THEM AND THERE IS NO 2687 01:48:13,723 --> 01:48:17,560 ADDITIONAL SERVICE THAT OCCURS, 2688 01:48:17,560 --> 01:48:20,229 THE MEDICATION ONLY BUNDLE IS 42 2689 01:48:20,229 --> 01:48:20,963 DOLLARS. 2690 01:48:20,963 --> 01:48:25,234 COMPARED TO IF IT IS UNDER APG 2691 01:48:25,234 --> 01:48:26,903 THE CLINIC CANNOT DO ANYTHING. 2692 01:48:26,903 --> 01:48:30,206 THERE IS NO ONSITE SERVICE. 2693 01:48:30,206 --> 01:48:34,076 SO YOU NOTICE THERE IS A VERY 2694 01:48:34,076 --> 01:48:35,678 SHARP DROP BETWEEN BUNDLE 2695 01:48:35,678 --> 01:48:38,314 PAYMENT AND MEDICATION-ONLY 2696 01:48:38,314 --> 01:48:38,681 BUNDLE. 2697 01:48:38,681 --> 01:48:40,583 IN ANY GIVEN WEEK, OPTIMAL 2698 01:48:40,583 --> 01:48:44,587 BILLING STRATEGY THAT IS BUNDLED 2699 01:48:44,587 --> 01:48:47,123 VERSUS APG YOU CAN SEE FUNCTION 2700 01:48:47,123 --> 01:48:49,892 OF TAKE-HOME SCHEDULE AND 2701 01:48:49,892 --> 01:48:54,130 COUNSELING AND IS INDEED VERY 2702 01:48:54,130 --> 01:48:55,965 COMPLICATED. 2703 01:48:55,965 --> 01:48:58,734 SO EARLY ON IN THE PROJECT THAT 2704 01:48:58,734 --> 01:49:01,704 IS FUNDED FROM HD2A CONSORTIUM, 2705 01:49:01,704 --> 01:49:04,740 WE NOTICED FROM BILLING DATA IN 2706 01:49:04,740 --> 01:49:07,310 NEW YORK STATE THAT MANY OF THE 2707 01:49:07,310 --> 01:49:09,745 OTPS WERE NOT BILLING OPTIMALLY 2708 01:49:09,745 --> 01:49:12,181 GIVEN AMOUNT OF TAKE-HOMES THEY 2709 01:49:12,181 --> 01:49:14,150 ARE DOING AND AT SAME TIME THEY 2710 01:49:14,150 --> 01:49:16,185 WERE CONCERNED THAT TAKE-HOMES 2711 01:49:16,185 --> 01:49:18,487 WERE HURTING THEM FINANCIALLY. 2712 01:49:18,487 --> 01:49:20,556 THE KEY QUESTIONS THAT SEEM TO 2713 01:49:20,556 --> 01:49:24,293 COME UP WITH WERE, YOU KNOW, HOW 2714 01:49:24,293 --> 01:49:25,962 TO CONDUCT OPTIMAL BILLING AND 2715 01:49:25,962 --> 01:49:29,365 YOU KNOW FROM THE PROVIDERS 2716 01:49:29,365 --> 01:49:32,201 PERSPECTIVE AND OTHER IS HOW 2717 01:49:32,201 --> 01:49:35,438 WILL TAKE-HOMES AFFECT OTP'S 2718 01:49:35,438 --> 01:49:35,771 BOTTOM LINE. 2719 01:49:35,771 --> 01:49:38,240 THAT GIVES ROOIZE TO THE IDEA OF 2720 01:49:38,240 --> 01:49:39,775 DESIGNING OR DEVELOPING A TOOL 2721 01:49:39,775 --> 01:49:42,912 TO HELP OTPS TO EXACTLY ADDRESS 2722 01:49:42,912 --> 01:49:45,481 THESE TWO NEEDS. FIRST OF ALL, 2723 01:49:45,481 --> 01:49:47,984 TO DETERMINE THE OPTIMAL BILLING 2724 01:49:47,984 --> 01:49:51,287 STRATEGY GIVEN TAKE-HOME 2725 01:49:51,287 --> 01:49:54,523 SCHEDULES AND TO SEE HOW 2726 01:49:54,523 --> 01:49:56,192 MEDICAID REVENUE CHAININGS WITH 2727 01:49:56,192 --> 01:49:59,829 CHANGES IN TAKE-HOME PRACTICES. 2728 01:49:59,829 --> 01:50:01,564 WE WENT TO YOU KNOW BETTER 2729 01:50:01,564 --> 01:50:04,734 UNDERSTAND NEEDS AND ALSO TO 2730 01:50:04,734 --> 01:50:08,237 INFORM THE TOOL DESIGN WE 2731 01:50:08,237 --> 01:50:09,605 INTERVIEWED 12 PROGRAMS AND 2732 01:50:09,605 --> 01:50:12,241 ORGANIZATIONS IN NEW YORK STATE 2733 01:50:12,241 --> 01:50:13,976 AND BASICALLY MOSTLY INVITED 2734 01:50:13,976 --> 01:50:16,646 FINANCIAL LEADERS AND STAFF TO 2735 01:50:16,646 --> 01:50:21,484 CONVERSATIONS THAT FOR MANY OTPS 2736 01:50:21,484 --> 01:50:23,085 THEIR CLINICAL AND MEDICAL 2737 01:50:23,085 --> 01:50:24,020 DIRECTORS JOIN THE CONVERSATION 2738 01:50:24,020 --> 01:50:26,288 AND WE ASKED WHAT IS YOUR 2739 01:50:26,288 --> 01:50:28,257 EXPERIENCE WITH THE BUNDLED 2740 01:50:28,257 --> 01:50:31,093 PAYMENT SINCE MARCH OF 2020? 2741 01:50:31,093 --> 01:50:33,529 WE ALSO SHOW THAT PRELIMINARY 2742 01:50:33,529 --> 01:50:35,865 TOOL TO SOLICIT THEIR FEEDBACK. 2743 01:50:35,865 --> 01:50:39,201 HERE IS WHAT WE LEARNED FROM OUR 2744 01:50:39,201 --> 01:50:41,237 CONVERSATIONS. I WON'T READ 2745 01:50:41,237 --> 01:50:42,672 THIS SUPPORTING QUOTES. 2746 01:50:42,672 --> 01:50:45,875 BUT YOU KNOW THE FIRST THING 2747 01:50:45,875 --> 01:50:47,576 THAT CAME UP WAS BUNDLE PAYMENT 2748 01:50:47,576 --> 01:50:51,313 OPTION REALLY PROVIDED REVENUE 2749 01:50:51,313 --> 01:50:54,050 PROTECTION THAT CONFIRMED TO US 2750 01:50:54,050 --> 01:50:56,152 BUNDLED PAYMENT IS A VIABLE 2751 01:50:56,152 --> 01:50:57,920 PAYMENT STRATEGY TO SUPPORT 2752 01:50:57,920 --> 01:51:01,757 FLEXIBLE TAKE-HOMES AND SECONDLY 2753 01:51:01,757 --> 01:51:06,662 YOU KNOW TO OTPS IT WAS 2754 01:51:06,662 --> 01:51:08,064 LOGISTICALLY CHALLENGING TO 2755 01:51:08,064 --> 01:51:08,898 LEVERAGE ALTERNATIVE PAYMENT 2756 01:51:08,898 --> 01:51:12,835 SYSTEM THAT IS A P. G BUNDLED 2757 01:51:12,835 --> 01:51:16,272 AND YOU KNOW OVER THE ENTIRE 2758 01:51:16,272 --> 01:51:18,607 STATE THERE IS ALMOST ALL OTPS 2759 01:51:18,607 --> 01:51:20,242 IN ENTIRE STATES THAT WERE DOING 2760 01:51:20,242 --> 01:51:24,280 IT MANUALLY AND THEY WERE 2761 01:51:24,280 --> 01:51:27,249 MANUALLY DETERMINING IN A GIVEN 2762 01:51:27,249 --> 01:51:30,586 WEEK AND FOR GIVEN PATIENT 2763 01:51:30,586 --> 01:51:31,520 SHARING BUNDLE AND BEING 2764 01:51:31,520 --> 01:51:34,090 ACTUALLY APG AND IF THEY ARE 2765 01:51:34,090 --> 01:51:36,158 ACTUALLY ATTEMPTING THAT. 2766 01:51:36,158 --> 01:51:38,394 SO IT REVEALED AND CONFIRMED TO 2767 01:51:38,394 --> 01:51:40,930 US DECISION SUPPORT NEEDS 2768 01:51:40,930 --> 01:51:43,966 REGARDING OPTIMAL BILLING 2769 01:51:43,966 --> 01:51:44,266 STRATEGIES. 2770 01:51:44,266 --> 01:51:48,704 AND THIRDLY, SO OTP STAKEHOLDERS 2771 01:51:48,704 --> 01:51:50,873 EXPRESSED CONCERN THAT THE 2772 01:51:50,873 --> 01:51:52,508 MEDICATION-ONLY RATE IN 2773 01:51:52,508 --> 01:51:55,511 TWO-TIERED BUNDLE PAYMENT WAS 2774 01:51:55,511 --> 01:51:57,346 PERCEIVED AS LOW AND 2775 01:51:57,346 --> 01:51:58,881 UNSUSTAINABLE THAT DOES NOT 2776 01:51:58,881 --> 01:52:00,216 DIRECTLY INFORM THE DESIGN OF 2777 01:52:00,216 --> 01:52:02,785 THE TOOL. IT DOES POINT OUT TO 2778 01:52:02,785 --> 01:52:04,620 A POSSIBLE DIRECTION FOR 2779 01:52:04,620 --> 01:52:05,888 REFINING THE BUNDLE PAYMENT 2780 01:52:05,888 --> 01:52:07,890 MODEL IF POLICY MAKERS WERE TO 2781 01:52:07,890 --> 01:52:09,325 CONSIDER THAT IN THE FUTURE 2782 01:52:09,325 --> 01:52:13,662 WHICH IS TO NARROW THE SPREAD OF 2783 01:52:13,662 --> 01:52:15,364 THE TWO TIERS TO MITIGATE 2784 01:52:15,364 --> 01:52:18,534 PERVERSE INCENTIVES. 2785 01:52:18,534 --> 01:52:22,972 OKAY. SO NO. 4, SORRY, 2786 01:52:22,972 --> 01:52:24,206 CONSOLING PRACTICES ON WHEN 2787 01:52:24,206 --> 01:52:27,409 SUBSTANTIAL CHANGES DURING THE 2788 01:52:27,409 --> 01:52:28,944 PANDEMIC AND POSING FINANCIAL 2789 01:52:28,944 --> 01:52:30,379 CONCERNS TO OTP ORGANIZATIONS 2790 01:52:30,379 --> 01:52:32,715 AND THIS INFORMED REALLY A MAJOR 2791 01:52:32,715 --> 01:52:34,517 DESIGN ELEMENT OF OUR TOOL, 2792 01:52:34,517 --> 01:52:36,385 WHICH IS THAT OUR REVENUE 2793 01:52:36,385 --> 01:52:39,388 CALCULATION WILL HAVE TO TAKE 2794 01:52:39,388 --> 01:52:41,791 INTO ACCOUNT CONSOLING 2795 01:52:41,791 --> 01:52:44,226 FREQUENCIES AND TOOL UNDERWENT 2796 01:52:44,226 --> 01:52:45,461 ITERATIVE UPDATES AND 2797 01:52:45,461 --> 01:52:47,363 REFINEMENTS AND WHAT IT LOOKS 2798 01:52:47,363 --> 01:52:48,764 LIKE NOW IN SEVERAL SCREENSHOTS 2799 01:52:48,764 --> 01:52:55,838 AND FIRST OF AUGUST, ALL THIS 2800 01:52:55,838 --> 01:52:57,606 MAJOR PIECE OF HOW BASICALLY 2801 01:52:57,606 --> 01:53:00,242 CASE LOAD OF CLINIC IS 2802 01:53:00,242 --> 01:53:02,344 DISTRIBUTED ACROSS 10 UNIQUE 2803 01:53:02,344 --> 01:53:04,213 SCHEDULES OF TAKE HOME OR PICK 2804 01:53:04,213 --> 01:53:06,849 UP SCHEDULES RANGING FROM 7 DAYS 2805 01:53:06,849 --> 01:53:08,851 A WEEK TO THEY NEED TO COME ON 2806 01:53:08,851 --> 01:53:11,320 SITE SEVEN DAYS A WEEK ALL THE 2807 01:53:11,320 --> 01:53:13,756 WAY TO EVERY FOUR WEEKS THAT IS 2808 01:53:13,756 --> 01:53:21,630 A TAKE-HOME 28 DAYS OF SUPPLY 2809 01:53:21,630 --> 01:53:24,567 AND SECOND PIECE OF INPUT IS 2810 01:53:24,567 --> 01:53:26,802 COUNSELING PIECE THAT WEIGHS IN 2811 01:53:26,802 --> 01:53:27,436 HEAVILY IMPORTANTLY IN 2812 01:53:27,436 --> 01:53:31,273 CALCULATION OF BUNDLE PAYMENT IN 2813 01:53:31,273 --> 01:53:35,377 APG AND SEE HERE WE ASK THE USER 2814 01:53:35,377 --> 01:53:36,779 TO INPUT AVERAGE INDIVIDUAL AND 2815 01:53:36,779 --> 01:53:39,381 GROUP COUNSELING FREQUENCIES AND 2816 01:53:39,381 --> 01:53:43,552 CONDITIONAL ON EACH TAKE-HOME 2817 01:53:43,552 --> 01:53:44,653 SCHEDULE THIS IS OUTPUT AND 2818 01:53:44,653 --> 01:53:49,024 FIRST PART OF THE OUTPUT IS 2819 01:53:49,024 --> 01:53:50,259 OPTIMAL PAYMENT STRATEGY FOR 2820 01:53:50,259 --> 01:53:52,228 EACH TAKE-HOME AND COUNSELING 2821 01:53:52,228 --> 01:53:53,762 SCHEDULE AND SEE HERE IN THE 2822 01:53:53,762 --> 01:53:58,200 PARTICULAR SCENARIO IN THIS 2823 01:53:58,200 --> 01:54:01,403 CLINIC GIVEN PRACTICES AND 2824 01:54:01,403 --> 01:54:05,608 COUNSELING FREQUENCIES PER 2825 01:54:05,608 --> 01:54:09,511 SERVICE OR APG PAYMENT GIVES 2826 01:54:09,511 --> 01:54:11,814 HIGHER PAYMENT AND SCHEDULE 7 2827 01:54:11,814 --> 01:54:13,849 DAYS A WEEK TO 4 DAYS A WEEK AND 2828 01:54:13,849 --> 01:54:16,218 STARTING 3 DAYS A WEEK BUNDLE 2829 01:54:16,218 --> 01:54:19,955 PAYMENT GIVES OPTIMAL PAYMENT 2830 01:54:19,955 --> 01:54:24,226 AND NEXT PART BASICALLY SUMS IT 2831 01:54:24,226 --> 01:54:26,495 UP TO ENTIRE CLINIC GIVING 2832 01:54:26,495 --> 01:54:29,031 ESTIMATE OF TOTAL ESTIMATED 2833 01:54:29,031 --> 01:54:30,599 MEDICAID REVENUE FOR FOUR WEEKS 2834 01:54:30,599 --> 01:54:33,769 AND OVER 12 MONTHS IF THE CLINIC 2835 01:54:33,769 --> 01:54:37,172 WERE TO BUILD OPTIMALLY EVERY 2836 01:54:37,172 --> 01:54:42,111 TIME COMPARED TO APG ONLY AND 2837 01:54:42,111 --> 01:54:42,611 BUNDLE ONLY. 2838 01:54:42,611 --> 01:54:46,815 THANK YOU. I WILL CONCLUDE MY 2839 01:54:46,815 --> 01:54:47,316 PRESENTATION HERE. 2840 01:54:47,316 --> 01:54:50,119 >> THANK YOU SO MUCH. 2841 01:54:50,119 --> 01:54:56,759 DR. BAO, NOW WE WILL HEAR FROM 2842 01:54:56,759 --> 01:55:00,796 DR. JOHN MCCONNELL FROM OREGON 2843 01:55:00,796 --> 01:55:03,899 HEALTH AND SCIENCE UNIVERSITY. 2844 01:55:03,899 --> 01:55:05,367 DR. MCCONEL? 2845 01:55:05,367 --> 01:55:07,436 >> THANK YOU. NOTING CHANGE IN 2846 01:55:07,436 --> 01:55:09,138 TITLE HERE AND GIVEN A FEW 2847 01:55:09,138 --> 01:55:11,106 OPPORTUNITIES TO GET IT RIGHT ON 2848 01:55:11,106 --> 01:55:13,542 AGENDA AND MISSED IT AND MY BAD 2849 01:55:13,542 --> 01:55:14,777 AND ORIGINALLY PLANNED TO DO 2850 01:55:14,777 --> 01:55:16,912 WORK ON UTILIZATION AND HAD A 2851 01:55:16,912 --> 01:55:18,914 LITTLE LAG IN CLAIMS DATA THAT 2852 01:55:18,914 --> 01:55:21,450 IS EASIER TO GET DATA ON BED 2853 01:55:21,450 --> 01:55:23,319 CAPACITY AND PROJECT WE WERE 2854 01:55:23,319 --> 01:55:24,887 WORKING ON AND WHAT I WANT TO 2855 01:55:24,887 --> 01:55:26,855 PRESENT AND RESEARCH IS 2856 01:55:26,855 --> 01:55:29,858 SUPPORTED FROM GRANT BY NIMH AND 2857 01:55:29,858 --> 01:55:32,428 LOOKING AT SEMIWAIVERS AND 2858 01:55:32,428 --> 01:55:35,264 GRATEFUL FOR SUPPORT. NEXT 2859 01:55:35,264 --> 01:55:37,199 SLIDE, PLEASE. 2860 01:55:37,199 --> 01:55:43,372 SO WHAT ARE SMI AND SMD WAIVERS 2861 01:55:43,372 --> 01:55:45,441 AND SERIOUS ILLNESS AND 2862 01:55:45,441 --> 01:55:46,942 EMOTIONAL DISTURBANCES FOR 2863 01:55:46,942 --> 01:55:51,313 CHILDREN? 1965 FEDERAL LAW 2864 01:55:51,313 --> 01:55:53,215 PROHIBITED MEDICAID FUNDS AGES 2865 01:55:53,215 --> 01:55:56,085 21 TO IN INSTITUTIONS FOR MENTAL 2866 01:55:56,085 --> 01:55:58,754 DISEASES IMDS AND FACILITIES 2867 01:55:58,754 --> 01:56:01,991 WITH MORE THAN 16 BEDS 2868 01:56:01,991 --> 01:56:03,826 SPECIALIZING IN BEHAVIORAL 2869 01:56:03,826 --> 01:56:07,029 HEALTH TREATMENT. EXCLUSION HAS 2870 01:56:07,029 --> 01:56:09,765 INHIBITED ACCESS TO PATIENT 2871 01:56:09,765 --> 01:56:11,533 PSYCHIATRIC CARE FOR MEDICAL 2872 01:56:11,533 --> 01:56:15,371 ENROLLEES FEELING IT IS 2873 01:56:15,371 --> 01:56:16,672 COMPARITIABLE WITH -- PEOPLE ON 2874 01:56:16,672 --> 01:56:18,340 ONE SIDE WANT THIS EXCLUSION TO 2875 01:56:18,340 --> 01:56:20,509 BE REMOVED FEELING IT IS 2876 01:56:20,509 --> 01:56:22,778 CRITICAL TO SIGNAL PARODY FOR 2877 01:56:22,778 --> 01:56:24,880 ALL SERVICES AND THOSE CONCERNED 2878 01:56:24,880 --> 01:56:28,217 ABOUT ANY USE OR EXPANSION OF 2879 01:56:28,217 --> 01:56:29,084 IN-PATIENT PSYCHIATRIC CARE 2880 01:56:29,084 --> 01:56:30,719 FEELING NOT EVIDENCE-BASED 2881 01:56:30,719 --> 01:56:32,454 TREATMENT THAT THEY WORRY ABOUT 2882 01:56:32,454 --> 01:56:35,357 SHIFT FROM OUT-PATIENT TO 2883 01:56:35,357 --> 01:56:39,795 IN-PATIENT AND NEXT SLIDE, 2884 01:56:39,795 --> 01:56:40,095 PLEASE. 2885 01:56:40,095 --> 01:56:44,233 SO TO DEAL WITH THE EXCLUSION IN 2886 01:56:44,233 --> 01:56:45,467 [INDISCERNIBLE] ALLOWED STATE TO 2887 01:56:45,467 --> 01:56:47,302 APPLY FOR A WAIVER THAT THEY 2888 01:56:47,302 --> 01:56:49,538 COULD RECEIVE FEDERAL MATCHING 2889 01:56:49,538 --> 01:56:51,040 FUNDS FOR SPECIAL TREATMENT IN 2890 01:56:51,040 --> 01:56:52,241 IMDS AND LIMITATIONS HERE AND 2891 01:56:52,241 --> 01:56:54,009 YOU ARE ONLY ALLOWED TO GET PAID 2892 01:56:54,009 --> 01:56:56,412 FOR PEOPLE THAT STAY FOR 60 DAYS 2893 01:56:56,412 --> 01:56:59,148 OR LESS AND AVERAGE STAY ACROSS 2894 01:56:59,148 --> 01:57:01,517 ALL MEDICAID ENROLLEES HAS TO BE 2895 01:57:01,517 --> 01:57:03,285 30 DAYS OR LESS AND IMPORTANT 2896 01:57:03,285 --> 01:57:05,220 MILESTONES HERE DESIGNED TO MAKE 2897 01:57:05,220 --> 01:57:07,423 SURE STATES ARE NOT JUST 2898 01:57:07,423 --> 01:57:09,458 FOCUSING ON IN-PATIENT CARE AND 2899 01:57:09,458 --> 01:57:11,693 SOME ENCOURAGE OUTPATIENT 2900 01:57:11,693 --> 01:57:13,562 SERVICE AND OTHER THINGS AND 2901 01:57:13,562 --> 01:57:16,065 THIS WAIVER LOOKS SIMILAR IN 2902 01:57:16,065 --> 01:57:17,399 LANGUAGE AND FEEL IT IS 2903 01:57:17,399 --> 01:57:20,235 DIFFERENT THAN 2015 WAIVERS 2904 01:57:20,235 --> 01:57:21,770 FOCUSING ON SUBSTANCE USE 2905 01:57:21,770 --> 01:57:22,771 DISORDER TREATMENT. 2906 01:57:22,771 --> 01:57:23,739 NEXT SLIDE, PLEASE. 2907 01:57:23,739 --> 01:57:26,275 TO GIVE YOU SOME IDEA OF TAKE UP 2908 01:57:26,275 --> 01:57:28,877 ON TWO WAIVERS YOU CAN SEE HERE 2909 01:57:28,877 --> 01:57:34,416 BLUE STATES ARE STATES THAT HAVE 2910 01:57:34,416 --> 01:57:36,718 SUD, IMD WAIVER AND ORANGE 2911 01:57:36,718 --> 01:57:39,655 STATES HAVE BOTH WAIVERS AND ONE 2912 01:57:39,655 --> 01:57:43,625 IN ALABAMA SMDI WAIVER AND TWO 2913 01:57:43,625 --> 01:57:45,427 THINGS TO NOTICE HERE. THOSE 2914 01:57:45,427 --> 01:57:47,963 WITH WAIVER HAVE SUD WAIVER AND 2915 01:57:47,963 --> 01:57:49,798 CAME BEHIND TOGETHER AND NEVER 2916 01:57:49,798 --> 01:57:52,167 DID SMI WAIVER AND THERE IS ONE 2917 01:57:52,167 --> 01:57:54,203 STATE WITH SMI WAIVER AND UPTAKE 2918 01:57:54,203 --> 01:57:57,272 IS HIGHER FOR STATES TAKING SUD 2919 01:57:57,272 --> 01:58:00,075 WAIVERS AND SMI WAIVERS AND 36 2920 01:58:00,075 --> 01:58:02,277 STATES HAVE DONE WAIVERS AND 13 2921 01:58:02,277 --> 01:58:05,347 HAVE DONE SMI WAIVERS AND WERE 2922 01:58:05,347 --> 01:58:07,449 INTRODUCED LATER AND UPTAKE HAS 2923 01:58:07,449 --> 01:58:09,885 BEEN SLOWER. 2924 01:58:09,885 --> 01:58:10,786 NEXT SLIDE, PLEASE. 2925 01:58:10,786 --> 01:58:13,622 SO WHY ARE WE INTERESTED IN BED 2926 01:58:13,622 --> 01:58:15,190 CAPACITY? WE HAVE GOTTEN 2927 01:58:15,190 --> 01:58:17,092 QUESTIONS FROM LEGISLATORS AT 2928 01:58:17,092 --> 01:58:19,428 FEDERAL AND STATE LEVEL ASKING 2929 01:58:19,428 --> 01:58:22,131 ABOUT WAIVERS WONDERING IF IT 2930 01:58:22,131 --> 01:58:24,967 CAN HELP INCREASE PATIENT 2931 01:58:24,967 --> 01:58:27,002 CAPACITY GENERAL CONSENSUS 2932 01:58:27,002 --> 01:58:30,239 SHORTAGE OF PSYCHIATRIC BEDS 2933 01:58:30,239 --> 01:58:31,773 CONTROVERSIAL AND IN SOME STATES 2934 01:58:31,773 --> 01:58:33,108 IS A LARGE CONCERN AND THAT 2935 01:58:33,108 --> 01:58:34,810 DECLINE IF YOU CAN BELIEVE IT 2936 01:58:34,810 --> 01:58:38,714 CAN BE TRACED TO 2937 01:58:38,714 --> 01:58:39,348 DEINSTITUTIONALIZATION EFFORTS 2938 01:58:39,348 --> 01:58:41,250 SPANNING MORE THAN 50 YEARS AND 2939 01:58:41,250 --> 01:58:42,818 BIG CONCERNS PATIENTS ARE 2940 01:58:42,818 --> 01:58:43,986 BOARDED IN EMERGENCY DEPARTMENTS 2941 01:58:43,986 --> 01:58:45,787 AND WE HAVE ONGOING WORK IN THE 2942 01:58:45,787 --> 01:58:48,891 GRANT WHERE WE LOOK AT BOARDING 2943 01:58:48,891 --> 01:58:50,826 RATES FOR MEDICAID ENROLLEES TO 2944 01:58:50,826 --> 01:58:53,562 SHOW UP AND THOSE WITH MENTAL 2945 01:58:53,562 --> 01:58:55,397 HEALTH CONDITIONS AND AVERAGE 2946 01:58:55,397 --> 01:58:57,699 LIKELIHOOD THAT YOU ARE PROBABLY 2947 01:58:57,699 --> 01:58:59,735 BEING BOARDED IS 1 IN 10 THAT IS 2948 01:58:59,735 --> 01:59:01,403 HIGH ACROSS STATES AND SOME 2949 01:59:01,403 --> 01:59:03,172 STATES 5 OR 6 STATES IS MORE 2950 01:59:03,172 --> 01:59:05,407 THAN 2 OUT OF -- SORRY MORE THAN 2951 01:59:05,407 --> 01:59:08,210 1 OUT OF EVERY 5 PATIENTS OR 2952 01:59:08,210 --> 01:59:10,279 MEDICAID ENROLLEES SHOWING UP IN 2953 01:59:10,279 --> 01:59:11,647 EMERGENCY DEPARTMENT AND MENTAL 2954 01:59:11,647 --> 01:59:13,015 HEALTH CONDITION STAYING THERE 2955 01:59:13,015 --> 01:59:14,883 LONGER THAN THREE DAYS THAT IS 2956 01:59:14,883 --> 01:59:16,218 PRETTY CONCERNING AND SOME 2957 01:59:16,218 --> 01:59:18,020 PEOPLE THINK THAT EXPANDING IN 2958 01:59:18,020 --> 01:59:20,522 PATIENT CAPACITY COULD REDUCE 2959 01:59:20,522 --> 01:59:22,624 BOARDING AND WE WANT TO ADDRESS 2960 01:59:22,624 --> 01:59:24,459 ABILITY TO SEE IF WAIVERS HAVE 2961 01:59:24,459 --> 01:59:28,230 INCREASED ABOUT ED CAPACITY YET. 2962 01:59:28,230 --> 01:59:32,501 NEXT SLIDE, PLEASE. 2963 01:59:32,501 --> 01:59:35,170 LOOKING AT DIFFERENT DATA 2964 01:59:35,170 --> 01:59:37,105 SOURCES MEDICARE PROVIDED 2965 01:59:37,105 --> 01:59:38,907 SERVICE GIVING INFORMATION ON 2966 01:59:38,907 --> 01:59:42,878 INFORMATION FOR BED COUNTS 2967 01:59:42,878 --> 01:59:44,980 PRESTANDING PATIENT PSYCHIATRY 2968 01:59:44,980 --> 01:59:46,815 AND A FEW DATA POINTS 2969 01:59:46,815 --> 01:59:48,850 DESCRIPTIVE TO GIVE IDEA WHAT IS 2970 01:59:48,850 --> 01:59:50,519 HAPPENING HERE AND HAVE DONE 2971 01:59:50,519 --> 01:59:52,221 QUALITATIVE FOCUS ON THIS GRANT 2972 01:59:52,221 --> 01:59:55,324 AND HAVE DONE INTERVIEWS WITH 2973 01:59:55,324 --> 01:59:57,859 PROVIDERS ADVOCATES AND MCOS TO 2974 01:59:57,859 --> 01:59:59,127 UNDERSTAND HOW THEY ARE VIEWING 2975 01:59:59,127 --> 02:00:01,430 WAIVERS AND MAIN ANALYSIS HERE 2976 02:00:01,430 --> 02:00:03,398 SHOWING DIFFERENCE OF DIFFERENCE 2977 02:00:03,398 --> 02:00:05,601 AND 13 STATES ADOPTED THIS 2978 02:00:05,601 --> 02:00:07,002 WAIVER DOING IT AT DIFFERENT 2979 02:00:07,002 --> 02:00:09,504 TIMES AND LOOKING AT STAGGERED 2980 02:00:09,504 --> 02:00:12,808 ROLLOUT AND WE ARE USING THIS TO 2981 02:00:12,808 --> 02:00:14,610 ADDRESS DIFFERENTIAL TIMING AND 2982 02:00:14,610 --> 02:00:17,613 ANALYSIS AND ALLOWING TO TEST 2983 02:00:17,613 --> 02:00:19,147 FOR HETEROGENEITY ACROSS STATES 2984 02:00:19,147 --> 02:00:22,517 AND OVER TIME AND NEXT SLIDE, 2985 02:00:22,517 --> 02:00:22,751 PLEASE. 2986 02:00:22,751 --> 02:00:26,822 MIGHT HAVE DUPLICATED NEXT 2987 02:00:26,822 --> 02:00:33,829 SLIDES PLEASE SO NEXT ONE. 2988 02:00:33,829 --> 02:00:35,998 KEEP GOING. THIS IS DESCRIPTIVE 2989 02:00:35,998 --> 02:00:38,900 DATA AND GIVING SENSE WHERE BED 2990 02:00:38,900 --> 02:00:41,136 GROWTH IS HAPPENING MEASURING IN 2991 02:00:41,136 --> 02:00:45,073 PROVIDER SERVICE DATA WE CAN 2992 02:00:45,073 --> 02:00:46,708 MEASURE FREE STANDING 2993 02:00:46,708 --> 02:00:48,210 PSYCHIATRIC HOSPITALS AND HARD 2994 02:00:48,210 --> 02:00:49,711 TO MEASURE AND EXTENT THERE HAS 2995 02:00:49,711 --> 02:00:51,013 BEEN GROWTH NATIONALLY IT HAS 2996 02:00:51,013 --> 02:00:52,614 BEEN IN THIS AREA AND 2997 02:00:52,614 --> 02:00:54,116 RESIDENTIAL BEDS HAVE BEEN 2998 02:00:54,116 --> 02:00:56,718 DECLINING AND OTHERS RELATIVELY 2999 02:00:56,718 --> 02:00:59,988 FLAT AND GROWTH FOR FREE 3000 02:00:59,988 --> 02:01:02,124 STANDING IN PSYCHIATRIC PATIENT 3001 02:01:02,124 --> 02:01:04,059 HOSPITAL AND FOR THIS GROUP TO 3002 02:01:04,059 --> 02:01:06,728 UNDERSTAND CHANGES. NEXT SLIDE, 3003 02:01:06,728 --> 02:01:07,195 PLEASE. 3004 02:01:07,195 --> 02:01:09,898 WE SEE LOTS OF VARIATION HERE IN 3005 02:01:09,898 --> 02:01:12,501 BED CAPACITY AND KIND OF LOOKING 3006 02:01:12,501 --> 02:01:15,437 AT THREE MEASURES ONE IS OVERALL 3007 02:01:15,437 --> 02:01:16,338 BEDS COMMUNITY HOSPITALS PER 3008 02:01:16,338 --> 02:01:17,939 HUNDRED THOUSAND POPULATION 3009 02:01:17,939 --> 02:01:22,277 LOOKING ACROSS STATES 10TH TO 3010 02:01:22,277 --> 02:01:23,779 NINETIETH PERCENTILE TAKING THAT 3011 02:01:23,779 --> 02:01:25,847 ONE MEASURE VARIATION 2.0 AND 3012 02:01:25,847 --> 02:01:27,816 KNOW THERE IS BED VARIATION OF 3013 02:01:27,816 --> 02:01:30,352 BED SUPPLY ACROSS STATES NOT TOO 3014 02:01:30,352 --> 02:01:31,953 SURPRISING GIVING YOU IDEA AND 3015 02:01:31,953 --> 02:01:34,222 LOOKING AT FREE STANDING 3016 02:01:34,222 --> 02:01:35,223 PSYCHIATRIC HOSPITALS PER 3017 02:01:35,223 --> 02:01:36,591 HUNDRED THOUSAND THEY ARE 3018 02:01:36,591 --> 02:01:39,594 SMALLER AND GREATER VARIATION 3019 02:01:39,594 --> 02:01:41,296 NINETIETH AND 10TH PERCENTILE 3020 02:01:41,296 --> 02:01:44,166 GOING FROM 2 TO 5 AND MEDICAID 3021 02:01:44,166 --> 02:01:47,102 AVAILABLE IMD BEDS AND THOSE 3022 02:01:47,102 --> 02:01:49,071 THAT DO AND IN DATA AND LOOKING 3023 02:01:49,071 --> 02:01:51,807 AT THOSE BEDS AND 100,000 3024 02:01:51,807 --> 02:01:54,309 MEDICAID ADULT ENROLLEES YOU SEE 3025 02:01:54,309 --> 02:01:55,177 LARGER VARIATION HERE. 3026 02:01:55,177 --> 02:01:57,179 THERE IS A LOT OF DIFFERENCE 3027 02:01:57,179 --> 02:02:00,015 HERE IN HOW -- WHAT CAPACITY 3028 02:02:00,015 --> 02:02:00,782 STATES HAVE ACROSS THESE 3029 02:02:00,782 --> 02:02:03,785 PARTICULAR MEASURES. 3030 02:02:03,785 --> 02:02:06,988 NEXT SLIDE, PLEASE. 3031 02:02:06,988 --> 02:02:09,791 SHOWING YOU FREE STANDING 3032 02:02:09,791 --> 02:02:11,693 PSYCHIATRIC BEDS -- GIVING YOU 3033 02:02:11,693 --> 02:02:14,262 VARIATION ACROSS STATES. 3034 02:02:14,262 --> 02:02:15,497 NEXT SLIDE. 3035 02:02:15,497 --> 02:02:16,798 ONE QUESTION IS ARE STATES WITH 3036 02:02:16,798 --> 02:02:20,001 LOWER BED CAPACITY MORE LIKELY 3037 02:02:20,001 --> 02:02:21,837 TO APPLY FOR SMI WAIVERS WE 3038 02:02:21,837 --> 02:02:24,272 DON'T HAVE FINDING IN THAT 50 3039 02:02:24,272 --> 02:02:26,341 STATES NOT SUPER HIGH POWERED 3040 02:02:26,341 --> 02:02:27,843 THERE MEASURES OF BED CAPACITY 3041 02:02:27,843 --> 02:02:29,945 THERE AND OTHER TYPES OF THINGS 3042 02:02:29,945 --> 02:02:31,913 WE THOUGHT MIGHT EFFECT DECISION 3043 02:02:31,913 --> 02:02:33,749 TO APPLY FOR ONE WAIVER AND 3044 02:02:33,749 --> 02:02:36,151 MEDICAID ENROLLMENT AND MCO 3045 02:02:36,151 --> 02:02:37,853 PENETRATION AND MEASURES OF 3046 02:02:37,853 --> 02:02:39,721 MENTAL HEALTH NEED AND 3047 02:02:39,721 --> 02:02:41,523 PREVALENCE AND WE DON'T SEE 3048 02:02:41,523 --> 02:02:45,093 ANYTHING THAT LOOKS MODESTLY 3049 02:02:45,093 --> 02:02:46,728 CORRELATED FOR DECISIONS TO 3050 02:02:46,728 --> 02:02:48,029 PURSUE WAIVERS AND CORRELATES 3051 02:02:48,029 --> 02:02:50,098 HERE WITH INTERVIEWS SOME STATES 3052 02:02:50,098 --> 02:02:51,900 FEEL THEY HAVE CAPACITY TO DO 3053 02:02:51,900 --> 02:02:54,102 THIS AND GO FOR IT AND SOMETIMES 3054 02:02:54,102 --> 02:02:55,904 DON'T AND NOT STRATEGIC AND 3055 02:02:55,904 --> 02:02:57,339 BASED ON PARTICULAR THINGS 3056 02:02:57,339 --> 02:02:58,807 HAPPENING IN THE STATE AS FAR AS 3057 02:02:58,807 --> 02:02:59,708 WE CAN TELL. 3058 02:02:59,708 --> 02:03:00,342 NEXT SLIDE. 3059 02:03:00,342 --> 02:03:02,978 HERE ARE RESULTS FROM DIFFERENCE 3060 02:03:02,978 --> 02:03:04,112 AND DIFFERENCE ANALYSIS AND 3061 02:03:04,112 --> 02:03:06,481 WON'T GO INTO ALL OF THE METHODS 3062 02:03:06,481 --> 02:03:07,682 BUT RUNNING RESULTS HERE. WE 3063 02:03:07,682 --> 02:03:10,318 ARE LOOKING AT A FEW DIFFERENT 3064 02:03:10,318 --> 02:03:11,319 COMPARISON GROUPS AND FIRST IS 3065 02:03:11,319 --> 02:03:13,789 STATES DOING SMI WAIVERS 3066 02:03:13,789 --> 02:03:15,190 COMPARED TO ALL OTHER STATES AND 3067 02:03:15,190 --> 02:03:17,793 OUTCOMES ARE LOOKING AT FOUR 3068 02:03:17,793 --> 02:03:18,660 DIFFERENT OUTCOMES AND ONE BIG 3069 02:03:18,660 --> 02:03:20,495 OUTCOME AND THREE THAT ARE A 3070 02:03:20,495 --> 02:03:24,499 SUBSET OF THAT AND BEDS IN IMDS 3071 02:03:24,499 --> 02:03:26,835 THAT ACCEPT MEDICAID AND DON'T 3072 02:03:26,835 --> 02:03:28,804 SEE ANYTHING SIGNIFICANT AND 3073 02:03:28,804 --> 02:03:29,838 DECREASE AMONG STATES PER 3074 02:03:29,838 --> 02:03:32,007 HUNDRED THOUSAND INDIVIDUALS AND 3075 02:03:32,007 --> 02:03:33,942 SLIGHT DECREASE IN STATES 3076 02:03:33,942 --> 02:03:35,477 ADOPTING WAIVERS AND LOOKING AT 3077 02:03:35,477 --> 02:03:38,280 RURAL IMDS YOU WOULD PERHAPS SEE 3078 02:03:38,280 --> 02:03:40,215 MORE CHANGES THERE AND DON'T SEE 3079 02:03:40,215 --> 02:03:43,218 CHANGES DECREASE SAME FOR IMDS 3080 02:03:43,218 --> 02:03:44,820 THAT PROVIDE SUD TREATMENT AND 3081 02:03:44,820 --> 02:03:47,022 ONE PAPER SUGGESTING IMDS THAT 3082 02:03:47,022 --> 02:03:49,458 DO BOTH SUD AND SMI TREATMENT 3083 02:03:49,458 --> 02:03:51,493 THAT ARE MORE LIKELY TO ADOPT 3084 02:03:51,493 --> 02:03:53,528 WAIVERS AND DON'T SEE THAT. 3085 02:03:53,528 --> 02:03:56,031 AND NO CHANGE IN FOR PROFIT BEDS 3086 02:03:56,031 --> 02:03:59,167 AND SOME LITERATURE SUGGESTING 3087 02:03:59,167 --> 02:04:01,570 FOR PROFIT CENTERS ARE LIKELY TO 3088 02:04:01,570 --> 02:04:03,972 RESPOND POSITIVELY AND DON'T SEE 3089 02:04:03,972 --> 02:04:04,206 CHANGE. 3090 02:04:04,206 --> 02:04:06,107 NEXT SLIDE, RUNNING COMPARISON 3091 02:04:06,107 --> 02:04:07,442 AGAINST OTHER STATES THAT DIDN'T 3092 02:04:07,442 --> 02:04:09,311 HAVE WAIVERS AND EXCLUDES STATES 3093 02:04:09,311 --> 02:04:11,546 WITH SUD WAIVERS AND LOOKED AT 3094 02:04:11,546 --> 02:04:14,883 STATES WITH SUD WAIVERS 3095 02:04:14,883 --> 02:04:16,017 COMPARING THEM TO STATES WITHOUT 3096 02:04:16,017 --> 02:04:17,586 WAIVERS AND CAN'T PICK UP SIGNAL 3097 02:04:17,586 --> 02:04:23,825 HERE FOR BWAIVERS DRIVING INCRE 3098 02:04:23,825 --> 02:04:24,726 IN BEDS. 3099 02:04:24,726 --> 02:04:27,128 NEXT SLIDE. ARE QUESTIONS HERE 3100 02:04:27,128 --> 02:04:28,897 OPTIMALLY DESIGNED? WE SEE 3101 02:04:28,897 --> 02:04:31,399 UPTAKE IS SLOWER THAN SUD 3102 02:04:31,399 --> 02:04:34,503 WAIVERS AND CONCERNS FROM STATE 3103 02:04:34,503 --> 02:04:35,770 ADMINISTRATORS 30 DAY AVERAGE 3104 02:04:35,770 --> 02:04:38,473 LENGTH OF STAY IS RESTRICTIVE 3105 02:04:38,473 --> 02:04:39,808 AND DOESN'T MATCH CLINICAL 3106 02:04:39,808 --> 02:04:41,309 EVIDENCE AND HAVING SOMEBODY 3107 02:04:41,309 --> 02:04:43,512 WITH SERIOUS MENTAL ILLNESS AND 3108 02:04:43,512 --> 02:04:44,880 HOSPITAL ADMISSION THAT SORT OF 3109 02:04:44,880 --> 02:04:46,982 SAYING THEY CAN ONLY STAY FOR 30 3110 02:04:46,982 --> 02:04:49,284 DAYS DOESN'T MEET CLINICAL NEEDS 3111 02:04:49,284 --> 02:04:51,186 OF PATIENT AND THERE SEEMS TO BE 3112 02:04:51,186 --> 02:04:52,721 CONCERN THAT ADMINISTRATIVE 3113 02:04:52,721 --> 02:04:54,856 BURDEN IS HIGH FOR SUD WAIVERS 3114 02:04:54,856 --> 02:04:57,392 AND WHY STATES ARE NOT ALWAYS 3115 02:04:57,392 --> 02:04:59,027 PURSUING THOSE AND THINK A LOT 3116 02:04:59,027 --> 02:05:01,963 OF CONCERN THAT FOCUS ON IN 3117 02:05:01,963 --> 02:05:03,431 PATIENT BEDS DISTRACT FROM NEED 3118 02:05:03,431 --> 02:05:06,101 TO LOOK AT LARGER CONTINUUM OF 3119 02:05:06,101 --> 02:05:07,702 CARE WITH STEP DOWN BEDS. 3120 02:05:07,702 --> 02:05:09,437 NEXT SLIDE. 3121 02:05:09,437 --> 02:05:10,839 WE WONDER ABOUT THE WAIVER 3122 02:05:10,839 --> 02:05:12,841 KNOWING THERE IS MENTAL HEALTH 3123 02:05:12,841 --> 02:05:14,509 CRISIS OUT THERE AND IMD 3124 02:05:14,509 --> 02:05:16,077 EXCLUSION IS A THORN IN THE SIDE 3125 02:05:16,077 --> 02:05:18,113 FOR SOME BUT IT IS YOU KNOW 3126 02:05:18,113 --> 02:05:19,581 REALLY ONLY PART OF THE PROBLEM. 3127 02:05:19,581 --> 02:05:21,583 IT IS A LITTLE BIT OF A FUNNY 3128 02:05:21,583 --> 02:05:25,153 THING TO HAVE THESE SMI/SMD 3129 02:05:25,153 --> 02:05:26,688 WAIVERS AND ADDRESS A SMALL PART 3130 02:05:26,688 --> 02:05:29,524 OF THE MENTAL HEALTH CONTINUUM 3131 02:05:29,524 --> 02:05:32,227 AND WONDER ABOUT IF WE WANT TO 3132 02:05:32,227 --> 02:05:33,461 USE MEDICAID TO DRIVER CHANGE 3133 02:05:33,461 --> 02:05:35,797 HERE LOOKING AT WAIVERS THAT 3134 02:05:35,797 --> 02:05:37,232 HAVE GONE OUT OF FASHION HERE 3135 02:05:37,232 --> 02:05:39,734 AND TIED TO SPECIFIC PERFORMANCE 3136 02:05:39,734 --> 02:05:42,504 METRICS AND IMPROVING CARE 3137 02:05:42,504 --> 02:05:44,005 DELIVERY ALLOW STATES TO USE 3138 02:05:44,005 --> 02:05:47,409 LOCAL CONTEXT HERE FOCUSING ON 3139 02:05:47,409 --> 02:05:48,610 OUTCOMES RATHER THAN ANCRIMINAL 3140 02:05:48,610 --> 02:05:51,246 ISSUE THAT IS INPATIENT BEDS. 3141 02:05:51,246 --> 02:05:52,080 NEXT SLIDE. 3142 02:05:52,080 --> 02:05:54,849 THINKING A GREAT OPPORTUNITY 3143 02:05:54,849 --> 02:05:56,184 HERE MEDICAID IS LARGEST PAYER 3144 02:05:56,184 --> 02:05:58,987 FOR MENTAL SERVICES OPPORTUNITY 3145 02:05:58,987 --> 02:06:01,957 TO ADDRESS MENTAL HEALTH IN 3146 02:06:01,957 --> 02:06:03,024 LARGE POPULATION AND DIRECT 3147 02:06:03,024 --> 02:06:04,626 RESPONSE IS WARRANTED RATHER 3148 02:06:04,626 --> 02:06:07,462 THAN FOCUSING ON NARROW SLICE OF 3149 02:06:07,462 --> 02:06:10,465 CONTINUUM OF CARE. THANK YOU. 3150 02:06:10,465 --> 02:06:14,369 >> THANK YOU SO MUCH, DR. 3151 02:06:14,369 --> 02:06:15,937 MCCONEL. 3152 02:06:15,937 --> 02:06:21,610 NEXT UP IS DR. CARA ZIBBON FROM 3153 02:06:21,610 --> 02:06:22,110 UNIVERSITY OF MICHIGAN. 3154 02:06:22,110 --> 02:06:25,814 DR. ZIBBON? 3155 02:06:25,814 --> 02:06:27,315 >> THANK YOU EVERYONE FOR HAVING 3156 02:06:27,315 --> 02:06:30,085 ME HERE TODAY. 3157 02:06:30,085 --> 02:06:31,987 NEXT SLIDE. 3158 02:06:31,987 --> 02:06:33,254 I WANTED TO GIVE CONTEXT FOR 3159 02:06:33,254 --> 02:06:35,790 WORK I WAS GOING TO PRESENT THAT 3160 02:06:35,790 --> 02:06:38,293 IS FUNDED BY NATIONAL INSTITUTE 3161 02:06:38,293 --> 02:06:40,829 OF HEALTH INCLUDING NIMH AMONG 3162 02:06:40,829 --> 02:06:42,364 OTHERS SHOWN HERE AND RESULTS I 3163 02:06:42,364 --> 02:06:44,232 WILL PRESENT TODAY ARE FROM 3164 02:06:44,232 --> 02:06:46,134 FIRST STUDY CALLED MATERNAL 3165 02:06:46,134 --> 02:06:48,236 BEHAVIOR HEALTH POLICY 3166 02:06:48,236 --> 02:06:49,671 EVALUATION STUDY WHERE WE 3167 02:06:49,671 --> 02:06:52,874 FOCUSED ON POLICIES EFFECTING 3168 02:06:52,874 --> 02:06:55,010 PERINATAL MOOD ANXIETY DISORDER 3169 02:06:55,010 --> 02:06:56,244 AND DETECTION AND TREATMENT AND 3170 02:06:56,244 --> 02:06:59,414 SEEING HERE WE LOOKED AT OTHER 3171 02:06:59,414 --> 02:07:00,115 CONDITIONS INCLUDING SUBSTANCE 3172 02:07:00,115 --> 02:07:04,052 USE DISORDER AS WELL AS MATERNAL 3173 02:07:04,052 --> 02:07:06,354 MORBIDITY AND MORTALITY AND NEXT 3174 02:07:06,354 --> 02:07:07,422 SLIDE, PLEASE. 3175 02:07:07,422 --> 02:07:08,923 SO TODAY I WILL SHARE FINDINGS 3176 02:07:08,923 --> 02:07:11,059 FOR ONE PARTICULAR PAPER WE DID 3177 02:07:11,059 --> 02:07:14,729 LOOKING AT PERINATAL 3178 02:07:14,729 --> 02:07:15,930 PSYCHOTHERAPY USED IN BEFORE AND 3179 02:07:15,930 --> 02:07:18,366 AFTER TWO DIFFERENT HEALTH 3180 02:07:18,366 --> 02:07:21,936 POLICIES AND LINK IS HERE. 3181 02:07:21,936 --> 02:07:23,471 NEXT SLIDE. 3182 02:07:23,471 --> 02:07:26,841 SO AS WE HAVE BEEN TALKING ABOUT 3183 02:07:26,841 --> 02:07:28,176 INSURANCE COVERAGE CAN IMPACT 3184 02:07:28,176 --> 02:07:30,078 HEALTH CARE ACCESS FOR MANY 3185 02:07:30,078 --> 02:07:31,946 DIFFERENT GROUPS OF PEOPLE THAT 3186 02:07:31,946 --> 02:07:34,315 INCLUDES OBVIOUSLY PEOPLE WITH 3187 02:07:34,315 --> 02:07:36,251 PERRI NATAL MOOD ANXIETY 3188 02:07:36,251 --> 02:07:38,920 DISORDERS SEEKING TO LOOK AT HOW 3189 02:07:38,920 --> 02:07:42,590 BOTH MENTAL HEALTH PARITY AND 3190 02:07:42,590 --> 02:07:44,259 AFFORDABLE CARE ACT IMPACTED 3191 02:07:44,259 --> 02:07:46,428 THESE POPULATIONS AND BOTH COULD 3192 02:07:46,428 --> 02:07:47,295 REPRESENT POLICIES THAT COULD 3193 02:07:47,295 --> 02:07:50,298 HAVE IMPROVED ACCESS TO MENTAL 3194 02:07:50,298 --> 02:07:52,267 HEALTH CARE THAT IS A NATURAL 3195 02:07:52,267 --> 02:07:54,069 EXPERIMENT THAT COULD CHANGE 3196 02:07:54,069 --> 02:07:55,637 ACCESS TO TREATMENT AND WE KNOW 3197 02:07:55,637 --> 02:07:56,971 THAT IN THIS POPULATION THERE 3198 02:07:56,971 --> 02:08:00,308 ARE MANY BARRIERS TO DIAGNOSIS 3199 02:08:00,308 --> 02:08:01,776 TREATMENT AND TREATMENT AND 3200 02:08:01,776 --> 02:08:04,646 HEALTH IMPROVEMENTS. 3201 02:08:04,646 --> 02:08:06,648 NEXT SLIDE, PLEASE. 3202 02:08:06,648 --> 02:08:07,716 SO SPECIFICALLY WE WANTED TO 3203 02:08:07,716 --> 02:08:09,851 UNDERSTAND WHAT ARE THE 3204 02:08:09,851 --> 02:08:12,420 ASSOCIATIONS BETWEEN MENTAL 3205 02:08:12,420 --> 02:08:16,524 HEALTH PARODY AND AFFORDABLE 3206 02:08:16,524 --> 02:08:19,360 HEALTH CARE ACT AND IN THIS 3207 02:08:19,360 --> 02:08:22,230 ANALYSIS WE DOESN'T FOCUS ON 3208 02:08:22,230 --> 02:08:23,465 CRYTOTROPIC -- LOOKING AT 3209 02:08:23,465 --> 02:08:25,600 DELIVERING WOMEN OVERALL AS WELL 3210 02:08:25,600 --> 02:08:28,803 AS SUBSET OF THOSE SPECIFICALLY 3211 02:08:28,803 --> 02:08:30,505 WITH [INDISCERNIBLE]. 3212 02:08:30,505 --> 02:08:31,706 NEXT STEP OR SLIDE. 3213 02:08:31,706 --> 02:08:34,676 IN OUR DATA WE ESTIMATED CHANGES 3214 02:08:34,676 --> 02:08:36,478 IN BOTH ANY PSYCHOTHERAPY USED 3215 02:08:36,478 --> 02:08:38,546 AS WELL AS PER VISIT OUT OF 3216 02:08:38,546 --> 02:08:40,749 POCKET COSTS FOR PSYCHOTHERAPY 3217 02:08:40,749 --> 02:08:42,117 ASSOCIATED WITH TWO POLICIES 3218 02:08:42,117 --> 02:08:44,919 THAT WE USED COMMERCIALLY 3219 02:08:44,919 --> 02:08:47,055 INSURED POPULATION BETWEEN 20 -- 3220 02:08:47,055 --> 02:08:50,692 2007 AND 2019 ACROSS STATES OF 3221 02:08:50,692 --> 02:08:52,260 REPRODUCTIVE AGED WOMEN DEFINED 3222 02:08:52,260 --> 02:08:55,463 BY CDC USING CONTINUOUS PLAN AND 3223 02:08:55,463 --> 02:08:57,665 ENROLLMENT IN THE YEAR AND 3224 02:08:57,665 --> 02:09:00,401 DELIVERY AND STATE OF SOURCE IS 3225 02:09:00,401 --> 02:09:02,003 OPTIMUM DATA. 3226 02:09:02,003 --> 02:09:02,670 NEXT SLIDE. 3227 02:09:02,670 --> 02:09:05,140 USING INTERRUPTED TIME SERIES 3228 02:09:05,140 --> 02:09:08,510 ANALYSIS TO ASSESS CHANGES IN 3229 02:09:08,510 --> 02:09:11,146 PSYCHOTHERAPY VISIT COSTS YEAR 3230 02:09:11,146 --> 02:09:12,147 BEFORE AND AFTER DELIVERY AND 3231 02:09:12,147 --> 02:09:14,382 CODES TO IDENTIFY PSYCHOTHERAPY 3232 02:09:14,382 --> 02:09:17,252 AND USING COPAYMENTS COINSURANCE 3233 02:09:17,252 --> 02:09:20,054 AND DEDUCTIBLES FOR 3234 02:09:20,054 --> 02:09:22,824 PSYCHOTHERAPY VISITS TIED TO 3235 02:09:22,824 --> 02:09:25,393 2019 ADJUSTED INFLATION DOLLARS. 3236 02:09:25,393 --> 02:09:27,028 NEXT SLIDE, PLEASE. 3237 02:09:27,028 --> 02:09:29,264 WE HAD FOUR INDEPENDENT 3238 02:09:29,264 --> 02:09:31,099 VARIABLES INTERESTED TO FOCUS ON 3239 02:09:31,099 --> 02:09:33,401 LEVEL CHANGES BEFORE AND AFTER 3240 02:09:33,401 --> 02:09:35,403 POLICY CHANGES AND TWO FOCUSING 3241 02:09:35,403 --> 02:09:37,739 ON SLOPE CHANGES OVER TIME 3242 02:09:37,739 --> 02:09:38,807 BETWEEN EACH POLICY CHANGE. 3243 02:09:38,807 --> 02:09:42,644 WE INCLUDED PLANS WITH EVIDENCE 3244 02:09:42,644 --> 02:09:44,679 OF ANY COVERAGE BASED ON -- 3245 02:09:44,679 --> 02:09:47,048 BECAUSE WE DIDN'T HAVE BENEFIT 3246 02:09:47,048 --> 02:09:49,651 DESIGN INFORMATION. 3247 02:09:49,651 --> 02:09:54,722 NEXT SLIDE, PLEASE LOOKING AT 3248 02:09:54,722 --> 02:09:56,825 THREE TIME PERIODS BEFORE BOTH 3249 02:09:56,825 --> 02:09:58,159 POLICIES. ONE SECOND TIME 3250 02:09:58,159 --> 02:10:00,328 PERIOD LOOKING AFTER MENTAL 3251 02:10:00,328 --> 02:10:03,364 HEALTH PARODY BEFORE ACA AND 3252 02:10:03,364 --> 02:10:04,999 THIRD BEFORE IMPLEMENTATION OF 3253 02:10:04,999 --> 02:10:07,569 POLICIES ACCOUNTING FOR PATIENT 3254 02:10:07,569 --> 02:10:09,204 DEMOGRAPHIC AND CHARACTERISTIC 3255 02:10:09,204 --> 02:10:11,606 SHOENZ HERE AGE AND RACE 3256 02:10:11,606 --> 02:10:13,975 ETHNICITY AND GEOGRAPHIC REASON 3257 02:10:13,975 --> 02:10:15,977 AND INSURANCE -- MODE OF 3258 02:10:15,977 --> 02:10:17,745 DELIVERY AND DIAGNOSIS OF 3259 02:10:17,745 --> 02:10:19,814 COMORBID MENTAL HEALTH AND 3260 02:10:19,814 --> 02:10:22,483 PHYSICAL HEALTH CONDITIONS. 3261 02:10:22,483 --> 02:10:23,651 NEXT SLIDE, PLEASE. 3262 02:10:23,651 --> 02:10:26,321 SO HERE, THE FIRST SLIDE I'M 3263 02:10:26,321 --> 02:10:28,256 SHOWING IS AMONG ALL DELIVERING 3264 02:10:28,256 --> 02:10:29,757 INDIVIDUALS NOT JUST PEOPLE WITH 3265 02:10:29,757 --> 02:10:31,826 MENTAL HEALTH CONDITIONS THAT 3266 02:10:31,826 --> 02:10:35,563 INCLUDED OVER 800,000 DELIVERIES 3267 02:10:35,563 --> 02:10:36,297 AMONG 700,000 WOMEN. 3268 02:10:36,297 --> 02:10:38,733 AS YOU CAN SEE HERE WITH DARKEST 3269 02:10:38,733 --> 02:10:40,902 LINE AT THE TOP AND MENTAL 3270 02:10:40,902 --> 02:10:43,471 HEALTH PARITY DID NO THE HAVE 3271 02:10:43,471 --> 02:10:44,239 STATISTICALLY SIGNIFICANT 3272 02:10:44,239 --> 02:10:47,275 IMMEDIATE OR SUSTAINED IMPACT ON 3273 02:10:47,275 --> 02:10:49,577 THOSE WHO USE PSYCHOTHERAPY AND 3274 02:10:49,577 --> 02:10:51,279 ACA DID NO THE HAVE IMMEDIATE 3275 02:10:51,279 --> 02:10:53,348 IMPACT AND AFTERWARDS IT 3276 02:10:53,348 --> 02:10:55,250 INCREASED OVER TIME PROPORTION 3277 02:10:55,250 --> 02:10:56,851 OF INDIVIDUALS THAT HAD 3278 02:10:56,851 --> 02:10:58,219 PSYCHOTHERAPY. AGAIN, NOTE HERE 3279 02:10:58,219 --> 02:11:00,255 THIS IS AMONG ALL DELIVERIES NO 3280 02:11:00,255 --> 02:11:01,689 THE JUST PEOPLE WITH MENTAL 3281 02:11:01,689 --> 02:11:03,591 HEALTH CONDITIONS. 3282 02:11:03,591 --> 02:11:05,426 NEXT SLIDE, PLEASE. 3283 02:11:05,426 --> 02:11:08,263 HERE WE LIMITED OUR SAMPLE TO 3284 02:11:08,263 --> 02:11:10,798 OVER 100,000 WOMEN WITH 3285 02:11:10,798 --> 02:11:13,735 PERINATAL MOOD ANXIETY DISORDERS 3286 02:11:13,735 --> 02:11:17,538 AND HERE WE SEE PARITY LEADED TO 3287 02:11:17,538 --> 02:11:20,241 IMMEDIATE DECREASE INCREASE IN 3288 02:11:20,241 --> 02:11:21,676 PSYCHOTHERAPY RECEIPT AND AFTER 3289 02:11:21,676 --> 02:11:23,945 THIS SAW IMMEDIATE AND SUSTAINED 3290 02:11:23,945 --> 02:11:28,049 INCREASES IN USE OF 3291 02:11:28,049 --> 02:11:28,416 PSYCHOTHERAPY. 3292 02:11:28,416 --> 02:11:31,352 NEXT SLIDE. 3293 02:11:31,352 --> 02:11:33,321 HERE, THIS IS THE FINDINGS FROM 3294 02:11:33,321 --> 02:11:34,055 BOTH GROUPS. 3295 02:11:34,055 --> 02:11:36,257 THEY WERE VERY SIMILAR AND AMONG 3296 02:11:36,257 --> 02:11:38,226 ALL DELIVERING WOMEN AND AMONG 3297 02:11:38,226 --> 02:11:40,595 THOSE WITH PERINATAL MOOD 3298 02:11:40,595 --> 02:11:41,696 ANXIETY DISORDERS AND I'M 3299 02:11:41,696 --> 02:11:42,463 SHOWING THIS ONCE. 3300 02:11:42,463 --> 02:11:44,666 THIS IS A BIT OF A NOISY SLIDE 3301 02:11:44,666 --> 02:11:46,501 THAT IS THE MAIN FOCUS OF WHY 3302 02:11:46,501 --> 02:11:47,835 I'M HERE TODAY. 3303 02:11:47,835 --> 02:11:49,637 I WANTED TO JUST EXPLAIN THAT 3304 02:11:49,637 --> 02:11:51,639 THESE LARGE VARIATIONS WE CAN 3305 02:11:51,639 --> 02:11:54,475 SEE THAT I BELIEVE HAS TO DO 3306 02:11:54,475 --> 02:11:56,177 WITH DEDUCTIBLES AT BEGINNING OF 3307 02:11:56,177 --> 02:11:57,545 ANY YEAR THAT PEOPLE WILL HAVE 3308 02:11:57,545 --> 02:12:00,581 MORE OUT OF POCKET COSTS UNTIL 3309 02:12:00,581 --> 02:12:02,917 THEY MEET THEIR DEDUCTIBLE. 3310 02:12:02,917 --> 02:12:06,721 PURPLE LINE DASHED GOING 3311 02:12:06,721 --> 02:12:08,856 HORIZONTALLY IS SHOWING THAT OUT 3312 02:12:08,856 --> 02:12:11,025 OF POCKET PAYMENTS DECREASED 3313 02:12:11,025 --> 02:12:13,828 AFTER MENTAL HEALTH PARITY 3314 02:12:13,828 --> 02:12:14,963 IMPLEMENTATION WITH IMMEDIATE 3315 02:12:14,963 --> 02:12:17,031 AND SUSTAINED INCREASE AFTER THE 3316 02:12:17,031 --> 02:12:19,133 ACA MRAF NEXT SLIDE, PLEASE. 3317 02:12:19,133 --> 02:12:20,935 SO WHY DO WE THINK THIS MIGHT 3318 02:12:20,935 --> 02:12:22,170 HAVE HAPPENED? 3319 02:12:22,170 --> 02:12:23,805 THERE IS A NUMBER OF DIFFERENT 3320 02:12:23,805 --> 02:12:27,008 REASONS FOR FINDINGS 3321 02:12:27,008 --> 02:12:30,111 POTENTIALLY. PARITY AND ACA AS 3322 02:12:30,111 --> 02:12:32,246 WELL LED TO POTENTIALLY INCREASE 3323 02:12:32,246 --> 02:12:33,481 IN DEMAND FOR ACCESS TO 3324 02:12:33,481 --> 02:12:35,583 TREATMENT AND NOT NECESSARILY 3325 02:12:35,583 --> 02:12:37,385 INCREASE OF SUPPLY OF PROVIDERS 3326 02:12:37,385 --> 02:12:39,721 AND WE KNOW THAT THERE IS A 3327 02:12:39,721 --> 02:12:42,857 SHORTAGE OF MENTAL HEALTH 3328 02:12:42,857 --> 02:12:44,192 PROVIDERS NATIONWIDE. 3329 02:12:44,192 --> 02:12:47,295 WE ALSO KNOW THAT THERE WAS A 3330 02:12:47,295 --> 02:12:50,465 NUMBER OF VIOLATIONS OF MENTAL 3331 02:12:50,465 --> 02:12:51,899 HEALTH PARITY AND FINDINGS MIGHT 3332 02:12:51,899 --> 02:12:54,669 HAVE BEEN BIASED TOWARDS NULL. 3333 02:12:54,669 --> 02:12:56,004 WE INCLUDED INDIVIDUALS WITH 3334 02:12:56,004 --> 02:12:57,171 OTHER MENTAL HEALTH CONDITIONS 3335 02:12:57,171 --> 02:12:59,941 AND THINK THAT BENEFITS OVER 3336 02:12:59,941 --> 02:13:01,576 TIME FROM AFFORDABLE CARE ACT 3337 02:13:01,576 --> 02:13:03,611 MIGHT HAVE BEEN BECAUSE OF A 3338 02:13:03,611 --> 02:13:04,912 DECREASING NUMBER OF 3339 02:13:04,912 --> 02:13:06,514 GRANDFATHERED PLANS OVER TIME 3340 02:13:06,514 --> 02:13:08,016 AND WE THINK THERE MIGHT BE 3341 02:13:08,016 --> 02:13:10,218 INCREASE IN USE OF HIGH 3342 02:13:10,218 --> 02:13:11,652 DEDUCTIBLE PLANS THAT COULD HAVE 3343 02:13:11,652 --> 02:13:13,821 IMPACTED OUT OF POCKET PAYMENTS. 3344 02:13:13,821 --> 02:13:15,356 ONE OTHER THING TO NOTE IS ALL 3345 02:13:15,356 --> 02:13:17,992 OF THE ANALYSIS SHOWN HERE WERE 3346 02:13:17,992 --> 02:13:20,128 CONDUCTED PRIOR TO THE PANDEMIC 3347 02:13:20,128 --> 02:13:24,232 AND IT LED TO INCREASE IN USE OF 3348 02:13:24,232 --> 02:13:26,401 TELEMENTAL HEALTH SERVICES 3349 02:13:26,401 --> 02:13:28,236 EXTENDING STUDY AND HAVING 3350 02:13:28,236 --> 02:13:31,005 AVAILABLE DATA TO DO SO WE MIGHT 3351 02:13:31,005 --> 02:13:34,042 HAVE SEEN PATTERNS AND IF SO 3352 02:13:34,042 --> 02:13:35,343 BASICALLY PAPER SHOWED SOME 3353 02:13:35,343 --> 02:13:37,345 MIXED FINDINGS ON CHANGES AND 3354 02:13:37,345 --> 02:13:39,947 ACCESS TO THERAPY AND OUT OF 3355 02:13:39,947 --> 02:13:42,517 POCKET PAYMENT AMONG DELIVERING 3356 02:13:42,517 --> 02:13:45,286 INDIVIDUALS AND THAT THESE WERE 3357 02:13:45,286 --> 02:13:47,255 COMPLEMENTARY AND COMPLEX 3358 02:13:47,255 --> 02:13:50,525 IMPACTS OF POLICIES ON MATERNAL 3359 02:13:50,525 --> 02:13:52,293 MENTAL HEALTH CARE AND USING A 3360 02:13:52,293 --> 02:13:53,861 FEW MINUTES OF REMAINING TIME TO 3361 02:13:53,861 --> 02:13:57,532 POINT TO WORK WE DO IN PERINATAL 3362 02:13:57,532 --> 02:13:59,734 MENTAL HEALTH SERVICES AND 3363 02:13:59,734 --> 02:14:01,069 POLICY PROGRAM AND HERE POLICIES 3364 02:14:01,069 --> 02:14:03,337 IS DOING LOTS OF THE WORK. 3365 02:14:03,337 --> 02:14:05,206 OTHER PROGRAMS FOCUS MORE ON 3366 02:14:05,206 --> 02:14:06,507 CLINICAL TREATMENT AND TEAM IS 3367 02:14:06,507 --> 02:14:09,177 RECENTLY USING THIS DATA TO PUT 3368 02:14:09,177 --> 02:14:11,112 OUT PROFILES WHERE WE HAVE 3369 02:14:11,112 --> 02:14:14,549 LOOKED AT A VARIETY OF DIFFERENT 3370 02:14:14,549 --> 02:14:15,183 SUBCHARACTERISTICS OF PEOPLE 3371 02:14:15,183 --> 02:14:16,884 WITH MENTAL HEALTH CONDITIONS 3372 02:14:16,884 --> 02:14:18,519 AND THIS IS A EXAMPLE FROM 3373 02:14:18,519 --> 02:14:20,254 MICHIGAN AND WE HAVE DONE THEM 3374 02:14:20,254 --> 02:14:21,589 FOR ALL STATES. 3375 02:14:21,589 --> 02:14:23,825 YOU CAN SEE THE LINK BELOW. 3376 02:14:23,825 --> 02:14:25,827 WE BELIEVE THAT ACCESSING 3377 02:14:25,827 --> 02:14:27,728 MATERNAL MENTAL HEALTH DATA CAN 3378 02:14:27,728 --> 02:14:30,164 HELP INFORM POLICY AND PRACTICE 3379 02:14:30,164 --> 02:14:31,732 GOING TO THE NEXT SLIDE YOU WILL 3380 02:14:31,732 --> 02:14:34,068 SEE INITIAL PAGES WHERE WE HAVE 3381 02:14:34,068 --> 02:14:35,470 AGGREGATED A VARIETY OF 3382 02:14:35,470 --> 02:14:37,872 DIFFERENT PUBLICLY AVAILABLE 3383 02:14:37,872 --> 02:14:40,808 DATA SOURCES AND AGAIN IS 3384 02:14:40,808 --> 02:14:41,909 MICHIGAN AND HAVE DONE FOR ALL 3385 02:14:41,909 --> 02:14:45,012 STATES ON ACCESS TO PROVIDERS 3386 02:14:45,012 --> 02:14:46,948 AND MENTAL HEALTH ELSEWHERE AND 3387 02:14:46,948 --> 02:14:49,650 GOING TO THE LINKS YOU CAN SEE 3388 02:14:49,650 --> 02:14:51,219 VARIETY OF DIFFERENT DATA 3389 02:14:51,219 --> 02:14:52,620 SOURCES AND ON NEXT SLIDE WE 3390 02:14:52,620 --> 02:14:55,756 SHOWED THAT WE ACTUALLY 3391 02:14:55,756 --> 02:14:57,825 CONDUCTED USING A DASHBOARD WRU 3392 02:14:57,825 --> 02:15:00,261 CAN CLICK ON MAPS AND SEE NOT 3393 02:15:00,261 --> 02:15:02,663 ONLY VARIATION BY STATE AND BY 3394 02:15:02,663 --> 02:15:05,433 TIME OF PERINATAL MENTAL HEALTH 3395 02:15:05,433 --> 02:15:06,667 CONDITIONS BUT CAN SEE SUBSETS 3396 02:15:06,667 --> 02:15:09,403 AND HERE WE ARE SHOWING 3397 02:15:09,403 --> 02:15:12,507 INDIVIDUALS WITH SUICIDAL 3398 02:15:12,507 --> 02:15:12,974 IDEATION. 3399 02:15:12,974 --> 02:15:14,142 NEXT SLIDE. 3400 02:15:14,142 --> 02:15:15,977 I WANT TO ACKNOWLEDGE MY 3401 02:15:15,977 --> 02:15:19,847 COLLABORATORS AND FUNDERS FOR 3402 02:15:19,847 --> 02:15:20,781 THIS WORK. 3403 02:15:20,781 --> 02:15:23,484 NEXT SLIDE. 3404 02:15:23,484 --> 02:15:24,886 THANK YOU. 3405 02:15:24,886 --> 02:15:29,891 >> THANK YOU SO MUCH, DR. ZIVIN. 3406 02:15:29,891 --> 02:15:33,694 FINAL PRESENTER IS DR. NICOLE 3407 02:15:33,694 --> 02:15:35,730 MAESTAS FROM HARVARD MEDICAL 3408 02:15:35,730 --> 02:15:37,932 SCHOOL. DR. MAESTAS. 3409 02:15:37,932 --> 02:15:39,467 >> THANK SO YOU MUCH. I TRUST 3410 02:15:39,467 --> 02:15:42,737 YOU WILL STOP ME IF YOU CAN'T 3411 02:15:42,737 --> 02:15:43,804 HEAR ME. 3412 02:15:43,804 --> 02:15:46,174 THIS PROJECT LOOKS WE WILL TAKE 3413 02:15:46,174 --> 02:15:48,342 A STEP BACK FOR PAYMENT MODELS 3414 02:15:48,342 --> 02:15:49,644 FOR A MOMENT AND THINK HARDER 3415 02:15:49,644 --> 02:15:51,145 ABOUT WHERE FACILITIES ARE 3416 02:15:51,145 --> 02:15:53,014 LOCATED RELATIVE TO POPULATIONS 3417 02:15:53,014 --> 02:15:54,515 THEY SERVE. 3418 02:15:54,515 --> 02:15:56,250 NEXT SLIDE, PLEASE. 3419 02:15:56,250 --> 02:15:58,286 MOTIVATION HERE IS THE SIMPLE 3420 02:15:58,286 --> 02:15:59,921 FACTS THAT ONE IN 5 ADULTS 3421 02:15:59,921 --> 02:16:02,623 SUFFER FROM MENTAL ILLNESS AND 3422 02:16:02,623 --> 02:16:03,758 FEWER THAN HALF RECEIVE 3423 02:16:03,758 --> 02:16:07,595 TREATMENT AND ARE LONG DELAYS 3424 02:16:07,595 --> 02:16:08,496 BETWEEN SYMPTOM ONSET AND 3425 02:16:08,496 --> 02:16:10,831 TREATMENT AND IN ADDITION UNMET 3426 02:16:10,831 --> 02:16:12,300 NEEDS ARE HIGHER IN CERTAIN 3427 02:16:12,300 --> 02:16:13,301 POPULATIONS THAN OTHERS AND 3428 02:16:13,301 --> 02:16:15,570 THOSE POPULATIONS MAY BE 3429 02:16:15,570 --> 02:16:17,371 DISTRIBUTED GEOGRAPHICALLY IN 3430 02:16:17,371 --> 02:16:19,740 WAYS THAT MAKE THE PROVIDER 3431 02:16:19,740 --> 02:16:21,309 LANDSCAPE I WILL EXPLAIN WHAT I 3432 02:16:21,309 --> 02:16:24,011 MEAN BY THAT IN A MOMENT 3433 02:16:24,011 --> 02:16:25,213 PARTICULARLY RELEVANT FOR THEM. 3434 02:16:25,213 --> 02:16:27,348 THERE IS VERY LITTLE RESEARCH 3435 02:16:27,348 --> 02:16:28,482 ABOUT PROVIDER LANDSCAPE. 3436 02:16:28,482 --> 02:16:30,718 BY THAT I MEAN THE NUMBER, 3437 02:16:30,718 --> 02:16:32,253 LOCATION, ORGANIZATION, AND THE 3438 02:16:32,253 --> 02:16:33,721 FINANCING OF HEALTH CARE 3439 02:16:33,721 --> 02:16:37,558 PROVIDERS ACROSS THE COUNTRY. 3440 02:16:37,558 --> 02:16:40,294 NEXT SLIDE, PLEASE. 3441 02:16:40,294 --> 02:16:42,964 THE PROJECT HERE THAT WE ARE 3442 02:16:42,964 --> 02:16:45,533 CALLING OUR PROVIDER LANDSCAPE 3443 02:16:45,533 --> 02:16:47,735 PROJECT AIMS TO REALLY 3444 02:16:47,735 --> 02:16:50,238 CHARACTERIZE THE US PROVIDER 3445 02:16:50,238 --> 02:16:52,139 LANDSCAPE IN TERMS OF VARIATIONS 3446 02:16:52,139 --> 02:16:54,942 AND ACCESS TO MENTAL HEALTH CARE 3447 02:16:54,942 --> 02:16:56,877 SERVICES AND ALSO THEN ANALYZE 3448 02:16:56,877 --> 02:16:58,713 CAUSAL IMPACTS OF CERTAIN 3449 02:16:58,713 --> 02:17:01,282 FEATURES OF THAT LANDSCAPE AND 3450 02:17:01,282 --> 02:17:03,884 CHANGES IN POLICY AND NOTABLY 3451 02:17:03,884 --> 02:17:05,886 MEDICAID POLICY AND OTHER 3452 02:17:05,886 --> 02:17:07,955 POLICIES THAT MAY ALTER THE 3453 02:17:07,955 --> 02:17:10,591 SPATIAL DISTRIBUTION OF 3454 02:17:10,591 --> 02:17:10,891 FACILITIES. 3455 02:17:10,891 --> 02:17:12,627 AND WHO CAN ACCESS THEM. 3456 02:17:12,627 --> 02:17:15,062 APPROACH WILL ULTIMATELY BE TO 3457 02:17:15,062 --> 02:17:17,231 BRING IN QUASI EXPERIMENTAL 3458 02:17:17,231 --> 02:17:18,633 RESEARCH DESIGNS APPLYING THEM 3459 02:17:18,633 --> 02:17:20,768 TO DIFFERENT POPULATIONS BEING 3460 02:17:20,768 --> 02:17:22,436 OBSERVED IN LARGE DATA BASES 3461 02:17:22,436 --> 02:17:26,807 SUCH AS COMMERCIALLY INSURED OR 3462 02:17:26,807 --> 02:17:29,610 MEDICAID OR MEDICARE PATIENTS 3463 02:17:29,610 --> 02:17:31,312 LEVEL PROVIDER ORGANIZATION AND 3464 02:17:31,312 --> 02:17:32,613 OWNERSHIP DATA AS WELL. TODAY I 3465 02:17:32,613 --> 02:17:34,148 WILL SHOW YOU WE ARE STILL AT 3466 02:17:34,148 --> 02:17:36,517 THE BEGINNING OF THE WORK AND 3467 02:17:36,517 --> 02:17:38,586 WILL SHOW YOU PORTRAITS AND 3468 02:17:38,586 --> 02:17:42,056 FINDINGS SO FAR OF THE PROVIDER 3469 02:17:42,056 --> 02:17:42,356 LANDSCAPE. 3470 02:17:42,356 --> 02:17:42,690 NEXT SLIDE. 3471 02:17:42,690 --> 02:17:44,258 SO OUR SPECIFIC QUESTIONS FOR 3472 02:17:44,258 --> 02:17:45,893 TODAY WILL BE SIMPLY WHAT SHARE 3473 02:17:45,893 --> 02:17:48,596 OF THE US POPULATION LIVES 3474 02:17:48,596 --> 02:17:49,630 WITHIN A REASONABLE DRIVING 3475 02:17:49,630 --> 02:17:52,033 DISTANCE FROM A MENTAL HEALTH 3476 02:17:52,033 --> 02:17:53,167 FACILITY? 3477 02:17:53,167 --> 02:17:54,969 DOES GEOGRAPHIC ACCESS VAR WHY I 3478 02:17:54,969 --> 02:17:57,004 BY INDIVIDUAL AND COUNTY 3479 02:17:57,004 --> 02:17:58,472 CHARACTERISTICS? 3480 02:17:58,472 --> 02:18:00,241 I WILL ALSO SHOW YOU ONE SLIDE 3481 02:18:00,241 --> 02:18:02,476 WHERE WE EXPLORE WHERE 3482 02:18:02,476 --> 02:18:04,245 GEOGRAPHIC ACCESS TO MENTAL 3483 02:18:04,245 --> 02:18:06,047 HEALTH FACILITIES TENDS TO 3484 02:18:06,047 --> 02:18:08,082 CORRELATE WITH MENTAL HEALTH 3485 02:18:08,082 --> 02:18:11,352 NEEDS IN THE POPULATION. 3486 02:18:11,352 --> 02:18:17,425 NEXT SLIDE. 3487 02:18:17,425 --> 02:18:19,060 PLEASE NEXT SLIDE AND USING 3488 02:18:19,060 --> 02:18:20,895 SEVERAL DATA BASES I WON'T GO 3489 02:18:20,895 --> 02:18:23,230 INTO THE DETAILS OF BUT FIRST 3490 02:18:23,230 --> 02:18:27,034 AND PROMINENT ONE IS MENTAL 3491 02:18:27,034 --> 02:18:29,370 HEALTH TRACKING REPOSITORY DATA 3492 02:18:29,370 --> 02:18:30,705 ON MENTAL HEALTH FACILITY 3493 02:18:30,705 --> 02:18:33,341 LOCATIONS AND THEY ARE BROAD AND 3494 02:18:33,341 --> 02:18:34,642 COVER EVERYTHING FROM COMMUNITY 3495 02:18:34,642 --> 02:18:38,012 MENTAL HEALTH CENTERS TO IN 3496 02:18:38,012 --> 02:18:39,513 PATIENT HOSPITALS OF DIFFERENT 3497 02:18:39,513 --> 02:18:40,981 TYPES AND OUTPATIENT CARE 3498 02:18:40,981 --> 02:18:42,483 FACILITIES AND FACILITIES THAT 3499 02:18:42,483 --> 02:18:45,820 ARE A BLENDED MIX OF IN-PATIENT 3500 02:18:45,820 --> 02:18:48,456 AND OUT-PATIENT AND BRINGING 3501 02:18:48,456 --> 02:18:51,192 CENSUS DATA TO BEAR AND 3502 02:18:51,192 --> 02:18:53,260 DEPRESSION PREVALENCE MEASURES 3503 02:18:53,260 --> 02:18:56,263 FROM BIRTH RATES AND HEALTH 3504 02:18:56,263 --> 02:18:59,900 AMERICA. NEXT SLIDE, PLEASE. 3505 02:18:59,900 --> 02:19:01,602 HERE IS A EXAMPLE OF PRIMARY 3506 02:19:01,602 --> 02:19:04,071 METHOD WE ARE USING TO 3507 02:19:04,071 --> 02:19:05,439 CHARACTERIZE ACCESS AND PICTURE 3508 02:19:05,439 --> 02:19:08,275 ON THE RIGHT SHOWS A COUNTY 3509 02:19:08,275 --> 02:19:12,046 COMPOSED OF TWO CENSUS TRACTS, 3510 02:19:12,046 --> 02:19:14,849 TRACTS 1 AND TRACT 2. BLACK DOT 3511 02:19:14,849 --> 02:19:17,952 IN MIDDLE OF THE RED SPLOTCHES 3512 02:19:17,952 --> 02:19:21,188 ARE MENTAL HEALTH FACILITIES AND 3513 02:19:21,188 --> 02:19:23,257 RED SPLOTCH DEFINES A POLYGON 3514 02:19:23,257 --> 02:19:25,459 AROUND EACH FACILITY THAT IS 3515 02:19:25,459 --> 02:19:27,261 DENOTING A DRIVING DISTANCE FROM 3516 02:19:27,261 --> 02:19:29,230 THE FACILITY AND LOOKING HERE AT 3517 02:19:29,230 --> 02:19:32,032 AN EXAMPLE OF A 20-MINUTE 3518 02:19:32,032 --> 02:19:33,534 DRIVING DISTANCE FROM THE 3519 02:19:33,534 --> 02:19:34,835 FACILITY. YOU CAN SEE DRIVING 3520 02:19:34,835 --> 02:19:36,237 DISTANCE IS NICE. YOU DON'T 3521 02:19:36,237 --> 02:19:37,905 WIND UP WITH PERFECT CIRCLES 3522 02:19:37,905 --> 02:19:40,207 AROUND A FACILITY THAT WILL BE 3523 02:19:40,207 --> 02:19:42,042 KIND OF CLOSE FLY DISTANCE AND 3524 02:19:42,042 --> 02:19:43,210 YOU ACTUALLY GET DRIVING 3525 02:19:43,210 --> 02:19:45,146 DISTANCE THAT FACTORS IN ROADS 3526 02:19:45,146 --> 02:19:47,348 AND ROAD CONDITIONS AND TRAFFIC 3527 02:19:47,348 --> 02:19:48,115 CONDITIONS, ET CETERA. 3528 02:19:48,115 --> 02:19:52,219 WE USE RTIS PRO HE TO CONSTRUCT 3529 02:19:52,219 --> 02:19:54,388 POLYGONS AROUND EVERY FACILITY 3530 02:19:54,388 --> 02:19:56,257 ACROSS CENSUS TRACTS AND TO 3531 02:19:56,257 --> 02:19:59,727 CHARACTERIZE SHARE OF THE 3532 02:19:59,727 --> 02:20:00,661 POPULATION THAT LIVES WITHIN 3533 02:20:00,661 --> 02:20:02,229 DRIVING DISTANCE THAT WE CAN DO 3534 02:20:02,229 --> 02:20:05,466 IT AT THE POPULATION OVERALL FOR 3535 02:20:05,466 --> 02:20:07,401 CENSUS TRACK AND BY DIFFERENT 3536 02:20:07,401 --> 02:20:13,441 POPULATION GROUPS SLIDE. 3537 02:20:13,441 --> 02:20:15,109 OKAY. WE WILL ALSO DO 3538 02:20:15,109 --> 02:20:16,477 CORRELATION ANALYSIS AND WON'T 3539 02:20:16,477 --> 02:20:20,247 GET INTO DETAILS OF THOSE GIVEN 3540 02:20:20,247 --> 02:20:21,615 TIME. THEY ARE SIMPLY TO SHOW 3541 02:20:21,615 --> 02:20:23,417 WHETHER NEED MATCHES ACCESS 3542 02:20:23,417 --> 02:20:25,886 ACROSS COUNTIES IN THE US AND 3543 02:20:25,886 --> 02:20:29,890 THESE PICTURES WILL AND FIGURES 3544 02:20:29,890 --> 02:20:32,560 HAVE A VARIETY OF CONTROL 3545 02:20:32,560 --> 02:20:34,195 VARIABLES IN THEM NONTHE 3546 02:20:34,195 --> 02:20:34,895 WILLINGS ARE ASSOCIATION AND 3547 02:20:34,895 --> 02:20:36,764 WILL GET INTO IT IN A MOMENT. 3548 02:20:36,764 --> 02:20:39,967 NEXT SLIDE. 3549 02:20:39,967 --> 02:20:42,503 OKAY. NEXT SLIDE, PLEASE. 3550 02:20:42,503 --> 02:20:44,405 OKAY. SO OUR FIRST FINDING IS 3551 02:20:44,405 --> 02:20:46,507 ACCESS IS HIGH AND IN MOST 3552 02:20:46,507 --> 02:20:48,242 PLACES EXCEPT FOR RURAL AREAS 3553 02:20:48,242 --> 02:20:50,945 AND I WILL FIRST SHOW YOU 3554 02:20:50,945 --> 02:20:52,446 20-MINUTE DRIVE DISTANCE AND WE 3555 02:20:52,446 --> 02:20:54,415 WILL LOOK AT 60-MINUTE DRIVE. 3556 02:20:54,415 --> 02:20:56,784 WHAT YOU ARE SEEING HERE IS A 3557 02:20:56,784 --> 02:21:00,688 MAP OF CENSUS TRACKS WHERE WE 3558 02:21:00,688 --> 02:21:02,723 CODED SHARE OF TRACK AREA AND 3559 02:21:02,723 --> 02:21:05,125 JUST PHYSICAL AREA WITHIN A 3560 02:21:05,125 --> 02:21:07,394 20-MINUTE DRIVE TO A FACILITY. 3561 02:21:07,394 --> 02:21:07,628 OKAY? 3562 02:21:07,628 --> 02:21:10,831 FROM THIS DATA WE CAN ROLL IT UP 3563 02:21:10,831 --> 02:21:14,401 AND ESTIMATE THAT 83.9% OF 3564 02:21:14,401 --> 02:21:15,736 INDIVIDUALS IN THE COUNTRY LIVE 3565 02:21:15,736 --> 02:21:17,605 WITHIN A 20 MINUTE DRIVE OF A 3566 02:21:17,605 --> 02:21:20,107 MENTAL HEALTH FACILITY AND 3567 02:21:20,107 --> 02:21:21,742 BREAKING IT DOWN TO TRACK LEVEL 3568 02:21:21,742 --> 02:21:24,712 WE SEE FOR EXAMPLE 50 -- 18% 3569 02:21:24,712 --> 02:21:27,348 HAVE 50% OR LESS OF AREA WITHIN 3570 02:21:27,348 --> 02:21:31,252 A 20 MINUTE DRIVE AND 72% HAVE 3571 02:21:31,252 --> 02:21:34,188 MORE THAN A 90% SHARE OF THEIR 3572 02:21:34,188 --> 02:21:36,257 AREA WITHIN A 20 MINUTE DRIVE. 3573 02:21:36,257 --> 02:21:39,159 THERE IS VARIATION ACROSS 3574 02:21:39,159 --> 02:21:39,393 TRACKS. 3575 02:21:39,393 --> 02:21:41,495 OVERALL, A VERY HIGH PROPORTION 3576 02:21:41,495 --> 02:21:43,497 OF INDIVIDUALS LIVE WITHIN A 20 3577 02:21:43,497 --> 02:21:46,367 MINUTE DRIVE. NEXT SLIDE. 3578 02:21:46,367 --> 02:21:48,669 NOW YOU CAN REALLY SEE THE 3579 02:21:48,669 --> 02:21:51,539 DIFFERENCE WHEN WE LOOK AT 60 3580 02:21:51,539 --> 02:21:53,641 MINUTE DRIVE FROM A FACILITY AND 3581 02:21:53,641 --> 02:21:54,975 IN THIS VIEW NEARLY EVERYONE IN 3582 02:21:54,975 --> 02:21:56,977 THE COUNTRY HAS A FACILITY OF 3583 02:21:56,977 --> 02:22:00,247 ANY TYPE WITHIN A 60-MINUTE 3584 02:22:00,247 --> 02:22:01,815 DRIVE. 3585 02:22:01,815 --> 02:22:03,517 97.7% OF INDIVIDUALS. 3586 02:22:03,517 --> 02:22:05,953 THERE IS STILL SOME VARIATION AT 3587 02:22:05,953 --> 02:22:07,821 THE TRACK LEVEL WHERE SOME 3588 02:22:07,821 --> 02:22:10,424 TRACKS ARE VIRTUALLY ENCOMPASSED 3589 02:22:10,424 --> 02:22:13,594 WITHIN 60-MINUTE DRIVE FROM A 3590 02:22:13,594 --> 02:22:15,129 FACILITY BUT TRACKS ARE PORTIONS 3591 02:22:15,129 --> 02:22:17,698 OF THEIR AREA THAT ARE NOT 3592 02:22:17,698 --> 02:22:21,435 SERVED BY EVEN A 60-MINUTE 3593 02:22:21,435 --> 02:22:21,769 DRIVE. 3594 02:22:21,769 --> 02:22:23,137 NEXT SLIDE. 3595 02:22:23,137 --> 02:22:25,539 BREAKING THIS OUT BY DEMOGRAPHIC 3596 02:22:25,539 --> 02:22:27,608 GROUP, WE SEE THAT ON THE LEFT 3597 02:22:27,608 --> 02:22:30,144 YOU SEE THE 20-MINUTE DRIVE AND 3598 02:22:30,144 --> 02:22:32,246 RIGHT YOU SEE 60-MINUTE DRIVE 3599 02:22:32,246 --> 02:22:34,782 AND 60-MINUTE VIEW, ALMOST 3600 02:22:34,782 --> 02:22:37,318 EVERYBODY HAS PRETTY GOOD ACCESS 3601 02:22:37,318 --> 02:22:39,620 TO EITHER IN-PATIENT OR 3602 02:22:39,620 --> 02:22:41,221 OUT-PATIENT FACILITY AND BY THAT 3603 02:22:41,221 --> 02:22:43,524 THEY CAN GET THERE WITHIN A 60 3604 02:22:43,524 --> 02:22:45,693 MINUTE DRIVE AND LESS THE CASE 3605 02:22:45,693 --> 02:22:47,795 FOR A 20 MINUTE DRIVE AND SEE 3606 02:22:47,795 --> 02:22:50,097 HERE IN-PATIENT FACILITY ACCESS 3607 02:22:50,097 --> 02:22:52,232 IS LOWER FOR PEOPLE IN SAY THE 3608 02:22:52,232 --> 02:22:54,802 SOUTH FOR WHITE INDIVIDUALS AND 3609 02:22:54,802 --> 02:22:59,139 OVERALL IT IS ONLY A LITTLE BIT 3610 02:22:59,139 --> 02:22:59,807 UNDER 60%. 3611 02:22:59,807 --> 02:23:00,441 NEXT SLIDE. 3612 02:23:00,441 --> 02:23:05,512 >> IF WE BREAK IT APART BY 3613 02:23:05,512 --> 02:23:08,048 IN-PATIENT VERSUS OUT-PATIENT 3614 02:23:08,048 --> 02:23:09,750 FACILITIES, YOU SEE HERE THAT IN 3615 02:23:09,750 --> 02:23:12,252 RURAL AREAS THERE IS AN ACCESS 3616 02:23:12,252 --> 02:23:15,756 GAP PARTICULARLY WITH RESPECT TO 3617 02:23:15,756 --> 02:23:17,057 IN-PATIENT FACILITIES AND 3618 02:23:17,057 --> 02:23:20,160 LIGHT-BLUE BARS SHOW URBAN AREAS 3619 02:23:20,160 --> 02:23:21,629 AND DARK BLUE SHOW RURAL AREAS 3620 02:23:21,629 --> 02:23:23,097 AND LOOKING AT SHARE OF 3621 02:23:23,097 --> 02:23:25,032 INDIVIDUALS WITH MENTAL HEALTH 3622 02:23:25,032 --> 02:23:28,235 FACILITY WITHIN A 60-MINUTE 3623 02:23:28,235 --> 02:23:29,837 DRIVE AND NEARLY EVERYBODY IN A 3624 02:23:29,837 --> 02:23:33,073 RURAL AREA CAN GET TO IN-PATIENT 3625 02:23:33,073 --> 02:23:35,275 FACILITY AND 60% OF THOSE IN 3626 02:23:35,275 --> 02:23:39,880 RURAL AREAS GET TO IN-PATIENT 3627 02:23:39,880 --> 02:23:40,147 FACILITY. 3628 02:23:40,147 --> 02:23:41,682 NEXT SLIDE. 3629 02:23:41,682 --> 02:23:43,017 COEFFICIENTS YOU SEE HERE ARE AS 3630 02:23:43,017 --> 02:23:45,719 I SAID ASSOCIATIONS THAT ARE 3631 02:23:45,719 --> 02:23:48,055 ELASTICITY AND SHOW EFFECT OF 1% 3632 02:23:48,055 --> 02:23:50,924 INCREASE IN COUNTY'S DEPRESSION 3633 02:23:50,924 --> 02:23:52,259 RATE AND OVERALL DEPRESSION RATE 3634 02:23:52,259 --> 02:23:56,897 AND SEVERE ASSESSED DEPRESSION 3635 02:23:56,897 --> 02:23:58,499 RATE BY -- IN THE COUNTY. WE 3636 02:23:58,499 --> 02:24:01,535 ARE DOING IT FOR DIFFERENT SIZED 3637 02:24:01,535 --> 02:24:01,769 AREAS. 3638 02:24:01,769 --> 02:24:04,238 MAIN THING TO FOCUS ON HERE IS 3639 02:24:04,238 --> 02:24:06,140 WHETHER CO EFFICIENT IS POSITIVE 3640 02:24:06,140 --> 02:24:08,242 OR NEGATIVE AND WHILE AGGREGATE 3641 02:24:08,242 --> 02:24:11,845 OVERALL DEPRESSION IS RELATED TO 3642 02:24:11,845 --> 02:24:13,647 HAVING MORE FACILITIES, IT IS 3643 02:24:13,647 --> 02:24:16,550 NOT THE CASE FOR SEVERE 3644 02:24:16,550 --> 02:24:17,251 DEPRESSION AND PARTICULARLY IN 3645 02:24:17,251 --> 02:24:21,288 RURAL AREAS SEEING STATISTICALLY 3646 02:24:21,288 --> 02:24:22,389 SIGNIFICANT NEGATIVE ELASTICITY 3647 02:24:22,389 --> 02:24:25,092 AND FEWER FACILITIES IN RURAL 3648 02:24:25,092 --> 02:24:28,262 AREAS GREATER NEED FOR TREATMENT 3649 02:24:28,262 --> 02:24:29,997 FOR SEVERE DEPRESSION. 3650 02:24:29,997 --> 02:24:31,498 NEXT SLIDE. 3651 02:24:31,498 --> 02:24:34,902 I WILL CONCLUDE. WE SHOW IN THE 3652 02:24:34,902 --> 02:24:37,304 WORK SO FAR LARGE SHARE OF US IS 3653 02:24:37,304 --> 02:24:39,540 WITHIN DRIVING DISTANCE TO 3654 02:24:39,540 --> 02:24:41,075 MENTAL HEALTH FACILITY AND 3655 02:24:41,075 --> 02:24:44,845 ACCESS IS -- IT IS LACKING FOR 3656 02:24:44,845 --> 02:24:47,214 BOTH FOR PEOPLE IN RURAL AREAS 3657 02:24:47,214 --> 02:24:50,551 AND WE DO SEE THAT, AGAIN, 3658 02:24:50,551 --> 02:24:52,252 FACILITY LOCATIONS POSSIBLY 3659 02:24:52,252 --> 02:24:53,654 CORRELATED WITH POPULATION NEED 3660 02:24:53,654 --> 02:24:55,622 EXCEPT IN RURAL AREAS AND 3661 02:24:55,622 --> 02:24:59,159 PARTICULARLY FOR PEOPLE WITH 3662 02:24:59,159 --> 02:25:00,260 SEVERE DEPRESSION. THANK YOU. 3663 02:25:00,260 --> 02:25:02,596 >> THANK YOU SO MUCH. 3664 02:25:02,596 --> 02:25:05,999 WE WILL NOW MOVE INTO OUR 3665 02:25:05,999 --> 02:25:06,767 QUESTION AND ANSWER PERIOD. WE 3666 02:25:06,767 --> 02:25:09,703 WILL TRY TO GO A LITTLE BIT INTO 3667 02:25:09,703 --> 02:25:11,872 THE BREAK UNTIL ABOUT 5 AFTER. 3668 02:25:11,872 --> 02:25:13,674 IF YOU CAN KEEP YOUR ANSWERS 3669 02:25:13,674 --> 02:25:16,076 FAIRLY SHORT TO GET TO A COUPLE 3670 02:25:16,076 --> 02:25:20,214 OF THESE I WOULD APPRECIATE IT. 3671 02:25:20,214 --> 02:25:22,282 DR. HORVITZ LENNON WAS 3672 02:25:22,282 --> 02:25:25,319 ENROLLMENT IN NEW YORK STATE 3673 02:25:25,319 --> 02:25:26,587 VOLUNTARY PAYMENT MODEL 3674 02:25:26,587 --> 02:25:28,789 VOLUNTEER OR SPECIFIC INCLUSION 3675 02:25:28,789 --> 02:25:30,758 CRITERIA AND TALKING ABOUT HOW 3676 02:25:30,758 --> 02:25:33,293 MANY PROVIDERS ENROLLED? 3677 02:25:33,293 --> 02:25:35,095 >> SURE. SO THE POLICY WAS 3678 02:25:35,095 --> 02:25:39,333 ACTUALLY VOLUNTARY. IT WAS NOT 3679 02:25:39,333 --> 02:25:39,800 MANDATORY. 3680 02:25:39,800 --> 02:25:42,202 THE -- THE INCLUSION -- THERE 3681 02:25:42,202 --> 02:25:51,345 WAS NO SPECIFIC INCLUSION 3682 02:25:51,345 --> 02:25:52,980 CRITERIA AND STATE WAS IN BROAD 3683 02:25:52,980 --> 02:25:55,482 ADOPTION OF POLICY AND THAT 3684 02:25:55,482 --> 02:25:57,384 PERIOD AND 5 YEAR WAIVER GOING 3685 02:25:57,384 --> 02:26:01,121 BETWEEN 2015 AND 2020. 3686 02:26:01,121 --> 02:26:02,823 WHAT WE KNOW IS THAT FOR THE 3687 02:26:02,823 --> 02:26:04,258 SPECIFIC POPULATION OF PEOPLE 3688 02:26:04,258 --> 02:26:08,562 WITH SERIOUS MENTAL ILLNESS, 3689 02:26:08,562 --> 02:26:14,668 FIRST YEAR, MOREOVER, HALF OF 3690 02:26:14,668 --> 02:26:16,236 THE BENEFICIARIES WITH SERIOUS 3691 02:26:16,236 --> 02:26:18,372 MENTAL ILLNESS WERE COVERED IN 3692 02:26:18,372 --> 02:26:20,741 VALUE BASED CONTRACTS 56%. 3693 02:26:20,741 --> 02:26:24,278 ALREADY IN 2018, SECOND YEAR, 3694 02:26:24,278 --> 02:26:26,079 PROPORTION WENT UP TO 75%. 3695 02:26:26,079 --> 02:26:28,148 WHAT WE KNOW IS THAT IN THE 3696 02:26:28,148 --> 02:26:31,318 SUBSEQUENT YEARS IT IS ACTUALLY 3697 02:26:31,318 --> 02:26:32,719 APPROACHING 100%. 3698 02:26:32,719 --> 02:26:35,756 >> GREAT. THANK YOU. DR. BAO, 3699 02:26:35,756 --> 02:26:38,592 IN GENERAL, HOW DO SYSTEMS AND 3700 02:26:38,592 --> 02:26:39,827 CLINICS UNDERSTAND PAYMENT 3701 02:26:39,827 --> 02:26:41,929 APPROACHES? WHAT IS OPTIMAL FOR 3702 02:26:41,929 --> 02:26:44,231 THEM? OTHER THAN CONSULTING 3703 02:26:44,231 --> 02:26:45,132 WITH EXCELLENT, EXCELLENT 3704 02:26:45,132 --> 02:26:46,733 EXPERTS LIKE YOURSELF ARE THERE 3705 02:26:46,733 --> 02:26:50,804 OTHER WAYS OR FOLKS THEY CAN 3706 02:26:50,804 --> 02:26:52,239 CONSULT WITH THAT DETERMINE WHAT 3707 02:26:52,239 --> 02:26:53,607 IS OPTIMAL? 3708 02:26:53,607 --> 02:26:56,643 >> GREAT QUESTION. SHORT ANSWER 3709 02:26:56,643 --> 02:26:59,713 IS IN [INDISCERNIBLE] THERE IS A 3710 02:26:59,713 --> 02:27:05,252 HUGE VARIATION ACROSS 100 PLUS 3711 02:27:05,252 --> 02:27:09,089 OTPS IN TERMS OF RESOURCES AND 3712 02:27:09,089 --> 02:27:11,525 CAPACITIES AND THERE ARE FOR 3713 02:27:11,525 --> 02:27:13,594 PROFIT ORGANIZATIONS THAT HAVE 3714 02:27:13,594 --> 02:27:18,799 MULTIPLE CLINICS WHO HIRE 3715 02:27:18,799 --> 02:27:20,500 PRIVATE CONSULTANTS AND BILLING 3716 02:27:20,500 --> 02:27:21,768 CONSULTANTS TO WORK WITH THEM, 3717 02:27:21,768 --> 02:27:23,937 YOU KNOW, ALL THE TIME. THEY 3718 02:27:23,937 --> 02:27:25,606 ARE ON TOP OF PAYMENT CHANGES 3719 02:27:25,606 --> 02:27:28,642 AND HOW TO LEVERAGE PAYMENT 3720 02:27:28,642 --> 02:27:29,643 INNOVATIONS. 3721 02:27:29,643 --> 02:27:31,712 THERE ARE NON-PROFIT AND NEWLY 3722 02:27:31,712 --> 02:27:36,683 ESTABLISHED OTPS IN RESOURCE 3723 02:27:36,683 --> 02:27:39,553 POOR AREAS THAT SERVE AS 3724 02:27:39,553 --> 02:27:41,488 CRITICAL TREATMENT RESOURCES FOR 3725 02:27:41,488 --> 02:27:45,893 THE AREA. THEY SIMPLY DON'T 3726 02:27:45,893 --> 02:27:49,096 HAVE BANDWIDTH AND DON'T HAVE 3727 02:27:49,096 --> 02:27:51,131 DESIGNATED FINANCIAL STAFF TO 3728 02:27:51,131 --> 02:27:53,934 CONDUCT BILLING. 3729 02:27:53,934 --> 02:27:59,973 SO THERE IS A HUGE VARIATION AND 3730 02:27:59,973 --> 02:28:02,309 GENERAL LESSON WE DRAW FROM THIS 3731 02:28:02,309 --> 02:28:04,244 IS WHEN STATE ROLLS 3732 02:28:04,244 --> 02:28:06,446 OUTINOVATIONS IT IS NOT JUST 3733 02:28:06,446 --> 02:28:07,948 BILLING GUIDANCE TYPICALLY. WOW 3734 02:28:07,948 --> 02:28:11,018 SEE A DOCUMENT OF BILLING 3735 02:28:11,018 --> 02:28:12,653 GUIDANCE THAT SOMETIMES IS NOT 3736 02:28:12,653 --> 02:28:16,256 GOING TO BE SUFFICIENT. 3737 02:28:16,256 --> 02:28:17,224 ESPECIALLY FOR THE LESS 3738 02:28:17,224 --> 02:28:20,894 ADVANTAGED ORGANIZERS. 3739 02:28:20,894 --> 02:28:25,632 >> THANK YOU. DR. SEVIN I SEE 3740 02:28:25,632 --> 02:28:27,968 USAGE LATE INCREASED AND WHY DO 3741 02:28:27,968 --> 02:28:30,003 YOU THINK IT LED TO IMMEDIATE 3742 02:28:30,003 --> 02:28:33,040 DECREASE IN PSYCHOTHERAPIUTE 3743 02:28:33,040 --> 02:28:34,975 WILLIZIZATION AMONG FOLKS WITH 3744 02:28:34,975 --> 02:28:35,275 PMAD? 3745 02:28:35,275 --> 02:28:37,277 >> GOOD QUESTION THAT WE 3746 02:28:37,277 --> 02:28:39,913 WONDERED ABOUT THIS. ONE 3747 02:28:39,913 --> 02:28:40,981 HYPOTHESIS IS THAT THERE MIGHT 3748 02:28:40,981 --> 02:28:43,650 NOT HAVE BEEN ENOUGH MENTAL 3749 02:28:43,650 --> 02:28:44,685 HEALTH CLINICIANS TO MEET THE 3750 02:28:44,685 --> 02:28:47,087 NEW DEMAND AND SOMETHING TO 3751 02:28:47,087 --> 02:28:49,389 EXPLORE FURTHER, A LOWER 3752 02:28:49,389 --> 02:28:51,692 STANDARD COSTS AND REIMBURSEMENT 3753 02:28:51,692 --> 02:28:53,093 TO PROVIDERS MIGHT HAVE 3754 02:28:53,093 --> 02:28:54,494 PREVENTED MORE PROVIDERS FROM 3755 02:28:54,494 --> 02:28:57,397 SEEKING TO COME INTO PROVIDE 3756 02:28:57,397 --> 02:28:59,399 CARE AND SO, AGAIN, THAT IS ONE 3757 02:28:59,399 --> 02:29:02,469 REASON AS WELL AS THE LACK OF 3758 02:29:02,469 --> 02:29:05,272 TELEMENTAL HEALTH AT THE TIME. 3759 02:29:05,272 --> 02:29:05,973 THANK YOU. 3760 02:29:05,973 --> 02:29:08,442 >> THANK YOU. 3761 02:29:08,442 --> 02:29:13,747 >> DR. MAESTAS, COULD YOU BE 3762 02:29:13,747 --> 02:29:15,816 SPECIFIC ABOUT DEFINITION OF 3763 02:29:15,816 --> 02:29:18,452 MENTAL HEALTH FACILITY THAT ARE 3764 02:29:18,452 --> 02:29:19,619 LOCATED IN NONSPECIAL HEALTH 3765 02:29:19,619 --> 02:29:21,188 FACILITIES AND DID THE STUDY 3766 02:29:21,188 --> 02:29:21,755 ACCOUNT FOR THAT? 3767 02:29:21,755 --> 02:29:25,158 >> YEAH. IT IS A VERY BROAD 3768 02:29:25,158 --> 02:29:28,895 LIST. YOU KNOW, AT THIS POINT 3769 02:29:28,895 --> 02:29:30,397 WHAT WE ARE ABLE TO TAKE ACCOUNT 3770 02:29:30,397 --> 02:29:32,065 OF IS WHAT LEVEL OF NEED WOULD 3771 02:29:32,065 --> 02:29:34,601 BE FOR GIVEN PAISHIENT AND 3772 02:29:34,601 --> 02:29:36,236 WHETHER THEY COULD ACCESS 3773 02:29:36,236 --> 02:29:38,171 FACILITY THAT WOULD MATCH LEVEL 3774 02:29:38,171 --> 02:29:40,240 OF NEED AND LIST DOESN'T INCLUDE 3775 02:29:40,240 --> 02:29:43,043 COMMUNITY MENTAL HEALTH CENTERS 3776 02:29:43,043 --> 02:29:45,379 AS I SAID AND HEALTH FACILITIES 3777 02:29:45,379 --> 02:29:48,248 OUT PATIENT FACILITIES 3778 02:29:48,248 --> 02:29:52,252 RESIDENTIAL TREATMENT FACILITIES 3779 02:29:52,252 --> 02:29:54,755 PARTIAL HEALTH PHYSICIAN AND DAY 3780 02:29:54,755 --> 02:29:55,689 TREATMENTS AND PSYCHIATRIC 3781 02:29:55,689 --> 02:29:59,059 HOSPITAL AND SEPARATE IN PATIENT 3782 02:29:59,059 --> 02:30:00,193 PSYCHIATRIC UNITS OF GENERAL OR 3783 02:30:00,193 --> 02:30:02,829 STATE HOSPITAL AND DON'T KNOW IF 3784 02:30:02,829 --> 02:30:06,033 IT ENCOMPASSES THE QUESTIONER'S 3785 02:30:06,033 --> 02:30:06,833 SPECIFIC QUESTION ABOUT 3786 02:30:06,833 --> 02:30:08,635 NONSPECIALTY FACILITIES BUT WE 3787 02:30:08,635 --> 02:30:11,738 WERE NOT COUNTER FOR EXAMPLE A 3788 02:30:11,738 --> 02:30:12,406 GENERAL EMERGENCY DEPARTMENT 3789 02:30:12,406 --> 02:30:15,308 WHERE SOMEBODY MIGHT BE BOARDED. 3790 02:30:15,308 --> 02:30:18,645 >> THANK YOU. DR. MCCONNELL, I 3791 02:30:18,645 --> 02:30:19,746 WILL CONCLUDE WITH YOU. 3792 02:30:19,746 --> 02:30:21,515 HOW DO YOU THINK ACCESS TO CARE 3793 02:30:21,515 --> 02:30:25,719 CAN IMPROVED WITHIN CONSTRAINED 3794 02:30:25,719 --> 02:30:27,487 PROVIDER LANDSCAPES AND DELIVERY 3795 02:30:27,487 --> 02:30:28,755 SYSTEMS? WHAT DO YOU SEE AS 3796 02:30:28,755 --> 02:30:30,590 NEXT STEP AFTER YOUR WORK THAT 3797 02:30:30,590 --> 02:30:31,758 SHOWED THAT ONE OPTION DIDN'T 3798 02:30:31,758 --> 02:30:33,760 REALLY DO WHAT WE HOPED IT WOULD 3799 02:30:33,760 --> 02:30:35,829 DO AND WHAT DO YOU SEE AS NEXT 3800 02:30:35,829 --> 02:30:37,597 STEPS AND HOW CAN ACCESS BE 3801 02:30:37,597 --> 02:30:39,232 IMPROVED WITHIN CONSTRAINTS? 3802 02:30:39,232 --> 02:30:41,735 >> I THINK THAT YOU KNOW THERE 3803 02:30:41,735 --> 02:30:44,004 IS DEBATE ABOUT WHETHER THE 3804 02:30:44,004 --> 02:30:45,439 FEDERALIST NATURE OF MEDICAID IS 3805 02:30:45,439 --> 02:30:48,442 A STRENGTH OR WEAKNESS AND TO 3806 02:30:48,442 --> 02:30:50,010 SOME EXTENT STATE'S FLEXIBILITY 3807 02:30:50,010 --> 02:30:52,245 TO OTHERS DOESN'T PROVIDE 3808 02:30:52,245 --> 02:30:53,080 STANDARDIZATION COMING FROM 3809 02:30:53,080 --> 02:30:54,214 FEDERAL LEVEL AND MORE 3810 02:30:54,214 --> 02:30:56,216 INTERESTING PLACE FOR LEVERS TO 3811 02:30:56,216 --> 02:30:59,953 BE APPLIED IS THAT MCO 3812 02:30:59,953 --> 02:31:01,388 PROCUREMENT STAGE AND MOST KNOW 3813 02:31:01,388 --> 02:31:03,023 MEDICAID IS INCREASINGLY 3814 02:31:03,023 --> 02:31:04,958 COVERING PEOPLE THROUGH MCOS AND 3815 02:31:04,958 --> 02:31:06,960 SO STATES HAVE SOME POWER THERE 3816 02:31:06,960 --> 02:31:11,631 TO REQUIRE MCOS TO -- TO PROVIDE 3817 02:31:11,631 --> 02:31:14,634 NETWORKS IN CERTAIN WAYS AND FOR 3818 02:31:14,634 --> 02:31:16,236 EXAMPLE REQUIRE ALL SCHOOL BASED 3819 02:31:16,236 --> 02:31:17,838 MENTAL HEALTH CARE TO BE AND 3820 02:31:17,838 --> 02:31:19,506 NETWORK AND THOSE THINGS AND 3821 02:31:19,506 --> 02:31:22,209 EXPAND PROVIDER SCOPE TO USE 3822 02:31:22,209 --> 02:31:23,810 MORE PEER SUPPORT OR COMMUNITY 3823 02:31:23,810 --> 02:31:26,413 HEALTH WORKERS OR OTHER TYPES OF 3824 02:31:26,413 --> 02:31:27,814 THINGS MAKING IT EASIER FOR 3825 02:31:27,814 --> 02:31:29,416 PEOPLE TO PAY FOR THOSE. 3826 02:31:29,416 --> 02:31:31,451 SO I THINK THAT YOU KNOW 3827 02:31:31,451 --> 02:31:32,886 EXPANDING OUR OPTIONS THERE AND 3828 02:31:32,886 --> 02:31:35,322 THINKING ABOUT REQUIRING MCOS TO 3829 02:31:35,322 --> 02:31:37,023 HAVE SOME OF THE NETWORK MAKING 3830 02:31:37,023 --> 02:31:40,527 IT EASIER FOR PEOPLE TO GET PAID 3831 02:31:40,527 --> 02:31:42,129 BEYOND TRADITIONAL PROVIDER 3832 02:31:42,129 --> 02:31:44,464 TYPES IS ONE WAY TO RESPOND TO 3833 02:31:44,464 --> 02:31:45,432 NEED FOR ACCESS. 3834 02:31:45,432 --> 02:31:46,867 >> THANK YOU. DOES ANYBODY ELSE 3835 02:31:46,867 --> 02:31:49,202 WA PT TO CONTRIBUTE TO THAT 3836 02:31:49,202 --> 02:31:49,736 QUESTION? 3837 02:31:49,736 --> 02:31:52,472 >> YEAH. IF I MAY JUMP, MARY. 3838 02:31:52,472 --> 02:31:57,544 I WOULD JUST ADD THAT IT IS 3839 02:31:57,544 --> 02:31:59,146 CRITICAL THAT PEOPLE WITH 3840 02:31:59,146 --> 02:32:01,314 SERIOUS MENTAL ILLNESS AND 3841 02:32:01,314 --> 02:32:03,750 SUBSTANCE USE DISORDERS REMAIN 3842 02:32:03,750 --> 02:32:07,687 COVERED BY MEDICAID WITH 3843 02:32:07,687 --> 02:32:08,555 MEDICAID BEING AN IMPORTANT 3844 02:32:08,555 --> 02:32:12,259 PAYER FOR THIS POPULATION. 3845 02:32:12,259 --> 02:32:14,427 COVERAGE HAVING LITTLE FRICTION 3846 02:32:14,427 --> 02:32:16,930 FOR THESE INDIVIDUALS WHO MAY 3847 02:32:16,930 --> 02:32:19,366 HAVE DIFFICULTY NEGOTIATING 3848 02:32:19,366 --> 02:32:22,569 COMPLEX APPLICATION PROCESSES AS 3849 02:32:22,569 --> 02:32:27,407 WELL AS ENSURING THAT PROVIDER 3850 02:32:27,407 --> 02:32:29,743 NETWORKS ARE EXTENSIVE AND REAL. 3851 02:32:29,743 --> 02:32:33,880 AND THAT MEDICAID PROVIDERS ARE 3852 02:32:33,880 --> 02:32:35,882 WELL-PAID SO THAT IT MAKES IT 3853 02:32:35,882 --> 02:32:38,318 POSSIBLE FOR THEM TO PROVIDERS 3854 02:32:38,318 --> 02:32:41,521 TO COME INTO THE MEDICAID SPACE. 3855 02:32:41,521 --> 02:32:43,156 >> THANK SO YOU MUCH. I THINK 3856 02:32:43,156 --> 02:32:44,624 THAT THIS WILL CONCLUDE OUR 3857 02:32:44,624 --> 02:32:51,965 PANEL AND THANKS SO MUCH TO OUR 3858 02:32:51,965 --> 02:32:53,565 PRESENTERS. 3859 02:32:53,565 --> 02:32:55,367 HELLO EVERYONE, WELCOME BACK 3860 02:32:55,367 --> 02:32:56,368 FROM BREAK. 3861 02:32:56,368 --> 02:32:59,438 A QUICK REMINDER IF YOU CAN'T 3862 02:32:59,438 --> 02:33:02,941 ACCESS THE Q&A POD E-MAIL YOUR 3863 02:33:02,941 --> 02:33:05,978 QUESTIONS TO CLARE BEARD WITH 3864 02:33:05,978 --> 02:33:10,049 THE SUBJECT LINE WORKSHOP 3865 02:33:10,049 --> 02:33:10,716 QUESTION. 3866 02:33:10,716 --> 02:33:12,651 I'M EXCITED TO ANNOUNCE OUR NEXT 3867 02:33:12,651 --> 02:33:14,386 SESSION ON SPECIAL POPULATIONS 3868 02:33:14,386 --> 02:33:16,188 AND AT THIS TIME I'M THRILLED TO 3869 02:33:16,188 --> 02:33:24,029 HAND IT OVER TO OUR FACILITATOR. 3870 02:33:24,029 --> 02:33:31,170 SHANNON, TAKE IT AWAY. 3871 02:33:31,170 --> 02:33:35,741 >> I HOPE YOUR ENJOYING THE 3872 02:33:35,741 --> 02:33:39,545 PRESENTATION AND I'M SHANNON 3873 02:33:39,545 --> 02:33:40,946 BIELLO AT AN ORGANIZATION CALLED 3874 02:33:40,946 --> 02:33:43,515 SHATTER PROOF AND LOOK AT 3875 02:33:43,515 --> 02:33:46,618 QUALITY OF CARE FOR SUBSTANCE 3876 02:33:46,618 --> 02:33:50,556 USE DISORDER SITES AND OFFERING 3877 02:33:50,556 --> 02:33:52,391 INFORMATION PUBLICALLY THROUGH 3878 02:33:52,391 --> 02:33:54,460 TREATMENT ATLAS. 3879 02:33:54,460 --> 02:33:57,062 I'M JOINED BY A GROUP OF 3880 02:33:57,062 --> 02:33:58,597 ESTEEMED PANELIST I'LL INTRODUCE 3881 02:33:58,597 --> 02:34:00,666 TO YOU BUT FIRST I WANT TO 3882 02:34:00,666 --> 02:34:01,667 EMPHASIZE HAVING A CLEAR 3883 02:34:01,667 --> 02:34:04,369 UNDERSTANDING OF THE NEEDS OF 3884 02:34:04,369 --> 02:34:06,605 SPECIAL POPULATIONS FOR PLANNING 3885 02:34:06,605 --> 02:34:08,807 FOR AND DELIVERING MENTAL HEALTH 3886 02:34:08,807 --> 02:34:09,942 AND SUBSTANCE USE DISORDER 3887 02:34:09,942 --> 02:34:11,410 TREATMENT IS IMPORTANT AS WE 3888 02:34:11,410 --> 02:34:12,478 WORK TO IMPROVE PATIENT 3889 02:34:12,478 --> 02:34:12,811 OUTCOMES. 3890 02:34:12,811 --> 02:34:15,147 ALL OF US HAVE A STRONG 3891 02:34:15,147 --> 02:34:18,450 UNDERSTANDING OF THAT. 3892 02:34:18,450 --> 02:34:21,553 I'VE CERTAINLY SEEN THIS IN MY 3893 02:34:21,553 --> 02:34:27,426 WORK AS WE OFFER SERVICES FOR 3894 02:34:27,426 --> 02:34:30,596 SPECIAL POPULATIONS AND PEOPLE 3895 02:34:30,596 --> 02:34:32,297 CAN MAKE INFORMED DECISIONS 3896 02:34:32,297 --> 02:34:34,099 ABOUT CARE AND EXPLORE TREATMENT 3897 02:34:34,099 --> 02:34:37,569 NEEDS FOR SPECIAL POPULATIONS 3898 02:34:37,569 --> 02:34:38,737 USING A HEALTH ECONOMIC LENS. 3899 02:34:38,737 --> 02:34:40,939 AGAIN, AS MENTIONED I'M THRILLED 3900 02:34:40,939 --> 02:34:44,276 TO WELCOME MY ESTEEMED PANELIST 3901 02:34:44,276 --> 02:34:46,011 AND INTRODUCE THEM IN ORDER OF 3902 02:34:46,011 --> 02:34:47,846 PRESENTATION AND DIVE INTO THEIR 3903 02:34:47,846 --> 02:34:48,247 WORK. 3904 02:34:48,247 --> 02:34:50,015 FIRST WE HAVE DR. SEAN MURPHY 3905 02:34:50,015 --> 02:34:51,784 PROFESSOR AT THE DEPARTMENT OF 3906 02:34:51,784 --> 02:34:56,355 POPULATION HEALTH SCIENCES AT 3907 02:34:56,355 --> 02:34:58,023 WEILL CORNELL MEDICINE AND 3908 02:34:58,023 --> 02:35:00,225 TRAINED HEALTH ECONOMIST WHO 3909 02:35:00,225 --> 02:35:01,527 UNDERSTANDS CHRONIC CONDITION 3910 02:35:01,527 --> 02:35:03,629 MANAGEMENT AND SUBSTANCE USE 3911 02:35:03,629 --> 02:35:04,730 DISORDERS AND DETERMINATES OF 3912 02:35:04,730 --> 02:35:08,367 HUMAN ACCESS OUTCOMES AND 3913 02:35:08,367 --> 02:35:10,769 ADVERSE AFFECTS. 3914 02:35:10,769 --> 02:35:17,676 FOLLOWING WE HAVE DR. ZHU AN 3915 02:35:17,676 --> 02:35:21,313 INTERNIST AND GERIATRICS WHOSE 3916 02:35:21,313 --> 02:35:22,915 RESEARCH FOCUSES ON RESEARCH 3917 02:35:22,915 --> 02:35:26,185 ACCESS AND QUALITY AND FINALLY A 3918 02:35:26,185 --> 02:35:32,491 PRESENTATION FROM DR. CATHERINE 3919 02:35:32,491 --> 02:35:39,398 MACLEAN AND ASSOCIATE EDITOR 3920 02:35:39,398 --> 02:35:41,366 FOCUSSING ON SUBSTANCE USE AND 3921 02:35:41,366 --> 02:35:42,067 PUBLIC POLICY. 3922 02:35:42,067 --> 02:35:44,002 I THINK WE'LL HAVE EXCELLENT 3923 02:35:44,002 --> 02:35:47,973 WORK TO LOOK FORWARD TO THESE 3924 02:35:47,973 --> 02:35:48,340 PRESENTATIONS. 3925 02:35:48,340 --> 02:35:50,409 AFTER THE PRESENTATION CONCLUDES 3926 02:35:50,409 --> 02:35:52,845 WE'LL USE REMAINING TIME FOR 3927 02:35:52,845 --> 02:35:53,111 QUESTIONS. 3928 02:35:53,111 --> 02:35:54,847 SUBMIT ANY QUESTIONS THROUGH THE 3929 02:35:54,847 --> 02:35:57,683 Q&A FEATURE AS MENTIONED AT THE 3930 02:35:57,683 --> 02:35:59,351 BEGINNING OF THE PRESENTATION. 3931 02:35:59,351 --> 02:36:00,786 OF COURSE FEEL FREE TO REACH OUT 3932 02:36:00,786 --> 02:36:02,054 IF YOU HAVE ISSUES WITH THAT AND 3933 02:36:02,054 --> 02:36:04,356 I'LL TURN IT OVER TO DR. MURPHY. 3934 02:36:04,356 --> 02:36:10,562 THANK YOU. 3935 02:36:10,562 --> 02:36:11,597 >> HELLO, EVERYONE. 3936 02:36:11,597 --> 02:36:14,366 IT'S A PRIVILEGE TO BE HERE. 3937 02:36:14,366 --> 02:36:19,238 I'M GOING TO TALK TODAY ABOUT 3938 02:36:19,238 --> 02:36:21,607 WHAT'S GOING ON WITH THE J COIN 3939 02:36:21,607 --> 02:36:23,475 AT WORK PRIMARILY AND THE 3940 02:36:23,475 --> 02:36:26,245 ECONOMIC ASPECT AROUND THAT AND 3941 02:36:26,245 --> 02:36:28,146 SPECIAL CONSIDERATIONS FOR 3942 02:36:28,146 --> 02:36:28,714 INDIVIDUALS ENGAGED IN THE 3943 02:36:28,714 --> 02:36:39,091 CRIMINAL LEGAL SYSTEM. 3944 02:36:46,965 --> 02:36:49,401 THESE ARE THE DIFFERENT STUDIES 3945 02:36:49,401 --> 02:36:52,938 WE WERE ENGAGED WITH DIRECTLY AS 3946 02:36:52,938 --> 02:36:55,841 WELL AS OTHER STUDIES THAT 3947 02:36:55,841 --> 02:37:06,251 HELPED INFORM THE WORK. 3948 02:37:15,294 --> 02:37:17,863 >> YOU MAY WANT TO TURN OFF YOUR 3949 02:37:17,863 --> 02:37:18,096 CAMERA. 3950 02:37:18,096 --> 02:37:18,897 WE'RE HAVING A LITTLE BIT OF A 3951 02:37:18,897 --> 02:37:23,936 LAG WITH YOUR FEED. 3952 02:37:23,936 --> 02:37:25,570 >> YEAH, SORRY. 3953 02:37:25,570 --> 02:37:34,479 MY NETWORK MAY NOT BE THE BEST. 3954 02:37:34,479 --> 02:37:38,483 WHAT I WANT TO HIGHLIGHT ARE KEY 3955 02:37:38,483 --> 02:37:42,054 GAPS IN THE AND WHAT J COIN WILL 3956 02:37:42,054 --> 02:37:43,388 DO TO ADDRESS THIS. 3957 02:37:43,388 --> 02:37:47,893 WE HAVE HIGH RATES OF OPIOID USE 3958 02:37:47,893 --> 02:37:51,096 DISORDER AMONG CRIMINAL 3959 02:37:51,096 --> 02:37:52,364 INDIVIDUALS AND FEW STILL 3960 02:37:52,364 --> 02:37:55,267 RECEIVE EVIDENCE-BASED CARE. 3961 02:37:55,267 --> 02:37:58,837 WE ALSO KNOW THAT CRIMINAL LEGAL 3962 02:37:58,837 --> 02:38:02,674 HEALTH CARE BUDGETS ARE POOR AND 3963 02:38:02,674 --> 02:38:04,376 THERE'S NOT A LOT OF FLEXIBILITY 3964 02:38:04,376 --> 02:38:07,813 SO JAILS AND PRISONS ARE ALREADY 3965 02:38:07,813 --> 02:38:11,249 ON MODEST FIXED ANNUAL BUDGETS 3966 02:38:11,249 --> 02:38:13,585 WITHOUT THE ABILITY TO HAVE 3967 02:38:13,585 --> 02:38:14,186 SEPARATE FUNDING SAY THROUGH 3968 02:38:14,186 --> 02:38:15,988 INSURANCE WITH THE EXCEPTION OF 3969 02:38:15,988 --> 02:38:20,359 A FEW STATES WITH WAIVERS FOR 3970 02:38:20,359 --> 02:38:20,559 THAT. 3971 02:38:20,559 --> 02:38:22,060 AND OF COURSE WE HAVE 3972 02:38:22,060 --> 02:38:22,694 EVALUATIONS. 3973 02:38:22,694 --> 02:38:25,230 THE POINT IS TO INFORM DECISION 3974 02:38:25,230 --> 02:38:26,164 MAKERS AND FOCUS ON EFFICIENCY 3975 02:38:26,164 --> 02:38:28,166 BECAUSE THAT'S HOW WE'LL BE ABLE 3976 02:38:28,166 --> 02:38:30,535 TO REACH THE LARGEST NUMBER OF 3977 02:38:30,535 --> 02:38:32,738 PEOPLE IN NEED. 3978 02:38:32,738 --> 02:38:36,008 AND THAT REQUIRES COST AND 3979 02:38:36,008 --> 02:38:36,608 EFFECTIVENESS OF ALTERNATIVE 3980 02:38:36,608 --> 02:38:43,749 STRATEGIES. 3981 02:38:43,749 --> 02:38:46,985 SO, WHEN IT COMES TO EVIDENCE 3982 02:38:46,985 --> 02:38:49,087 REGARDING THE RELATIVE ECONOMIC 3983 02:38:49,087 --> 02:38:51,189 VALUE OF DIFFERENT O.U.D. 3984 02:38:51,189 --> 02:38:53,125 POPULATIONS AND ACROSS THE 3985 02:38:53,125 --> 02:38:55,060 SETTINGS, WHEN IT COMES DOWN TO 3986 02:38:55,060 --> 02:38:58,497 IT WE DON'T KNOW A WHOLE LOT. 3987 02:38:58,497 --> 02:39:00,365 THERE'S A GREAT DEAL OF 3988 02:39:00,365 --> 02:39:02,901 VARIATION WITH THE STUDY DESIGNS 3989 02:39:02,901 --> 02:39:05,237 AS WELL AS OTHER ASPECT OF WHEN 3990 02:39:05,237 --> 02:39:08,240 WE THINK ABOUT THE PERSPECTIVES, 3991 02:39:08,240 --> 02:39:09,908 HOW WE'RE MEASURING RESOURCES 3992 02:39:09,908 --> 02:39:12,744 AND HOW WE'RE MEASURING 3993 02:39:12,744 --> 02:39:13,078 EFFECTIVENESS. 3994 02:39:13,078 --> 02:39:17,115 THEY'RE ALL COMPLICATIONS THAT 3995 02:39:17,115 --> 02:39:19,117 ARE FACED AS WELL AS 3996 02:39:19,117 --> 02:39:19,584 UNDERSTANDING. 3997 02:39:19,584 --> 02:39:20,719 EVEN WHEN WE HAVE EVIDENCE-BASED 3998 02:39:20,719 --> 02:39:24,056 TREATMENT WHEN IT COMES DOWN TO 3999 02:39:24,056 --> 02:39:26,191 THERE'S A NEED FOR UNDERSTANDING 4000 02:39:26,191 --> 02:39:27,826 WHAT IT WILL TAKE TO GET IT 4001 02:39:27,826 --> 02:39:32,364 START AND GOING IN SETTINGS LIKE 4002 02:39:32,364 --> 02:39:38,737 JAIL OR PRISON. 4003 02:39:38,737 --> 02:39:41,139 GATE COIN IS GOING TO ADDRESS A 4004 02:39:41,139 --> 02:39:43,575 GREAT DEAL OF THESE LIMITATIONS 4005 02:39:43,575 --> 02:39:45,610 AND GREATLY EXPAND WHAT WE KNOW 4006 02:39:45,610 --> 02:39:48,080 ESPECIALLY WITH REGARD TO 4007 02:39:48,080 --> 02:39:50,749 ECONOMIC INFORMATION IN THIS 4008 02:39:50,749 --> 02:39:50,949 AREA. 4009 02:39:50,949 --> 02:39:52,517 IT'S A LARGE PROJECT. 4010 02:39:52,517 --> 02:39:56,288 WE HAVE 12 RESEARCH HUBS AND TWO 4011 02:39:56,288 --> 02:39:57,522 LARGE RESOURCE CENTERS AND 4012 02:39:57,522 --> 02:40:02,594 COVERS MULTIPLE KEY TOUCH POINTS 4013 02:40:02,594 --> 02:40:04,162 FOR INDIVIDUALS INVOLVED IN THE 4014 02:40:04,162 --> 02:40:06,231 CRIMINAL LEGAL SYSTEM AND JAILS 4015 02:40:06,231 --> 02:40:09,468 AND PRISONS, COMMUNITY 4016 02:40:09,468 --> 02:40:11,236 SUPERVISION, DRUG COURTS AND 4017 02:40:11,236 --> 02:40:13,905 I'LL TALK MORE ABOUT THAT IN A 4018 02:40:13,905 --> 02:40:16,208 SECOND AND A RANGE OF 4019 02:40:16,208 --> 02:40:17,742 INTERVENTIONS INCLUDING THERAPY, 4020 02:40:17,742 --> 02:40:22,214 PEER SUPPORT INTERVENTIONS, CASE 4021 02:40:22,214 --> 02:40:24,349 MANAGEMENT, NOVEL COURT MODELS 4022 02:40:24,349 --> 02:40:29,254 AND MY FAVORITE, JCOIN OR NIDA 4023 02:40:29,254 --> 02:40:31,823 HAD THE FORESIGHT TO EMPHASIZE 4024 02:40:31,823 --> 02:40:32,424 RIGOROUS ECONOMIC CONDITIONS 4025 02:40:32,424 --> 02:40:42,934 ACROSS THE DIFFERENT STUDIES. 4026 02:40:45,203 --> 02:40:47,339 BECAUSE EVERY SITE WAS 4027 02:40:47,339 --> 02:40:49,141 ENCOURAGED TO HAVE AN ECONOMIC 4028 02:40:49,141 --> 02:40:50,609 EVALUATION WE ESTABLISHED AN 4029 02:40:50,609 --> 02:40:54,246 INFORMAL WHAT WE CALL A HEALTH 4030 02:40:54,246 --> 02:40:56,248 ECONOMIC ANALYTIC TEAM AND 4031 02:40:56,248 --> 02:40:57,015 WORKED TOGETHER ACROSS THE 4032 02:40:57,015 --> 02:41:00,352 DIFFERENT HUBS TO MAKE SURE WE 4033 02:41:00,352 --> 02:41:02,554 HAD COMMON ECONOMIC MEASURES 4034 02:41:02,554 --> 02:41:04,556 INCLUDING WITH REGARD TO 4035 02:41:04,556 --> 02:41:07,959 MEASURING INTERVENTION COST AND 4036 02:41:07,959 --> 02:41:08,560 HEALTH CARE UTILIZATION AND 4037 02:41:08,560 --> 02:41:11,796 CRIMINAL ACTIVITY AND OTHER 4038 02:41:11,796 --> 02:41:12,664 SOCIAL COSTS. 4039 02:41:12,664 --> 02:41:14,466 WE DID THIS ACROSS THE VARIOUS 4040 02:41:14,466 --> 02:41:14,799 TOUCH POINTS. 4041 02:41:14,799 --> 02:41:16,601 NOT EVERYTHING IS GOING TO BE 4042 02:41:16,601 --> 02:41:19,004 RELEVANT IN EVERY SETTING SO 4043 02:41:19,004 --> 02:41:19,905 THERE WAS CONSIDERATION ACROSS 4044 02:41:19,905 --> 02:41:29,281 ALL THE SETTINGS YOU SEE HERE. 4045 02:41:29,281 --> 02:41:32,184 HAD TO HAVE COMPARISONS 4046 02:41:32,184 --> 02:41:33,718 INCLUDING THE NEW XR 4047 02:41:33,718 --> 02:41:35,453 FORMULATIONS AND WHEN IT COMES 4048 02:41:35,453 --> 02:41:38,089 TO THESE SETTINGS THERE'S A 4049 02:41:38,089 --> 02:41:39,925 GREAT DEAL OF UNCERTAINTY AND 4050 02:41:39,925 --> 02:41:41,092 POTENTIAL PRIZE. 4051 02:41:41,092 --> 02:41:42,594 AGAIN, THOSE ARE VERY EXPENSIVE 4052 02:41:42,594 --> 02:41:44,362 SO WE NEED TO REALLY LOOK AT 4053 02:41:44,362 --> 02:41:49,534 THOSE ALTERNATIVES CAREFULLY. 4054 02:41:49,534 --> 02:41:52,204 AND IN THE SERVICE MODEL 4055 02:41:52,204 --> 02:41:55,073 EXAMPLES AND NAVIGATION AND 4056 02:41:55,073 --> 02:41:59,411 SUPPORT AND TELEHEALTH, CASE 4057 02:41:59,411 --> 02:42:04,049 MANAGE 4058 02:42:04,049 --> 02:42:05,350 MANAGEMENT, TRANSITIONS CLINIC 4059 02:42:05,350 --> 02:42:06,718 AND SYSTEMS LEVELS AS PEOPLE 4060 02:42:06,718 --> 02:42:08,353 EXIT THE COMMUNITY HOW TO 4061 02:42:08,353 --> 02:42:14,759 SUPPORT THEM. 4062 02:42:14,759 --> 02:42:17,429 SO, THE SPECIAL CONSIDERATIONS 4063 02:42:17,429 --> 02:42:22,968 WHEN IT COMES TO FOCUSSING ON 4064 02:42:22,968 --> 02:42:23,702 ECONOMIC EVALUATIONS AND 4065 02:42:23,702 --> 02:42:26,871 DIFFERENT SETTINGS, AS WE KNOW 4066 02:42:26,871 --> 02:42:28,306 WITH REGARD TO THE SECOND PANEL 4067 02:42:28,306 --> 02:42:33,311 AND COST EFFECTIVENESS THE TWO 4068 02:42:33,311 --> 02:42:36,014 PERSPECTIVES ARE THE HEALTH CARE 4069 02:42:36,014 --> 02:42:42,387 SECTOR AND SOCIETAL PERSPECTIVE 4070 02:42:42,387 --> 02:42:45,857 AND WHEN IT COMES TO MAKING SURE 4071 02:42:45,857 --> 02:42:46,925 WE'RE INFORMING OUR DECISION 4072 02:42:46,925 --> 02:42:47,158 MAKERS. 4073 02:42:47,158 --> 02:42:49,694 AND OF COURSE WHEN IT COMES TO 4074 02:42:49,694 --> 02:42:51,997 THESE POPULATIONS, ONE OF OUR 4075 02:42:51,997 --> 02:42:54,032 PRIMARY DECISION MAKERS ARE SAY 4076 02:42:54,032 --> 02:42:56,735 POLICY MAKERS, TAXPAYERS. 4077 02:42:56,735 --> 02:43:00,739 SO NEXT SLIDE. 4078 02:43:00,739 --> 02:43:03,975 AS YOU CAN SEE, WHEN IT CAME 4079 02:43:03,975 --> 02:43:07,012 TIME TO DESIGN THE ECONOMIC 4080 02:43:07,012 --> 02:43:08,747 EVALUATIONS, THIS WAS SOMETHING 4081 02:43:08,747 --> 02:43:11,182 WE PUT A GREAT DEAL OF THOUGHT 4082 02:43:11,182 --> 02:43:14,185 INTO WHAT DO WE NEED TO COLLECT 4083 02:43:14,185 --> 02:43:20,358 AND MEASURE AND VALUE IT SO IT 4084 02:43:20,358 --> 02:43:21,493 SPEAKS DIRECTLY TO THE POLICY 4085 02:43:21,493 --> 02:43:21,826 MAKERS. 4086 02:43:21,826 --> 02:43:22,594 SO THAT WAS A MAJOR 4087 02:43:22,594 --> 02:43:28,500 CONSIDERATION. 4088 02:43:28,500 --> 02:43:31,936 ALSO, OTHER CHALLENGES THAT WE 4089 02:43:31,936 --> 02:43:33,805 WE FACE WITH REGARD TO DATA 4090 02:43:33,805 --> 02:43:34,539 COLLECTION. 4091 02:43:34,539 --> 02:43:37,942 WE HAVE FRAGMENTED SYSTEMS, 4092 02:43:37,942 --> 02:43:44,349 HEALTH CARE DATA ARE RARELY 4093 02:43:44,349 --> 02:43:46,918 LINKED WITH CRIMINAL LEGAL DATA 4094 02:43:46,918 --> 02:43:49,054 AND HAVE INSTRUMENTS SUCH AS 4095 02:43:49,054 --> 02:43:51,990 SERVICES AND CRIMINAL ACTIVITY 4096 02:43:51,990 --> 02:43:53,258 FORMS WITH ADMINISTRATIVE 4097 02:43:53,258 --> 02:43:54,326 RECORDS WHENEVER THEY WERE 4098 02:43:54,326 --> 02:43:55,827 AVAILABLE. 4099 02:43:55,827 --> 02:44:01,466 ONE OF THE THINGS WE SPENT A LOT 4100 02:44:01,466 --> 02:44:03,201 OF TIME ON IS UNIQUE CHALLENGES 4101 02:44:03,201 --> 02:44:06,504 AND WHEN WE TALK ABOUT SOURCES 4102 02:44:06,504 --> 02:44:11,576 IN SUSTAINED IN A PROGRAM WITHIN 4103 02:44:11,576 --> 02:44:14,713 AN A FACILITY SOME THINGS THAT 4104 02:44:14,713 --> 02:44:17,782 COME UP CONSISTENTLY ARE STIGMA 4105 02:44:17,782 --> 02:44:18,516 OF COURSE. 4106 02:44:18,516 --> 02:44:20,285 THERE'S CONSIDERATION FOR STAFF 4107 02:44:20,285 --> 02:44:30,795 TRAINING AND STIGMA REDUCTION. 4108 02:44:31,696 --> 02:44:33,465 DIVERSION OF PREVENTION MEASURES 4109 02:44:33,465 --> 02:44:37,235 IN CARCERAL SETTINGS AND 4110 02:44:37,235 --> 02:44:38,036 REGULATORY COMPLIANCE. 4111 02:44:38,036 --> 02:44:41,272 SO DECISIONS REGARDING WHICH 4112 02:44:41,272 --> 02:44:44,876 WE'LL OFFER AND HOW TO 4113 02:44:44,876 --> 02:44:50,248 ADMINISTER THEM ARE BY LOCAL 4114 02:44:50,248 --> 02:44:52,617 LAWS AND BUDGET CONSTRAINTS AS 4115 02:44:52,617 --> 02:45:01,659 WELL. 4116 02:45:01,659 --> 02:45:03,728 SOME DIFFERENT MODELS WE 4117 02:45:03,728 --> 02:45:06,097 IDENTIFIED WITH REGARD TO 4118 02:45:06,097 --> 02:45:08,700 SUPPORTING INDIVIDUALS WITH OUD 4119 02:45:08,700 --> 02:45:12,303 AND OFF SIGHT MEDICATION, 4120 02:45:12,303 --> 02:45:13,805 ADMINISTRATION, ON SITE 4121 02:45:13,805 --> 02:45:17,275 ADMINISTRATION BY AN EXTERNAL 4122 02:45:17,275 --> 02:45:22,547 PROVIDER, NALTREXONE AND 4123 02:45:22,547 --> 02:45:23,081 LICENSED CORRECTIONAL 4124 02:45:23,081 --> 02:45:28,386 PROEFRLPROEFRLD 4125 02:45:28,386 --> 02:45:32,223 ERS -- PROVIDERS PROVIDING 4126 02:45:32,223 --> 02:45:34,058 BUPRENORPHINE ON SITE AND DO 4127 02:45:34,058 --> 02:45:35,460 THEY BRING THE MEDICATION IN? 4128 02:45:35,460 --> 02:45:38,663 DO THEY BECOME A LICENSED HEALTH 4129 02:45:38,663 --> 02:45:39,030 CARE FACILITY? 4130 02:45:39,030 --> 02:45:40,899 THERE'S DIFFERENT OPTIONS AND 4131 02:45:40,899 --> 02:45:44,369 THEY CAN BE COMBINED AS WELL. 4132 02:45:44,369 --> 02:45:47,539 WHEN IT COMES TO QUITE A FEW 4133 02:45:47,539 --> 02:45:52,177 DIFFERENT PACKAGES THAT CAN BE 4134 02:45:52,177 --> 02:45:55,580 PUTTING TOGETHER WITH THESE IN 4135 02:45:55,580 --> 02:45:56,080 CORRECTIONAL SETTINGS. 4136 02:45:56,080 --> 02:45:58,316 SO ONE OF THE THINGS WE DID 4137 02:45:58,316 --> 02:46:01,753 EARLY ON AND THIS WAS INFORMED 4138 02:46:01,753 --> 02:46:03,988 BY OUR WORK WITH JCOIN AND OUR 4139 02:46:03,988 --> 02:46:07,192 WORK WITH JAILS AND PRISONS 4140 02:46:07,192 --> 02:46:09,494 OUTSIDE OF JCOIN BUT WAS PUTTING 4141 02:46:09,494 --> 02:46:12,964 TOGETHER A BUDGET IMPACT TOOL TO 4142 02:46:12,964 --> 02:46:19,170 HELP INFORM SITES THAT ARE 4143 02:46:19,170 --> 02:46:26,711 GETTING READY TO IMPLEMENT OUD 4144 02:46:26,711 --> 02:46:36,254 WHETHER BY CHOICE OR STATE LAW. 4145 02:46:36,254 --> 02:46:38,890 THIS IS A SCREEN SHOT OF THE 4146 02:46:38,890 --> 02:46:40,725 DASHBOARD AS WELL AS AN EXAMPLE 4147 02:46:40,725 --> 02:46:49,501 OF OTHER SHEETS AND THE 4148 02:46:49,501 --> 02:46:52,170 MANUSCRIPT IS A USER MANUAL, IF 4149 02:46:52,170 --> 02:46:54,572 YOU WILL, IN OPEN ACCESS AND ON 4150 02:46:54,572 --> 02:46:56,708 THE WEBSITE. 4151 02:46:56,708 --> 02:47:00,044 IT'S EASY TO FIND AND IF YOU GO 4152 02:47:00,044 --> 02:47:02,213 TO THE JCOIN WEBSITE YOU CAN 4153 02:47:02,213 --> 02:47:04,716 DOWNLOAD THE TOOL AND ACCESS IT 4154 02:47:04,716 --> 02:47:06,951 FOR FREE SO WE'RE WORKING TO 4155 02:47:06,951 --> 02:47:08,353 PROMOTE THAT AND SUPPORT 4156 02:47:08,353 --> 02:47:12,190 FACILITIES THAT ARE UNDERTAKING 4157 02:47:12,190 --> 02:47:12,690 THIS EN GEFER. 4158 02:47:14,792 --> 02:47:15,293 ENDEAVOR. 4159 02:47:15,293 --> 02:47:19,097 IN ADDITION, WE THEN USE THAT 4160 02:47:19,097 --> 02:47:29,073 TOOL TO DO A COST ANALYSIS WE 4161 02:47:29,073 --> 02:47:29,741 OBSERVED WITH THE MASSACHUSETTS 4162 02:47:29,741 --> 02:47:40,084 JCOIN INTERVENTION. 4163 02:47:51,195 --> 02:47:54,532 YOU CAN SEE THE MOUD INTO 4164 02:47:54,532 --> 02:47:56,167 CARCERAL FACILITIES AND WE 4165 02:47:56,167 --> 02:47:57,268 IDENTIFIED BASICALLY THREE 4166 02:47:57,268 --> 02:48:00,338 DIFFERENT MODELS THAT WERE BEING 4167 02:48:00,338 --> 02:48:03,508 USED ACROSS SITES AT LEAST IN A 4168 02:48:03,508 --> 02:48:05,276 MASSACHUSETTS MODEL. 4169 02:48:05,276 --> 02:48:07,312 A-B WERE SITES THAT CONTRACTED 4170 02:48:07,312 --> 02:48:08,680 FOR METHADONE MAINTENANCE. 4171 02:48:08,680 --> 02:48:13,084 WE DID BUPRENORPHINE AND 4172 02:48:13,084 --> 02:48:14,452 NALTREXONE WITHIN THE FACILITY. 4173 02:48:14,452 --> 02:48:17,989 C AND D WERE SITES THAT 4174 02:48:17,989 --> 02:48:19,824 CONTRACTED FOR BASICALLY ALL 4175 02:48:19,824 --> 02:48:21,859 INDUCTION AND MAINTENANCE WITHIN 4176 02:48:21,859 --> 02:48:24,162 THEIR SITES AND THEN SITES D AND 4177 02:48:24,162 --> 02:48:27,198 F WERE SITES THAT CHOSE TO 4178 02:48:27,198 --> 02:48:29,867 BECOME OTP CERTIFIED. 4179 02:48:29,867 --> 02:48:31,436 INTERESTING THING HERE IS WE SEE 4180 02:48:31,436 --> 02:48:34,305 A GREAT DEAL OF VARIATION WITH 4181 02:48:34,305 --> 02:48:35,940 REGARD TO THE IMPLEMENTATION AND 4182 02:48:35,940 --> 02:48:38,242 SUSTAINING COST BUT ONCE WE 4183 02:48:38,242 --> 02:48:40,745 ACCOUNT FOR THE DIFFERENT 4184 02:48:40,745 --> 02:48:42,146 POPULATIONS AND WE SEE VARIATION 4185 02:48:42,146 --> 02:48:46,684 DECREASES A GREAT DEAL AND WE 4186 02:48:46,684 --> 02:48:48,353 GET TO A PER PATIENT BASIS WHICH 4187 02:48:48,353 --> 02:48:51,623 IS PROMISING REGARDLESS OF WHICH 4188 02:48:51,623 --> 02:48:53,958 MODEL YOU CHOOSE TO GO WITH WE 4189 02:48:53,958 --> 02:48:55,693 BELIEVE YOU CAN KEEP THE PER 4190 02:48:55,693 --> 02:48:56,327 PATIENT COST RELATIVELY LOW AND 4191 02:48:56,327 --> 02:49:01,799 STABLE. 4192 02:49:01,799 --> 02:49:04,335 SO ALONG SIDE OF THAT WE WERE 4193 02:49:04,335 --> 02:49:07,071 ALSO ABLE TO DEVELOP SOME 4194 02:49:07,071 --> 02:49:10,575 RECOMMENDATIONS THAT INCLUDE FOR 4195 02:49:10,575 --> 02:49:12,644 EXAMPLE DOING ENVIRONMENTAL 4196 02:49:12,644 --> 02:49:13,044 SCAN. 4197 02:49:13,044 --> 02:49:16,347 DOING RESEARCH. 4198 02:49:16,347 --> 02:49:17,815 VISIT OTHER JAILS WHO HAVE 4199 02:49:17,815 --> 02:49:19,283 SIMILAR CHARACTERISTICS OF YOURS 4200 02:49:19,283 --> 02:49:21,719 AND LEARN FROM WHAT THEY'VE 4201 02:49:21,719 --> 02:49:21,919 DONE. 4202 02:49:21,919 --> 02:49:24,188 KNOW YOUR COMMUNITY AND BUILD 4203 02:49:24,188 --> 02:49:25,323 RELATIONSHIPS WITH THE OPIOID 4204 02:49:25,323 --> 02:49:26,791 TREATMENT PROVIDERS AND OTHER 4205 02:49:26,791 --> 02:49:27,125 CLINICS. 4206 02:49:27,125 --> 02:49:30,461 SO WHEN IT COMES TIME TO RELEASE 4207 02:49:30,461 --> 02:49:34,699 AND LINK INDIVIDUALS TO CARE, 4208 02:49:34,699 --> 02:49:36,267 THAT'S A MUCH MORE 4209 02:49:36,267 --> 02:49:36,768 STRAIGHTFORWARD PROCESS. 4210 02:49:36,768 --> 02:49:38,136 UNDERSTAND WHAT VENDORS ARE 4211 02:49:38,136 --> 02:49:38,903 OFFERING AND WHETHER IT'S AN 4212 02:49:38,903 --> 02:49:44,742 OPTION YOU SHOULD CONSIDER. 4213 02:49:44,742 --> 02:49:47,412 CONSIDER THE TRADE-OFFS AND 4214 02:49:47,412 --> 02:49:48,112 MAYBE YOU WANT TO COMBINE 4215 02:49:48,112 --> 02:49:51,315 CONSIDERATION THE OPTIONS AND 4216 02:49:51,315 --> 02:49:52,150 TRAINING FOR STAFF. 4217 02:49:52,150 --> 02:49:54,118 AND THEN OF COURSE THINK ABOUT 4218 02:49:54,118 --> 02:49:55,453 SPACE CONSIDERATIONS. 4219 02:49:55,453 --> 02:49:56,587 DO YOU HAVE THE SPACE, FOR 4220 02:49:56,587 --> 02:49:58,122 EXAMPLE, DO YOU HAVE SPACE NOT 4221 02:49:58,122 --> 02:50:00,725 BEING USED, CAN YOU BUILD THE 4222 02:50:00,725 --> 02:50:05,496 DISPENSARIES, IS THAT AN OPTION? 4223 02:50:05,496 --> 02:50:08,633 >> WE'RE AT TIME. 4224 02:50:08,633 --> 02:50:08,900 APOLOGIES. 4225 02:50:08,900 --> 02:50:10,168 >> THANK YOU. 4226 02:50:10,168 --> 02:50:11,836 THAT'S PRETTY MUCH THE END 4227 02:50:11,836 --> 02:50:12,370 ANYWAY. 4228 02:50:12,370 --> 02:50:14,972 THANK YOU. 4229 02:50:14,972 --> 02:50:19,744 >> THANK YOU, DR. MURPHY. 4230 02:50:19,744 --> 02:50:21,145 NEXT WE WILL HAVE A PRESENTATION 4231 02:50:21,145 --> 02:50:31,422 BY DR. JANE ZHU. 4232 02:50:32,290 --> 02:50:40,565 >> GOOD MORNING THANK YOU F. 4233 02:50:40,565 --> 02:50:43,434 I'M GRATEFUL TO NIMHD FOR FUND 4234 02:50:43,434 --> 02:50:44,736 THIG ING THE WORK AND OUR TEAM 4235 02:50:44,736 --> 02:50:45,036 SHOWN HERE. 4236 02:50:45,036 --> 02:50:48,306 4237 02:50:48,539 --> 02:50:50,041 SO, MEDICAID HAS BEEN TALKED 4238 02:50:50,041 --> 02:50:51,809 ABOUT BEFORE AS THE LARGEST PAIR 4239 02:50:51,809 --> 02:50:54,445 FOR MENTAL HEALTH SERVICES IN 4240 02:50:54,445 --> 02:50:55,146 THE U.S. 4241 02:50:55,146 --> 02:50:59,784 ABOUT 2 IN 5 ENROLLEES HAVE A 4242 02:50:59,784 --> 02:51:00,618 DIAGNOSED MENTAL HEALTH OR 4243 02:51:00,618 --> 02:51:01,486 SUBSTANCE USE CONDITION AND 4244 02:51:01,486 --> 02:51:03,054 THEY'RE MORE LIKELY TO HAVE 4245 02:51:03,054 --> 02:51:05,623 SERIOUS MENTAL ILLNESS BUT HALF 4246 02:51:05,623 --> 02:51:07,625 OF THOSE INDIVIDUALS REPORT 4247 02:51:07,625 --> 02:51:08,392 UNMET NEEDS. 4248 02:51:08,392 --> 02:51:10,394 IN THE SETTING MANAGED CARE 4249 02:51:10,394 --> 02:51:12,363 ORGANIZATIONS OR MCOs HAVE HAD A 4250 02:51:12,363 --> 02:51:15,967 GROWING INFLUENCE IN ACCESS TO 4251 02:51:15,967 --> 02:51:21,005 CARE ON HOW CARE'S DELIVERED AND 4252 02:51:21,005 --> 02:51:24,075 87% OF ENROLLEES ARE NOW COVERED 4253 02:51:24,075 --> 02:51:25,309 WITH STATE VARIATION BUT THEY'RE 4254 02:51:25,309 --> 02:51:29,113 STATE CONTRACTED RISK VARYING 4255 02:51:29,113 --> 02:51:30,548 HEALTH PLANS WITH A CAPPED RATE 4256 02:51:30,548 --> 02:51:35,119 TO MANAGE AND DELIVER CARE. 4257 02:51:35,119 --> 02:51:36,621 MCOs CONTROL SEVERAL LEVERS THAT 4258 02:51:36,621 --> 02:51:38,856 CAN SHAPE ACCESS TO CARE. 4259 02:51:38,856 --> 02:51:41,893 THEY INTERSECT WITH STATE 4260 02:51:41,893 --> 02:51:43,928 POLICIES AND PROCUREMENT 4261 02:51:43,928 --> 02:51:47,098 PROCESSES AS WELL AS PLANNED 4262 02:51:47,098 --> 02:51:48,366 STRUCTU 4263 02:51:48,366 --> 02:51:53,471 STRUCTURES CRITICALLY DESIGN AND 4264 02:51:53,471 --> 02:51:55,740 MAINTAIN NETWORKS AND THESE ARE 4265 02:51:55,740 --> 02:51:59,744 THE CLINICIANS AND FACILITIES 4266 02:51:59,744 --> 02:52:01,279 ENROLLEES CAN ACCESS PLANS 4267 02:52:01,279 --> 02:52:02,480 CONTRACT WITH FOR CARE. 4268 02:52:02,480 --> 02:52:05,283 SELECTIVE CONTRACTING CAN 4269 02:52:05,283 --> 02:52:06,918 PROMOTE EFFICIENCY OR QUALITY 4270 02:52:06,918 --> 02:52:09,687 BUT IF YOU HAVE OVERLY NARROW 4271 02:52:09,687 --> 02:52:11,556 NETWORKS YOU RISK REDUCING 4272 02:52:11,556 --> 02:52:12,456 ACCESS AND POTENTIALLY WORSENING 4273 02:52:12,456 --> 02:52:22,333 OUTCOMES. 4274 02:52:22,333 --> 02:52:25,436 IN PRIOR WORK WE'VE SHOWN MENTAL 4275 02:52:25,436 --> 02:52:26,637 HEALTH PROVIDER NETWORKS TEND TO 4276 02:52:26,637 --> 02:52:28,773 BE NARROW ACROSS MARKETS. 4277 02:52:28,773 --> 02:52:32,343 WHEN WE LOOK FOR EXAMPLE AT 4278 02:52:32,343 --> 02:52:35,379 NETWORK BREADTH ACROSS MEDICARE 4279 02:52:35,379 --> 02:52:36,814 ADVANTAGE PLAN HALF OF ALL 4280 02:52:36,814 --> 02:52:39,817 PSYCHIATRIST NETWORKS INCLUDE 4281 02:52:39,817 --> 02:52:44,188 FEWER THAN 25% OF AVAILABLE 4282 02:52:44,188 --> 02:52:45,323 PSYCHIATRIST MARKET AND ACROSS 4283 02:52:45,323 --> 02:52:47,491 STUDIES NETWORKS ARE NARROWER 4284 02:52:47,491 --> 02:52:49,827 THAN FOR PRIMARY CARE OR OTHER 4285 02:52:49,827 --> 02:52:53,664 SPECIALTIES LIKELY DUE TO A 4286 02:52:53,664 --> 02:52:55,967 COMBINATION OF MCO STRATEGIES 4287 02:52:55,967 --> 02:52:56,434 AND WORKFORCE SUPPLY 4288 02:52:56,434 --> 02:53:06,644 CONSTRAINTS. 4289 02:53:07,078 --> 02:53:11,749 QUE KNOW IN OREGON OVER HALF 4290 02:53:11,749 --> 02:53:13,918 LISTED HAD LITTLE CLAIMS 4291 02:53:13,918 --> 02:53:16,420 ACTIVITIES OR NONE AT ALL AND 4292 02:53:16,420 --> 02:53:20,057 WERE GHOST NETWORKS OF PROVIDERS 4293 02:53:20,057 --> 02:53:20,324 INACTIVE. 4294 02:53:20,324 --> 02:53:24,328 SO PROVIDER NETWORKS ARE A KEY 4295 02:53:24,328 --> 02:53:29,567 LEVER THROUGH WHICH MCOs ACCESS 4296 02:53:29,567 --> 02:53:32,169 CARE AND LITTLE IS KNOWN HOW 4297 02:53:32,169 --> 02:53:33,838 THEY'RE STRUCTURED OR IN 4298 02:53:33,838 --> 02:53:35,806 PRACTICE AND IS PROBLEMATIC 4299 02:53:35,806 --> 02:53:37,541 WHERE IN MEDICAID OUT OF NETWORK 4300 02:53:37,541 --> 02:53:45,182 ARE LIMITED FOR ROUTINE CARE. 4301 02:53:45,182 --> 02:53:48,352 OUR WORK IS PART OF A LARGER 4302 02:53:48,352 --> 02:53:53,291 GRANT TO ACCESS MEDICARE CLAIM 4303 02:53:53,291 --> 02:53:57,261 DATA TO LOOK AT AC SIS SAYS AND 4304 02:53:57,261 --> 02:54:03,034 OUTCOMES AND WE HAVE FOUR AIMS. 4305 02:54:03,034 --> 02:54:07,138 EXITS OUT OF MARKETS TO STUDY 4306 02:54:07,138 --> 02:54:10,608 UNVOLUNTARY NETWORK DISRUPTIONS 4307 02:54:10,608 --> 02:54:15,613 AND I'LL FOCUS TO LOOK AT 4308 02:54:15,613 --> 02:54:16,247 FOUNDATIONAL DESCRIPTIVE WORK 4309 02:54:16,247 --> 02:54:19,717 WE'VE DONE IN SUPPORT OF THESE 4310 02:54:19,717 --> 02:54:24,922 AIMS. 4311 02:54:24,922 --> 02:54:27,825 WE USED SOURCES FROM THE TAFT 4312 02:54:27,825 --> 02:54:32,330 FILES, 2016 ON AS MANY KNOW, THE 4313 02:54:32,330 --> 02:54:35,666 TAFT FILES ARE COMPREHENSIVE 4314 02:54:35,666 --> 02:54:37,702 ENROLLEE LEVEL CLAIMS DATA 4315 02:54:37,702 --> 02:54:39,503 RELATED TO SERVICE UTILIZATION 4316 02:54:39,503 --> 02:54:42,740 FOR ALL 50 STATES AND THE 4317 02:54:42,740 --> 02:54:43,941 DISTRICT OF COLUMBIA. 4318 02:54:43,941 --> 02:54:47,878 PART OF THE FILES INCLUDING APL 4319 02:54:47,878 --> 02:54:53,150 OR MANAGED PLAN FILES CLAIMING 4320 02:54:53,150 --> 02:54:53,718 INFORMATION AND PROVIDER 4321 02:54:53,718 --> 02:54:56,354 INFORMATION AND SUPPLEMENT THE 4322 02:54:56,354 --> 02:54:57,421 DATA SOURCES WITH ADDITIONAL 4323 02:54:57,421 --> 02:55:03,928 DATA ON PLAN QUALITY. 4324 02:55:03,928 --> 02:55:08,199 BEYOND NETWORK WE MEASURE 4325 02:55:08,199 --> 02:55:13,104 NETWORKS INCLUDING A PROVIDER TO 4326 02:55:13,104 --> 02:55:17,108 ENROLLEE AND LOOK AT MEASURE 4327 02:55:17,108 --> 02:55:18,642 PROVIDER CHURN AND MEASURE OF 4328 02:55:18,642 --> 02:55:20,277 PANEL SIZE TO UNDERSTAND 4329 02:55:20,277 --> 02:55:22,246 PATTERNS OF ENGAGEMENT WITHIN 4330 02:55:22,246 --> 02:55:24,348 THE MCO NETWORKS. 4331 02:55:24,348 --> 02:55:26,517 WE'VE CONNECTED A FEW KEY 4332 02:55:26,517 --> 02:55:28,285 MILESTONES SO FAR INCLUDING THE 4333 02:55:28,285 --> 02:55:32,456 DEVELOPMENT OF AN MCO CROSSWALK. 4334 02:55:32,456 --> 02:55:36,527 THIS IS A HERCULEAN EFFORT TO 4335 02:55:36,527 --> 02:55:38,662 SIMPLIFY THE TAFT FILES AGAINST 4336 02:55:38,662 --> 02:55:41,866 CMS ENROLLMENT AND MANUAL 4337 02:55:41,866 --> 02:55:44,335 CHECKING THAT IS LED BY THE 4338 02:55:44,335 --> 02:55:47,071 CENTER FOR HEALTH SYSTEMS 4339 02:55:47,071 --> 02:55:48,572 EFFECTIVENESS AND IS A 4340 02:55:48,572 --> 02:55:50,207 CROSS-CENTER EFFORT. 4341 02:55:50,207 --> 02:55:52,743 WE'VE ALSO BUILT ENROLLEE AND 4342 02:55:52,743 --> 02:55:54,345 PROVIDER COHORTS AND LINKED THEM 4343 02:55:54,345 --> 02:55:58,549 TO MCOs AT THE COUNTY LEVEL AND 4344 02:55:58,549 --> 02:56:01,552 PERFORMED DESCRIPTIVE ANALYSIS 4345 02:56:01,552 --> 02:56:03,287 ON NETWORK COMPOSITION AND 4346 02:56:03,287 --> 02:56:03,587 TURNOVER. 4347 02:56:03,587 --> 02:56:04,355 LET'S LOOK AT SELECTED RESULTS 4348 02:56:04,355 --> 02:56:14,365 NOW. 4349 02:56:14,365 --> 02:56:20,071 USING TAF APR AND CLAIMS DATA WE 4350 02:56:20,071 --> 02:56:23,340 ESTIMATED ENROLLMENT. 4351 02:56:23,340 --> 02:56:26,977 THESE RANGE FROM 68% TO 89% AND 4352 02:56:26,977 --> 02:56:36,554 THE LOWEST AMONG PSYCHIATRISTS. 4353 02:56:36,554 --> 02:56:39,323 EVEN AMONGST THE ENROLLED 4354 02:56:39,323 --> 02:56:42,660 PARTICIPATION IS SHALLOW. 4355 02:56:42,660 --> 02:56:45,729 THIS SHOWS PROVIDER ACTIVITY AND 4356 02:56:45,729 --> 02:56:49,300 GHOST S AND CORE S SEE MORE THAN 4357 02:56:49,300 --> 02:56:52,069 150 UNIQUE ENROLLEES AND THE 4358 02:56:52,069 --> 02:56:54,371 PSYCHIATRISTS ARE IN THE MAGENTA 4359 02:56:54,371 --> 02:56:56,974 BARS AND AMONG THEM 43% WERE 4360 02:56:56,974 --> 02:56:58,976 GHOST PROVIDERS AND 15% WERE 4361 02:56:58,976 --> 02:57:01,345 CORE PROVIDERS. 4362 02:57:01,345 --> 02:57:03,681 INTERESTINGLY NOT SHOWN HERE BUT 4363 02:57:03,681 --> 02:57:05,683 ACROSS ALL SPECIALTIES ONE IN 4364 02:57:05,683 --> 02:57:07,151 FIVE GHOST PROVIDERS UP 2019 4365 02:57:07,151 --> 02:57:11,055 MOVE TO A DIFFERENT LEVEL OF 4366 02:57:11,055 --> 02:57:11,555 PROVIDER PARTICIPATION 4367 02:57:11,555 --> 02:57:13,424 SUGGESTING THERE'S SOME FLUIDITY 4368 02:57:13,424 --> 02:57:18,529 IN MEDICAID ENGAGEMENT. 4369 02:57:18,529 --> 02:57:19,697 PSYCHIATRISTS ALSO DELIVER CARE 4370 02:57:19,697 --> 02:57:21,866 TO FAR FEWER ENROLLEES. 4371 02:57:21,866 --> 02:57:24,435 IN 2021 THE MEDIAN PSYCHIATRIST 4372 02:57:24,435 --> 02:57:26,504 SAW THREE UNIQUE ENROLLEES 4373 02:57:26,504 --> 02:57:29,940 COMPARED TO 81 FOR THE MEDIAN 4374 02:57:29,940 --> 02:57:30,341 CARDIOLOGIST. 4375 02:57:30,341 --> 02:57:34,945 IT HIGHLIGHTS THE FUNDAMENTAL 4376 02:57:34,945 --> 02:57:36,347 MISMATCH BETWEEN NETWORK 4377 02:57:36,347 --> 02:57:39,583 INCLUSION AND CARE DELIVERY. 4378 02:57:39,583 --> 02:57:44,155 AT THE MCL LEVEL WE OBSERVE 4379 02:57:44,155 --> 02:57:50,661 PERSISTENT TURN FROM 2020 TO 4380 02:57:50,661 --> 02:57:55,733 2021 THERE WERE 670 MCO COUNTY 4381 02:57:55,733 --> 02:57:58,536 EXITS AND AFFECTING OVER 2 4382 02:57:58,536 --> 02:58:00,704 MILLION ENROLLEES. 4383 02:58:00,704 --> 02:58:04,108 PLAN TURNOVER IS FAIRLY MODEST 4384 02:58:04,108 --> 02:58:04,875 BUT AFFECTS A SUBSTANTIAL NUMBER 4385 02:58:04,875 --> 02:58:07,344 OF ENROLLEES POTENTIALLY 4386 02:58:07,344 --> 02:58:09,313 CREATING DISRUPTIONS IN CARE. 4387 02:58:09,313 --> 02:58:11,482 FINALLY WE FIND EARLY EVIDENCE 4388 02:58:11,482 --> 02:58:15,519 EXISTING MCOs MAY DIFFER FROM 4389 02:58:15,519 --> 02:58:16,587 EXISTING MCOs. 4390 02:58:16,587 --> 02:58:18,689 THERE'S MORE LIKELY TO SERVE NON 4391 02:58:18,689 --> 02:58:21,992 METRO AREAS, TO HAVE LOWER 4392 02:58:21,992 --> 02:58:24,295 ENROLLMENT AND HAVE SMALLER MORE 4393 02:58:24,295 --> 02:58:24,862 CONCENTRATED MENTAL HEALTH 4394 02:58:24,862 --> 02:58:32,570 PROVIDER NETWORKS. 4395 02:58:32,570 --> 02:58:35,940 THERE'S LIMITATIONS TO THE 4396 02:58:35,940 --> 02:58:37,575 DESCRIPTIVE WORK AND RISK OF 4397 02:58:37,575 --> 02:58:40,945 MISCLASSIFICATION OF MCOs AND 4398 02:58:40,945 --> 02:58:41,912 PROVIDERS AS WELL AS RELIANCE ON 4399 02:58:41,912 --> 02:58:44,348 CLAIMS DATA TO INFER 4400 02:58:44,348 --> 02:58:46,450 PARTICIPATION. 4401 02:58:46,450 --> 02:58:49,987 BUT IN SUMMARY, MEDICAID 4402 02:58:49,987 --> 02:58:51,021 PARTICIPATION AMONG 4403 02:58:51,021 --> 02:58:52,356 PSYCHIATRISTS IS GENERALLY 4404 02:58:52,356 --> 02:58:54,425 SHALLOW WITH HIGH RATES OF GHOST 4405 02:58:54,425 --> 02:58:54,758 PSYCHIATRISTS. 4406 02:58:54,758 --> 02:58:56,360 THIS HAS BEEN DEMONSTRATED IN 4407 02:58:56,360 --> 02:58:58,562 THE PAST IN A SINGLE STATE OR 4408 02:58:58,562 --> 02:59:00,464 SELECT STATE BUT WE SEE IT'S 4409 02:59:00,464 --> 02:59:03,901 TRUE ACROSS THE U.S. USING 4410 02:59:03,901 --> 02:59:05,769 NATIONAL CLAIMS DATA AND THIS 4411 02:59:05,769 --> 02:59:07,871 COULD BE DUE TO FACTORS LIKE 4412 02:59:07,871 --> 02:59:10,608 SELECTIVE ENGAGEMENT ON THE PART 4413 02:59:10,608 --> 02:59:12,776 OF PHYSICIANS OR GROUP-BASED 4414 02:59:12,776 --> 02:59:14,778 CONTRACTING PRACTICES. 4415 02:59:14,778 --> 02:59:17,548 MCO CHURN IS MODEST BUT 4416 02:59:17,548 --> 02:59:18,916 MEANINGFUL SUPPORTING OUR 4417 02:59:18,916 --> 02:59:21,785 PLANNED ANALYTIC APPROACH IN OUR 4418 02:59:21,785 --> 02:59:23,053 MAIN AIMS. 4419 02:59:23,053 --> 02:59:25,155 WHILE WE DIDN'T COVER THESE WE 4420 02:59:25,155 --> 02:59:27,024 SEE NETWORK COMPOSITION AND WE 4421 02:59:27,024 --> 02:59:29,960 SEE SOME NETWORKS RELY 4422 02:59:29,960 --> 02:59:32,229 RELATIVELY MORE ON MENTAL HEALTH 4423 02:59:32,229 --> 02:59:34,131 PRESCRIBERS AND OTHERS MORE ON 4424 02:59:34,131 --> 02:59:37,167 THERAPISTS AND COUNSELORS SO 4425 02:59:37,167 --> 02:59:38,435 WHAT METRICS CORRELATE WITH USE 4426 02:59:38,435 --> 02:59:40,337 AND QUALITY OF CARE ARE 4427 02:59:40,337 --> 02:59:41,972 QUESTIONS WE'LL BE EVALUATING IN 4428 02:59:41,972 --> 02:59:47,311 SUBSEQUENT AIMS OF THE PROJECT. 4429 02:59:47,311 --> 02:59:51,148 FINALLY, THIS WORK UNDER SCORES 4430 02:59:51,148 --> 02:59:54,351 THAT STATES AS BROUGHT UP IN 4431 02:59:54,351 --> 02:59:56,120 PRIOR TENSIONS HAVE POWERFUL 4432 02:59:56,120 --> 03:00:02,192 TOOLS TO INFLUENCE MCOs, 4433 03:00:02,192 --> 03:00:06,430 ADEQUACY REQUIREMENTS AND 4434 03:00:06,430 --> 03:00:08,098 VARIATION IN PARTICULAR IN 4435 03:00:08,098 --> 03:00:11,769 NETWORK STRUCTURE CAN BE 4436 03:00:11,769 --> 03:00:17,041 LEVERAGED IN RESEARCH TOE BETTER 4437 03:00:17,041 --> 03:00:18,475 TARGET OVERSIGHT AND SHARE 4438 03:00:18,475 --> 03:00:20,644 LEARNING AND HOPEFULLY IMPROVE 4439 03:00:20,644 --> 03:00:22,746 ACCESS TO QUALITY MENTAL HEALTH 4440 03:00:22,746 --> 03:00:23,280 SERVICES IN THE MEDICAID 4441 03:00:23,280 --> 03:00:24,348 PROGRAM. 4442 03:00:24,348 --> 03:00:32,890 THANKS SO MUCH. 4443 03:00:32,890 --> 03:00:34,358 >> THANK YOU, DR. ZHU. 4444 03:00:34,358 --> 03:00:36,360 I WANT TO REMIND EVERYONE ALL 4445 03:00:36,360 --> 03:00:39,596 OUR PARTICIPANTS IF YOU HAVE 4446 03:00:39,596 --> 03:00:40,698 QUESTIONS PLEASE SUBMIT THEM 4447 03:00:40,698 --> 03:00:41,965 THROUGH THE Q&A FUNCTIONALITY 4448 03:00:41,965 --> 03:00:51,742 BECAUSE IT HELPS US GET THEM KU 4449 03:00:52,409 --> 03:00:56,013 QUEUED UP FOR THE QUESTION AND 4450 03:00:56,013 --> 03:00:59,116 ANSWER SECTION AND WITH THAT 4451 03:00:59,116 --> 03:00:59,616 DR. MACLEAN. 4452 03:00:59,616 --> 03:01:01,685 >> THANK YOU TO THE ORGANIZERS. 4453 03:01:01,685 --> 03:01:06,523 IT'S BEEN A FANTASTIC WORKSHOP 4454 03:01:06,523 --> 03:01:08,492 I'M LEARNING A LOT SO THANK YOU. 4455 03:01:08,492 --> 03:01:10,694 WHAT I'LL BE TALKING ABOUT TODAY 4456 03:01:10,694 --> 03:01:12,563 IS WHAT I'M CALLING A SLIGHTLY 4457 03:01:12,563 --> 03:01:14,131 DIFFERENT TITLE THAN ON THE 4458 03:01:14,131 --> 03:01:15,399 WORKSHOP AGENDA SO APOLOGIES BUT 4459 03:01:15,399 --> 03:01:18,469 THE CONTENT IS THE SAME. 4460 03:01:18,469 --> 03:01:21,939 TIME FOR MENTAL HEALTH CARE, 4461 03:01:21,939 --> 03:01:23,874 EVIDENCE FROM PAID SICK LEAVE 4462 03:01:23,874 --> 03:01:25,008 MANDATES. 4463 03:01:25,008 --> 03:01:31,749 I'D LIKE TO THANK MY AUTHORS. 4464 03:01:31,749 --> 03:01:34,151 I'D ALSO LIKE TO ACKNOWLEDGE 4465 03:01:34,151 --> 03:01:36,353 NIMHD FOR FUNDING THE WORK. 4466 03:01:36,353 --> 03:01:40,357 WE'RE GRATEFUL AND USING 4467 03:01:40,357 --> 03:01:42,359 RESTRICTED USE BUREAU OF LABOR 4468 03:01:42,359 --> 03:01:44,862 STATISTICS DATA AND OUR FINDINGS 4469 03:01:44,862 --> 03:01:45,596 DO NOT REPRESENT THE VIEWS OF 4470 03:01:45,596 --> 03:01:50,501 THOSE ENTITIES. 4471 03:01:50,501 --> 03:01:53,437 A BIT OF MOTIVATION, I PROBABLY 4472 03:01:53,437 --> 03:01:56,206 DON'T HAVE TO SPEND MUCH TIME 4473 03:01:56,206 --> 03:01:58,041 GIVEN THE AUDIENCE BUT MENTAL 4474 03:01:58,041 --> 03:01:58,876 HEALTH DISORDERS ARE COMMON IN 4475 03:01:58,876 --> 03:02:00,344 THE UNITED STATES ONE IN FIVE 4476 03:02:00,344 --> 03:02:05,315 INDIVIDUALS EXPERIENCE THE 4477 03:02:05,315 --> 03:02:07,351 CONDITIONS. 4478 03:02:07,351 --> 03:02:08,352 THERE'S TREATMENTS AVAILABLE FOR 4479 03:02:08,352 --> 03:02:09,319 MENTAL HEALTH CARE AND THERE'S 4480 03:02:09,319 --> 03:02:10,854 DIFFERENT TYPES OF MENTAL HEALTH 4481 03:02:10,854 --> 03:02:14,658 CARE AND THEY'RE VARY THEIR TIME 4482 03:02:14,658 --> 03:02:16,093 INTENSITY THE TIME IT TAKES TO 4483 03:02:16,093 --> 03:02:17,194 RECEIVE THAT TIME OF CARE. 4484 03:02:17,194 --> 03:02:21,899 WE CAN THINK OF A MEDICAID 4485 03:02:21,899 --> 03:02:22,699 MANAGEMENT SYSTEM ROUGHLY 15 4486 03:02:22,699 --> 03:02:28,205 MINUTES OR THINK ABOUT LONGER 4487 03:02:28,205 --> 03:02:28,839 DURATI 4488 03:02:28,839 --> 03:02:35,579 DURATIONS OR RESIDENTIAL COSTS 4489 03:02:35,579 --> 03:02:39,416 AND THEY MAY BE SALIENT FOR 4490 03:02:39,416 --> 03:02:40,751 INDIVIDUALS FACING TROUBLE 4491 03:02:40,751 --> 03:02:42,586 SCHEDULING CARE AROUND 4492 03:02:42,586 --> 03:02:44,354 INFLEXIBLE WORK SCHEDULES AND 4493 03:02:44,354 --> 03:02:45,322 THERE'S HIGHER LEVEL OF UNMET 4494 03:02:45,322 --> 03:02:48,358 NEEDS OF CARE IN THE UNITED 4495 03:02:48,358 --> 03:02:52,729 STATES. 4496 03:02:52,729 --> 03:02:55,666 WE'LL THINK ABOUT THE IMPACT OF 4497 03:02:55,666 --> 03:02:59,303 STATE PAID SICK LEAVE MANDATES. 4498 03:02:59,303 --> 03:02:59,903 THE UTILITIES DOESN'T HAVE A 4499 03:02:59,903 --> 03:03:00,704 PAID SICK LEAVE POLICY. 4500 03:03:00,704 --> 03:03:02,873 THE U.S. IS ONE OF FOUR 4501 03:03:02,873 --> 03:03:05,976 COUNTRIES THAT LACK A POLICY. 4502 03:03:05,976 --> 03:03:12,149 IT'S LARGELY LEFT THE OFFERING 4503 03:03:12,149 --> 03:03:13,417 TO THE DISCRETION OF EMPLOYERS 4504 03:03:13,417 --> 03:03:16,353 AND 30% SAY THEY LACK PAID SICK 4505 03:03:16,353 --> 03:03:20,524 LEAVE AT THEIR EMPLOYMENT. 4506 03:03:20,524 --> 03:03:26,263 17 STATES HAVE ADOPTED A PAID 4507 03:03:26,263 --> 03:03:30,601 SICK LEAVE PLAN DATE TO REQUIRE 4508 03:03:30,601 --> 03:03:32,703 EMPLOYERS TO PROVIDE ONE WEEK OF 4509 03:03:32,703 --> 03:03:33,904 PROTECTED TIME A YEAR. 4510 03:03:33,904 --> 03:03:39,243 IT CAN BE USED FOR THE 4511 03:03:39,243 --> 03:03:40,010 EMPLOYEE'S OWN HEALTH CARE NEEDS 4512 03:03:40,010 --> 03:03:43,647 OR DEPENDENTS AND MENTAL HEALTH 4513 03:03:43,647 --> 03:03:46,149 CARE IS AN ELIGIBLE SERVICE 4514 03:03:46,149 --> 03:03:47,184 UNDER PAID LEAVE MANDATE. 4515 03:03:47,184 --> 03:03:49,553 THERE'S A GROWING BODY OF 4516 03:03:49,553 --> 03:03:50,621 LITERATURE AND IT'S VERY MUCH A 4517 03:03:50,621 --> 03:03:58,962 SUMMARY ON THE IMPACT OF THE 4518 03:03:58,962 --> 03:03:59,229 MANDATES. 4519 03:03:59,229 --> 03:03:59,897 THERE'S EVIDENCE IT WILL IMPROVE 4520 03:03:59,897 --> 03:04:04,067 USE OF MANDATES AND WILL ALLOW 4521 03:04:04,067 --> 03:04:05,035 INDIVIDUAL TO USE MORE HEALTH 4522 03:04:05,035 --> 03:04:06,537 CARE AND INFLUENZA AND OTHER 4523 03:04:06,537 --> 03:04:08,205 TYPES OF PREVENTATIVE CARE. 4524 03:04:08,205 --> 03:04:12,342 WE HAVE AN EARLIER STUDY THAT 4525 03:04:12,342 --> 03:04:16,146 SHOWS MEDICAID FINANCE FOR 4526 03:04:16,146 --> 03:04:17,447 PRESCRIPTION MEDICATIONS FOR 4527 03:04:17,447 --> 03:04:20,350 MENTAL HEALTH CONDITIONS ALSO 4528 03:04:20,350 --> 03:04:25,622 INCREASED. 4529 03:04:25,622 --> 03:04:26,390 WE CAN LOOK AT THESE ACROSS THE 4530 03:04:26,390 --> 03:04:30,994 UNITED STATES. 4531 03:04:30,994 --> 03:04:32,362 THERE'S CLUSTERING OF CARE AND 4532 03:04:32,362 --> 03:04:34,665 WE DON'T SEE A LOT IN THE 4533 03:04:34,665 --> 03:04:35,065 SOUTHERN STATES. 4534 03:04:35,065 --> 03:04:38,468 HERE WE LOOK AT THE TEMPORAL 4535 03:04:38,468 --> 03:04:41,505 VARIATION OF THE PAID SICK LEAVE 4536 03:04:41,505 --> 03:04:41,772 MANDATES. 4537 03:04:41,772 --> 03:04:43,073 THEY'RE BEING ADAPTED AT 4538 03:04:43,073 --> 03:04:44,775 DIFFERENT POINTS FROM DIFFERENT 4539 03:04:44,775 --> 03:04:45,008 STATES. 4540 03:04:45,008 --> 03:04:47,177 THE DISTRICT OF COLUMBIA WAS THE 4541 03:04:47,177 --> 03:04:56,320 EARLIEST ADOPTER IN MAY OF 2008. 4542 03:04:56,320 --> 03:05:00,357 OUR RESEARCH QUESTION AND HIGH 4543 03:05:00,357 --> 03:05:07,664 BOTH -- HYPOTHESES NEXT AND WE 4544 03:05:07,664 --> 03:05:11,168 CONJECTURE MANDATES WILL REDUCE 4545 03:05:11,168 --> 03:05:12,970 THE TIME COST FOR REDUCED HEALTH 4546 03:05:12,970 --> 03:05:16,039 CARE AND MAY REDUCE THE 4547 03:05:16,039 --> 03:05:18,375 FINANCIAL COST BECAUSE THEY'LL 4548 03:05:18,375 --> 03:05:25,415 HAVE TO FORGO WAGES TO RECEIVE 4549 03:05:25,415 --> 03:05:27,618 WAGES DURING STANDARD WORK TIME 4550 03:05:27,618 --> 03:05:33,657 IN 2004 THE MEDIAN DAILY WAGES 4551 03:05:33,657 --> 03:05:35,559 WERE $240 AND WE'LL SEE AN 4552 03:05:35,559 --> 03:05:38,128 INCREASE IN MENTAL HEALTH CARE 4553 03:05:38,128 --> 03:05:38,929 UTILIZATION AND SHIFT FROM LESS 4554 03:05:38,929 --> 03:05:42,699 TIME INTENSIVE TO MORE TIME 4555 03:05:42,699 --> 03:05:44,101 INTENSIVE TREATMENT AND WE'LL 4556 03:05:44,101 --> 03:05:46,670 ALSO LOOK AT THE HEALTH OUTCOMES 4557 03:05:46,670 --> 03:05:49,940 AND THINK MENTAL HEALTH OUTCOMES 4558 03:05:49,940 --> 03:05:58,882 MAY IMPROVE POST MANDATE. 4559 03:05:58,882 --> 03:06:04,354 NU OF THE MAIN DATA SET WILL 4560 03:06:04,354 --> 03:06:05,489 HAVE PRESCRIPTION AND CLAIMS AND 4561 03:06:05,489 --> 03:06:07,791 WE'LL HAVE A SAMPLE OF PATIENTS 4562 03:06:07,791 --> 03:06:11,261 WHO RECEIVE A MENTAL HEALTH OR 4563 03:06:11,261 --> 03:06:12,329 SUBSTANCE USE DISORDER DIAGNOSES 4564 03:06:12,329 --> 03:06:14,364 BETWEEN 2015 AND 2022. 4565 03:06:14,364 --> 03:06:16,767 WE DO LOOK AT A RANGE OF 4566 03:06:16,767 --> 03:06:19,436 OUTCOMES TO TRY TO GET AT THE 4567 03:06:19,436 --> 03:06:22,806 DIFFERENT TYPE OF CARE WITH TIME 4568 03:06:22,806 --> 03:06:24,675 INTENSITIES AND TREATMENT USE 4569 03:06:24,675 --> 03:06:31,848 PER STATE, YEAR, MONTH AND WE'RE 4570 03:06:31,848 --> 03:06:32,849 FOCUSSING ON PATIENT COUNTS IN 4571 03:06:32,849 --> 03:06:40,190 THE ANALYSES PRESENTED TODAY. 4572 03:06:40,190 --> 03:06:42,192 THE DESIGN DIFFERENCES WE'LL 4573 03:06:42,192 --> 03:06:43,794 HAVE DIFFERENT STATES ADOPTING 4574 03:06:43,794 --> 03:06:46,296 POLICIES AT DIFFERENT POINTS. 4575 03:06:46,296 --> 03:06:48,331 WE'LL COMPARE OUTCOMES BEFORE 4576 03:06:48,331 --> 03:06:51,168 AND AFTER THE INTERVENTION. 4577 03:06:51,168 --> 03:06:52,569 THAT'S THE STATE SICK PAID 4578 03:06:52,569 --> 03:06:55,238 MANDATE AND COMPARE OUTCOMES IN 4579 03:06:55,238 --> 03:06:57,174 THE TREATMENT STATE AND USE 4580 03:06:57,174 --> 03:07:00,110 STATES THAT DID NOT ADOPT THE 4581 03:07:00,110 --> 03:07:02,345 POLICY AS THE COUNTER FACTUAL. 4582 03:07:02,345 --> 03:07:07,317 WE'LL BORROW THE TREND WITH 4583 03:07:07,317 --> 03:07:09,953 GREEN REPRESENTING TREATMENT AND 4584 03:07:09,953 --> 03:07:12,656 COMPARISON AND THE GAP POST 4585 03:07:12,656 --> 03:07:14,858 INTERVENTION FORP THE TREATMENT 4586 03:07:14,858 --> 03:07:20,363 STATES AND OF COURSE OUR SETTING 4587 03:07:20,363 --> 03:07:23,100 WILL BE MORE COMPLICATED AND 4588 03:07:23,100 --> 03:07:26,937 WE'LL USE AN ESTIMATOR GIVEN THE 4589 03:07:26,937 --> 03:07:30,107 VARIATION WE HAVE AND LOOK AT 4590 03:07:30,107 --> 03:07:30,874 CHARACTERISTICS AND CLUSTER 4591 03:07:30,874 --> 03:07:35,612 STANDARD ERRORS BY THE STATE. 4592 03:07:35,612 --> 03:07:37,247 I'LL MOVE TO THE FINDINGS. 4593 03:07:37,247 --> 03:07:39,483 FIRST I'LL SHOW YOU WHAT I CALL 4594 03:07:39,483 --> 03:07:40,917 OUR FIRST STAGE FINDINGS. 4595 03:07:40,917 --> 03:07:47,224 WE WANT TO ENSURE WHEN THERE'S 4596 03:07:47,224 --> 03:07:48,425 AN ADOPTION EMPLOYERS ARE 4597 03:07:48,425 --> 03:07:51,828 GAINING ACCESS AND THE CIRCLES 4598 03:07:51,828 --> 03:07:53,764 ARE THE COEFFICIENT ESTIMATES 4599 03:07:53,764 --> 03:07:56,333 AND THE WHISKERS ARE THE 4600 03:07:56,333 --> 03:07:57,868 CONFIDENCE INTERVALS AND 4601 03:07:57,868 --> 03:07:59,236 CONVERTED EVERYTHING TO A 4602 03:07:59,236 --> 03:08:00,804 PERCENT CHANGE FOR EASE OF 4603 03:08:00,804 --> 03:08:01,638 INTERPRETATION. 4604 03:08:01,638 --> 03:08:04,975 WE'RE GOING TO BE USING THE 4605 03:08:04,975 --> 03:08:06,009 NATIONAL COMPENSATION SURVEY AND 4606 03:08:06,009 --> 03:08:08,945 FOLLOWING THE MANDATE THERE'S A 4607 03:08:08,945 --> 03:08:12,349 ROUGHLY 10% INCREASE IN THE 4608 03:08:12,349 --> 03:08:15,652 PROBABILITY THE EMPLOYER OFFERS 4609 03:08:15,652 --> 03:08:19,556 TO THE EMPLOYEE AND THE 4610 03:08:19,556 --> 03:08:20,690 UTILIZATION INCREASED BY 17% 4611 03:08:20,690 --> 03:08:21,691 POST MANDATE. 4612 03:08:21,691 --> 03:08:23,260 WE TAKE THE EVIDENCE AND 4613 03:08:23,260 --> 03:08:24,761 FOLLOWING THE MANDATE, EMPLOYEES 4614 03:08:24,761 --> 03:08:28,031 ARE GAINING ACCESS AND USING THE 4615 03:08:28,031 --> 03:08:32,502 BENEFIT. 4616 03:08:32,502 --> 03:08:34,871 HERE WE'RE LOOKING AT THE ALL 4617 03:08:34,871 --> 03:08:37,040 CLAIMS DATABASE AND LOOK AT THE 4618 03:08:37,040 --> 03:08:39,609 IMPACT OF THE MANDATES ON ANY 4619 03:08:39,609 --> 03:08:41,144 MENTAL HEALTH CARE AND THEN LOOK 4620 03:08:41,144 --> 03:08:43,280 AT TYPE OF MENTAL HEALTH CARE 4621 03:08:43,280 --> 03:08:44,447 AND FOCUSSING ON LESS AND MORE 4622 03:08:44,447 --> 03:08:47,450 TIME INTENSIVE CARE. 4623 03:08:47,450 --> 03:08:49,319 WHAT WE OBSERVE IS NO EVIDENCE 4624 03:08:49,319 --> 03:08:52,189 THAT THERE'S A CHANGE IN THE 4625 03:08:52,189 --> 03:08:55,659 EXTENSIVE MARGIN OF USE. 4626 03:08:55,659 --> 03:08:56,893 THAT'S ANY MENTAL HEALTH AND 4627 03:08:56,893 --> 03:08:59,396 WHEN WE BREAK IT UP WE SEE A 4628 03:08:59,396 --> 03:09:03,033 DECLINE IN PRESCRIPTIONS OF 3.6% 4629 03:09:03,033 --> 03:09:04,835 POST MANDATE AND LOOK AT OUT 4630 03:09:04,835 --> 03:09:07,838 PATIENT AND IN PATIENT CARE WE 4631 03:09:07,838 --> 03:09:13,577 SEE A 22.4 AND 23.5% INCREASE 4632 03:09:13,577 --> 03:09:18,548 POST MANDATE AND VIEW IT AS SOME 4633 03:09:18,548 --> 03:09:20,350 SUBSTITUTION IN TERMS OF TIMES 4634 03:09:20,350 --> 03:09:25,455 INTENSITY. 4635 03:09:25,455 --> 03:09:27,090 WE WANT TO TAKE IT FOR 4636 03:09:27,090 --> 03:09:30,193 SUBSTITUTION ACROSS THE SETTINGS 4637 03:09:30,193 --> 03:09:35,899 OF CARE AND USING DATA WE LOOK 4638 03:09:35,899 --> 03:09:37,467 AT SIX MONTHS BLOCKS TO ALLOW 4639 03:09:37,467 --> 03:09:39,069 PATIENTS TIME TO RECEIVE MORE 4640 03:09:39,069 --> 03:09:43,073 THAN ONE TYPE OF CARE. 4641 03:09:43,073 --> 03:09:45,442 AND DIVIDE CARE TO THREE 4642 03:09:45,442 --> 03:09:47,944 MUTUALLY EXCLUSIVE CATEGORIES. 4643 03:09:47,944 --> 03:09:51,314 PRESCRIPTION MEDICATIONS AND 4644 03:09:51,314 --> 03:09:52,515 PRESCRIPTIONS AND NO OUT 4645 03:09:52,515 --> 03:09:52,849 PATIENT. 4646 03:09:52,849 --> 03:09:55,385 WHEN WE LOOK AT PRESCRIPTION AND 4647 03:09:55,385 --> 03:09:56,887 IN OR OUT PATIENT. 4648 03:09:56,887 --> 03:09:58,588 FINALLY WE LOOK AT NO 4649 03:09:58,588 --> 03:10:00,056 PRESCRIPTIONS AND IN PATIENT OR 4650 03:10:00,056 --> 03:10:00,857 OUT PATIENT. 4651 03:10:00,857 --> 03:10:04,094 WE CAN THINK ABOUT THESE BEING 4652 03:10:04,094 --> 03:10:05,295 LESS AND MORE TIME INTENSIVE. 4653 03:10:05,295 --> 03:10:12,168 WHEN WE LOOK AT THE CATEGORIES 4654 03:10:12,168 --> 03:10:13,737 WE SEE THE DECLINE IN 4655 03:10:13,737 --> 03:10:14,271 PRESCRIPTIONS ONLY. 4656 03:10:14,271 --> 03:10:17,607 IT WILL BE A DECLINE OF 7.3% 4657 03:10:17,607 --> 03:10:20,577 POST MANDATE AND WE SEE 4658 03:10:20,577 --> 03:10:26,750 INCREASES IN THESE ARGUABLY MORE 4659 03:10:26,750 --> 03:10:28,318 INTENSIVE TREATMENTS AND THOSE 4660 03:10:28,318 --> 03:10:31,922 AFFECTS ARE RELATIVELY SIZABLE 4661 03:10:31,922 --> 03:10:39,729 ABOUT 16% TO 21% INCREASE. 4662 03:10:39,729 --> 03:10:40,664 FINALLY WE WANT TO PROVIDE 4663 03:10:40,664 --> 03:10:42,532 EVIDENCE TO SEE IF THE EVIDENCE 4664 03:10:42,532 --> 03:10:43,934 IN TERMS OF THE TYPE OF CARE 4665 03:10:43,934 --> 03:10:44,534 WE'RE SEEING. 4666 03:10:44,534 --> 03:10:47,003 ARE WE SEEING IMPROVEMENTS IN 4667 03:10:47,003 --> 03:10:48,004 MENTAL HEALTH OUTCOMES. 4668 03:10:48,004 --> 03:10:53,610 HOW WE'RE GOING TO DO THIS IS 4669 03:10:53,610 --> 03:10:55,178 LOOK AT SURVEY DATA FROM 4670 03:10:55,178 --> 03:10:57,113 SURVEILLANCE DATA OF ROUGHLY 4671 03:10:57,113 --> 03:10:59,616 400,000 INDIVIDUALS EACH YEAR. 4672 03:10:59,616 --> 03:11:03,954 WE HAD A MEASURE OF 4673 03:11:03,954 --> 03:11:05,789 SELF-PERCEIVED MENTAL HEALTH 4674 03:11:05,789 --> 03:11:07,090 PROBLEMS AND REPORTED DAYS OF 4675 03:11:07,090 --> 03:11:09,426 POOR MENTAL HEALTH IN THE PAST 4676 03:11:09,426 --> 03:11:11,695 30 DAYS AND LOOK AT INDIVIDUALS 4677 03:11:11,695 --> 03:11:14,931 BREAKING THEM UP AND LOOK AT 4678 03:11:14,931 --> 03:11:17,200 THOSE 18 PLUS THEN BREAK THEM 4679 03:11:17,200 --> 03:11:20,103 INTO NON-ELDERLY AND ELDERLY 4680 03:11:20,103 --> 03:11:20,337 ADULTS. 4681 03:11:20,337 --> 03:11:25,342 WE SEE REDUCTIONS IN THE DAYS IN 4682 03:11:25,342 --> 03:11:28,244 POOR MENTAL HEALTH AND IT WILL 4683 03:11:28,244 --> 03:11:31,114 RANGE FROM 7.3% AMONGST 18 YEARS 4684 03:11:31,114 --> 03:11:39,456 AND OLDER TO 8.3% AMONGST THE 4685 03:11:39,456 --> 03:11:41,257 NON-ELDERLY ADULT. 4686 03:11:41,257 --> 03:11:51,801 THIS IS WHERE WE SEE INDICATION 4687 03:11:55,205 --> 03:11:58,641 OF IMPROVEMENT OF MENTAL HEALTH 4688 03:11:58,641 --> 03:12:00,343 AND I'LL SKIP THIS SLIDE BUT 4689 03:12:00,343 --> 03:12:09,019 HAPPY TO DISCUSS LATER. 4690 03:12:09,019 --> 03:12:10,720 WE WANT TO LOOK AT PROTECTED 4691 03:12:10,720 --> 03:12:12,789 TIME AWAY FROM WORK AND YOUR 4692 03:12:12,789 --> 03:12:16,826 EMPLOYER ALLOWING YOU TO TAKE 4693 03:12:16,826 --> 03:12:18,962 TIME OFF WITHOUT FOREGOING WAGES 4694 03:12:18,962 --> 03:12:21,931 AND DO WE SEE CHANGES IN MENTAL 4695 03:12:21,931 --> 03:12:22,332 HEALTH SERVICES. 4696 03:12:22,332 --> 03:12:27,537 OUR FINDINGS ARE SOMEWHAT 4697 03:12:27,537 --> 03:12:28,371 INLINE. 4698 03:12:28,371 --> 03:12:32,342 WE EXPECTED TO SEE AN INCREASE 4699 03:12:32,342 --> 03:12:38,348 IN OVER ALL MENTAL HEALTH CARE 4700 03:12:38,348 --> 03:12:41,017 UTILIZAT 4701 03:12:41,017 --> 03:12:41,317 UTILIZATION. 4702 03:12:41,317 --> 03:12:42,585 HOWEVER WE STARTED TO CONSIDER 4703 03:12:42,585 --> 03:12:45,555 DIFFERENT TYPES OF MENTAL HEALTH 4704 03:12:45,555 --> 03:12:45,755 CARE. 4705 03:12:45,755 --> 03:12:52,362 EMPHASIZING THOSE THAT DELIVERED 4706 03:12:52,362 --> 03:12:54,564 AND SAW PRESCRIPTIONS ONLY AND 4707 03:12:54,564 --> 03:12:59,369 INCREASES IN MORE TIME INTENSIVE 4708 03:12:59,369 --> 03:13:04,707 MENTAL HEALTH AND SAW SOME 4709 03:13:04,707 --> 03:13:06,376 CHANGES IN HEALTH CARE AND TIME 4710 03:13:06,376 --> 03:13:07,911 CONSTRAINTS MAY ALLOW PATIENTS 4711 03:13:07,911 --> 03:13:09,779 TO SORT INTO THEIR MORE 4712 03:13:09,779 --> 03:13:11,347 PREFERRED TYPE OF CARE. 4713 03:13:11,347 --> 03:13:14,217 WE ALSO THINK THIS IS EVIDENCE 4714 03:13:14,217 --> 03:13:16,352 PATIENTS RESPOND TO PRICE 4715 03:13:16,352 --> 03:13:16,586 CHANGES. 4716 03:13:16,586 --> 03:13:18,154 IF YOU THINK ABOUT TIME. 4717 03:13:18,154 --> 03:13:20,657 I TELL MY STUDENTS, TIME IS 4718 03:13:20,657 --> 03:13:20,857 MONEY. 4719 03:13:20,857 --> 03:13:22,425 IF YOU THINK OF TIME AS BEING 4720 03:13:22,425 --> 03:13:24,894 MONEY THINK OF IT AS A FINANCIAL 4721 03:13:24,894 --> 03:13:26,896 COST AS WELL BUT THINK THIS 4722 03:13:26,896 --> 03:13:28,131 STUDY CONTRIBUTE TO THE BROADER 4723 03:13:28,131 --> 03:13:30,467 LITERATURE ON UNDERSTANDING THE 4724 03:13:30,467 --> 03:13:31,701 IMPACTS OF PAID SICK LEAVE 4725 03:13:31,701 --> 03:13:35,038 MANDATES ON AMERICAN SOCIETY. 4726 03:13:35,038 --> 03:13:36,739 THAT'S ABOUT IT. 4727 03:13:36,739 --> 03:13:40,343 THANK YOU VERY MUCH FOR YOUR 4728 03:13:40,343 --> 03:13:43,379 TIME. 4729 03:13:43,379 --> 03:13:45,315 >> THANK YOU, DR. MACLEAN. 4730 03:13:45,315 --> 03:13:54,124 WE'RE GOING TO JUMP OVER TO OUR 4731 03:13:54,124 --> 03:13:54,524 PANEL DISCUSSION. 4732 03:13:54,524 --> 03:13:55,925 I'LL START WITH A QUESTION ON 4733 03:13:55,925 --> 03:13:56,526 DATA. 4734 03:13:56,526 --> 03:13:58,695 I THINK WE'VE SEEN SOME RICH 4735 03:13:58,695 --> 03:14:02,031 USES OF DATA IN THE VARIOUS 4736 03:14:02,031 --> 03:14:11,107 PRESENTATIONS. 4737 03:14:11,107 --> 03:14:12,842 AND WE SAW CONSIDERATIONS THAT 4738 03:14:12,842 --> 03:14:15,545 HAVE IMPACTED YOUR ABILITY TO 4739 03:14:15,545 --> 03:14:16,679 CONDUCT THESE ECONOMIC 4740 03:14:16,679 --> 03:14:16,980 EVALUATIONS. 4741 03:14:16,980 --> 03:14:20,350 WHY DON'T WE START WITH YOU, 4742 03:14:20,350 --> 03:14:21,784 DR. ZHU. 4743 03:14:21,784 --> 03:14:22,986 >> SURE. 4744 03:14:22,986 --> 03:14:29,192 OUR EVALUATIONS ARE RELIANT ON 4745 03:14:29,192 --> 03:14:32,295 TAF DATA NOW SEVERAL YEARS IT'S 4746 03:14:32,295 --> 03:14:38,568 BEEN AVAILABLE AND THERE'S 4747 03:14:38,568 --> 03:14:41,538 VARIATION AND DATA CAUGHT AS 4748 03:14:41,538 --> 03:14:42,772 THOSE WHO USED THE TAF DATA 4749 03:14:42,772 --> 03:14:43,106 KNOW. 4750 03:14:43,106 --> 03:14:45,675 THE DATA CONSIDERATIONS WITH THE 4751 03:14:45,675 --> 03:14:53,850 TAF DATA ARE REALLY FOCUSSED ON 4752 03:14:53,850 --> 03:14:56,819 CAN'T GIVE DATA ON WHAT DATA IS 4753 03:14:56,819 --> 03:14:58,254 RELIABLE CLEANING THROUGH STATES 4754 03:14:58,254 --> 03:14:58,855 AND CLEANING INFORMATION AND 4755 03:14:58,855 --> 03:15:00,723 SHARING THAT. 4756 03:15:00,723 --> 03:15:03,960 THE MEDICAID DATA LEARNING 4757 03:15:03,960 --> 03:15:08,298 NETWORK WITH JOHN McCONNEL AND 4758 03:15:08,298 --> 03:15:10,867 EARLIER PRESENTERS LEADING IN 4759 03:15:10,867 --> 03:15:12,068 THE WORKSHOP THEY'RE SHARING 4760 03:15:12,068 --> 03:15:13,303 THOSE LEARNINGS ACROSS A NUMBER 4761 03:15:13,303 --> 03:15:14,871 OF INSTITUTIONS AND THAT'S BEEN 4762 03:15:14,871 --> 03:15:15,905 A GREAT RESOURCE. 4763 03:15:15,905 --> 03:15:19,342 OVER ALL IN TERMS OF THE 4764 03:15:19,342 --> 03:15:21,544 MEDICAID DATA IT'S PROPRIETARY 4765 03:15:21,544 --> 03:15:24,948 AND LABOR INTENSIVE AND 4766 03:15:24,948 --> 03:15:26,916 EXPENSIVE AND REQUIRES SHARED 4767 03:15:26,916 --> 03:15:28,952 LEARNINGS TO MAKE THAT 4768 03:15:28,952 --> 03:15:31,454 MEANINGFUL IN A TIMELY MANNER. 4769 03:15:31,454 --> 03:15:41,698 >> THANK YOU. 4770 03:15:44,400 --> 03:15:46,703 >> THE CLAIMS DATA ARE VERY 4771 03:15:46,703 --> 03:15:49,172 USEFUL AND ALSO VERY EXPENSIVE. 4772 03:15:49,172 --> 03:15:51,040 THAT MAKES STUDYING THE QUESTION 4773 03:15:51,040 --> 03:15:53,409 WITH DATA YOU BELIEVE ARE 4774 03:15:53,409 --> 03:15:55,011 SUITABLE AND CAN PROVIDE 4775 03:15:55,011 --> 03:15:56,779 INTERESTING PICTURES YOU MAY NOT 4776 03:15:56,779 --> 03:16:00,350 BE ABLE TO GATHER FROM 4777 03:16:00,350 --> 03:16:02,385 PUBLICALLY AVAILABLE DATA DOES 4778 03:16:02,385 --> 03:16:04,120 REQUIRE SHARED LEARNING AND 4779 03:16:04,120 --> 03:16:04,387 RESOURCES. 4780 03:16:04,387 --> 03:16:06,155 WE'RE GRATEFUL TO NIH. 4781 03:16:06,155 --> 03:16:08,324 WE COULD NOT HAVE BEEN ABLE TO 4782 03:16:08,324 --> 03:16:09,726 CONDUCT THE RESEARCH WITHOUT THE 4783 03:16:09,726 --> 03:16:12,395 FINANCIAL SUPPORT THAT ALLOWS US 4784 03:16:12,395 --> 03:16:15,531 TO UTILIZE THE DATA. 4785 03:16:15,531 --> 03:16:17,533 I THINK IT'S UNFORTUNATE THAT 4786 03:16:17,533 --> 03:16:22,238 THERE ARE THESE COSTS. 4787 03:16:22,238 --> 03:16:25,141 WE'RE GRATEFUL FOR THE SUPPORT 4788 03:16:25,141 --> 03:16:27,277 AND LEARNING ABOUT THE VARIOUS 4789 03:16:27,277 --> 03:16:28,645 NUANCES OF THE CLAIMS DATABASE. 4790 03:16:28,645 --> 03:16:31,180 EACH HAS STRENGTHS AND 4791 03:16:31,180 --> 03:16:33,116 WEAKNESSES BUT DR. ZHU DID A 4792 03:16:33,116 --> 03:16:35,451 GREAT JOB SUMMARIZING THOSE. 4793 03:16:35,451 --> 03:16:36,019 >> PERFECT. 4794 03:16:36,019 --> 03:16:37,987 DR. MURPHY, ANYTHING YOU WANT TO 4795 03:16:37,987 --> 03:16:39,956 ADD WITH DATA CONSIDERATIONS 4796 03:16:39,956 --> 03:16:41,824 WITH THESE RESEARCH PROJECTS IN 4797 03:16:41,824 --> 03:16:43,693 RELATION TO MENTAL HEALTH AND 4798 03:16:43,693 --> 03:16:45,328 SUBSTANCE USE DISORDER? 4799 03:16:45,328 --> 03:16:51,067 >> I THINK ONE THING AMONG 4800 03:16:51,067 --> 03:16:52,335 CRIMINAL-LEGAL POPULATIONS IS 4801 03:16:52,335 --> 03:16:56,272 OUR INABILITY TO UNDERSTAND THE 4802 03:16:56,272 --> 03:17:01,411 LONG-TERM IMPACTS IN TERMS OF 4803 03:17:01,411 --> 03:17:05,548 THE ONLY DATA AVAILABLE SAY 4804 03:17:05,548 --> 03:17:07,750 ADMINISTRATIVE DATA AND NO 4805 03:17:07,750 --> 03:17:11,154 MATTER HOW COMPREHENSIVE THAT IS 4806 03:17:11,154 --> 03:17:14,190 YOU'RE STILL GET NUANCES WITH 4807 03:17:14,190 --> 03:17:14,757 THE INDIVIDUAL TRIALS AND 4808 03:17:14,757 --> 03:17:16,959 UNDERSTAND WHO THE INDIVIDUALS 4809 03:17:16,959 --> 03:17:18,828 ARE AND WHAT'S GOING ON IN THEIR 4810 03:17:18,828 --> 03:17:20,330 LIVES AND SOME OF THE IMPORTANT 4811 03:17:20,330 --> 03:17:30,306 CONSIDERATIONS. 4812 03:17:30,306 --> 03:17:31,774 I WOULD SAY ACROSS THE JCOIN 4813 03:17:31,774 --> 03:17:33,443 NETWORK THERE'S OTHER 4814 03:17:33,443 --> 03:17:33,810 CONSIDERATIONS. 4815 03:17:33,810 --> 03:17:39,115 >> I WOULD ALSO ADD THAT AS MANY 4816 03:17:39,115 --> 03:17:42,285 KNOW THERE'S NOT REELY GREAT 4817 03:17:42,285 --> 03:17:43,653 QUALITY MEASURES IN PUBLIC 4818 03:17:43,653 --> 03:17:43,886 HEALTH. 4819 03:17:43,886 --> 03:17:47,023 AND SO WE'RE JUST TRYING TO GET 4820 03:17:47,023 --> 03:17:48,358 AS CLOSE TO THE TRUTH AS 4821 03:17:48,358 --> 03:17:50,326 POSSIBLE BUT THE ADMINISTRATIVE 4822 03:17:50,326 --> 03:17:53,129 CLAIMS DATA HAS TRADE-OFFS AND 4823 03:17:53,129 --> 03:17:54,797 DISADVANTAGES AND SOME THINGS WE 4824 03:17:54,797 --> 03:17:57,934 CAN'T GET AT ARE PATIENT 4825 03:17:57,934 --> 03:18:02,972 EXPERIENCE. 4826 03:18:02,972 --> 03:18:05,975 THOSE DIMENSIONS ARE IMPORTANT 4827 03:18:05,975 --> 03:18:09,345 IN MENTAL HEALTH BUT UNDER 4828 03:18:09,345 --> 03:18:10,546 STUDIED BECAUSE WE DON'T HAVE 4829 03:18:10,546 --> 03:18:12,181 GREAT SOURCES AN THERE'S PROXY 4830 03:18:12,181 --> 03:18:14,817 MEASURES OF QUALITY AND THERE'S 4831 03:18:14,817 --> 03:18:16,352 STILL CONTENTION AND DEBATE 4832 03:18:16,352 --> 03:18:20,056 WITHIN THE FIELD AS TO WHAT BEST 4833 03:18:20,056 --> 03:18:21,991 MEASURES QUALITY AND OUTCOMES IN 4834 03:18:21,991 --> 03:18:24,093 MENTAL HEALTH AND THAT COULD BE 4835 03:18:24,093 --> 03:18:28,431 A WHOLE OTHER PANEL BY ITSELF. 4836 03:18:28,431 --> 03:18:31,667 RECOGNIZING THERE ARE 4837 03:18:31,667 --> 03:18:35,705 LIMITATIONS ARE IS IMPORTANT. 4838 03:18:35,705 --> 03:18:38,941 AS SOMEONE WHO LOVES WORKING 4839 03:18:38,941 --> 03:18:41,010 WITH BIG DATA HAS MADE ME 4840 03:18:41,010 --> 03:18:43,546 COGNITIVE OF THE ROLE OF DATA 4841 03:18:43,546 --> 03:18:45,481 AND INTERVIEWS TO HELP MOTIVATE 4842 03:18:45,481 --> 03:18:48,184 QUESTIONS AND GET AT THINGS THAT 4843 03:18:48,184 --> 03:18:50,386 LARGE DATA AND ADMINISTRATIVE 4844 03:18:50,386 --> 03:18:56,325 CLIMBS OF -- CLAIMS DATA CAN'T 4845 03:18:56,325 --> 03:18:58,761 GET TO. 4846 03:18:58,761 --> 03:19:02,298 >> THOSE ARE TERRIFIC POINTS AND 4847 03:19:02,298 --> 03:19:06,836 WE HAD A QUESTION RELATED TO 4848 03:19:06,836 --> 03:19:08,604 DATA ASKING WHAT ARE SOME 4849 03:19:08,604 --> 03:19:09,605 PUBLICALLY AVAILABLE DATA SETS. 4850 03:19:09,605 --> 03:19:11,574 I KNOW WE MENTIONED CLAIMS HERE 4851 03:19:11,574 --> 03:19:13,609 BUT OTHERWISE PEOPLE MAY BE ABLE 4852 03:19:13,609 --> 03:19:16,112 TO USE WHEN THINKING ABOUT DOING 4853 03:19:16,112 --> 03:19:19,816 THIS TYPE OF RESEARCH WITH 4854 03:19:19,816 --> 03:19:21,751 SPECIAL POPULATIONS. 4855 03:19:21,751 --> 03:19:27,657 DOES ANYONE WANT TO JUMP IN? 4856 03:19:27,657 --> 03:19:28,090 MAYBE DR. MACLEAN. 4857 03:19:28,090 --> 03:19:30,593 >> I THINK IT'S A GREAT 4858 03:19:30,593 --> 03:19:30,860 QUESTION. 4859 03:19:30,860 --> 03:19:34,230 I'M STILL A FAN OF SURVEY DATA. 4860 03:19:34,230 --> 03:19:39,735 THEY HAVE THEIR OWN LIMITATIONS 4861 03:19:39,735 --> 03:19:42,271 BUT LOOKING AT THE SURVEILLANCE 4862 03:19:42,271 --> 03:19:45,341 SURVEY OF 400,000 PER YEAR I 4863 03:19:45,341 --> 03:19:48,678 BELIEVE I MENTIONED EARLIER AND 4864 03:19:48,678 --> 03:19:54,617 THINKING ABOUT SPECIAL 4865 03:19:54,617 --> 03:19:56,319 POPULATIONS THE DATA IS 4866 03:19:56,319 --> 03:19:57,820 PUBLICALLY AVAILABLE AND OFFER 4867 03:19:57,820 --> 03:20:00,122 THE LARGE SAMPLES AND THERE'S 4868 03:20:00,122 --> 03:20:02,658 OTHER DATA SOURCES COLLECTED BY 4869 03:20:02,658 --> 03:20:05,228 THE FEDERAL GOVERNMENT AND CAN 4870 03:20:05,228 --> 03:20:09,799 BE USEFUL. 4871 03:20:09,799 --> 03:20:15,805 THAT'S A NICE PLACE TO START. 4872 03:20:15,805 --> 03:20:17,406 >> DR. MURPHY ANYTHING YOU WANT 4873 03:20:17,406 --> 03:20:20,276 TO ADD ABOUT PUBLICALLY 4874 03:20:20,276 --> 03:20:23,179 AVAILABLE DATA SETS FOR THESE 4875 03:20:23,179 --> 03:20:24,347 SPECIAL POPULATIONS? 4876 03:20:24,347 --> 03:20:29,552 >> THE ONE THAT COMES TO MIND 4877 03:20:29,552 --> 03:20:34,123 WITH PERMISSION OR WITH THAT 4878 03:20:34,123 --> 03:20:37,527 CAVEAT OR THE MASSACHUSETTS 4879 03:20:37,527 --> 03:20:44,200 Ph.D. AND THOSE DATA SETS WHERE 4880 03:20:44,200 --> 03:20:45,835 YOU CAN LOOK AT INDIVIDUALS 4881 03:20:45,835 --> 03:20:46,702 ACROSS THE SYSTEM. 4882 03:20:46,702 --> 03:20:51,841 THE MORE WE ACCESS THOSE THE 4883 03:20:51,841 --> 03:20:54,310 BETTER OFF WE'LL BE IN 4884 03:20:54,310 --> 03:20:56,345 ESTIMATING LONG-TERM EFFECTS. 4885 03:20:56,345 --> 03:20:58,481 >> DR. ZHU, ANYTHING YOU'D LIKE 4886 03:20:58,481 --> 03:20:59,515 TO ADD. 4887 03:20:59,515 --> 03:21:04,353 >> WE'VE COVERED IT. 4888 03:21:04,353 --> 03:21:04,587 PERFECT. 4889 03:21:04,587 --> 03:21:04,854 THANK YOU. 4890 03:21:04,854 --> 03:21:07,223 THE QUESTION THAT RELATES TO THE 4891 03:21:07,223 --> 03:21:11,127 RICHNESS OF DATA YOU'VE ALL BEEN 4892 03:21:11,127 --> 03:21:13,763 ABLE TO PRESENT AND ASKING DO 4893 03:21:13,763 --> 03:21:15,431 YOU HAVE STRATEGIES OR BEST 4894 03:21:15,431 --> 03:21:16,899 PRACTICES WHEN COMMUNICATING THE 4895 03:21:16,899 --> 03:21:19,101 FINDING OR RESULTS TO PEOPLE 4896 03:21:19,101 --> 03:21:22,939 OUTSIDE OF FIELDS THAT AREN'T AS 4897 03:21:22,939 --> 03:21:25,007 FAMILIAR WITH HEALTH ECONOMICS 4898 03:21:25,007 --> 03:21:26,809 WHO DON'T APPLY THAT LENS TO 4899 03:21:26,809 --> 03:21:27,877 THEIR WORK IN SPECIAL OPTIONS. 4900 03:21:27,877 --> 03:21:30,913 I DON'T KNOW IF YOU HAVE 4901 03:21:30,913 --> 03:21:32,081 THOUGHTS ON THAT. 4902 03:21:32,081 --> 03:21:36,352 DR. MURPHY, LET'S START WITH 4903 03:21:36,352 --> 03:21:38,154 YOU. 4904 03:21:38,154 --> 03:21:40,356 >> ONE EXAMPLE WITH COST 4905 03:21:40,356 --> 03:21:42,925 EFFECTIVENESS ANALYSIS IS TO 4906 03:21:42,925 --> 03:21:46,629 MAKE SURE WE'RE INCLUDING AN 4907 03:21:46,629 --> 03:21:49,565 EFFECTIVENESS MEASURE THAT IS 4908 03:21:49,565 --> 03:21:52,702 MORE EASY TO UNDERSTAND AND 4909 03:21:52,702 --> 03:21:56,572 TRANSLATE AND ALL THOSE THINGS 4910 03:21:56,572 --> 03:21:58,708 AND QUALITY ADJUSTED LIFE YEARS. 4911 03:21:58,708 --> 03:22:00,843 THEY DON'T NECESSARILY SPEAK AS 4912 03:22:00,843 --> 03:22:01,811 CLEARLY TO POLICY MAKERS. 4913 03:22:01,811 --> 03:22:03,913 MAKING SURE YOU HAVE SOME OF 4914 03:22:03,913 --> 03:22:08,351 THOSE SAY CLINICAL OR OTHER 4915 03:22:08,351 --> 03:22:16,325 TYPES OF EFFECTIVENESS MEASURES. 4916 03:22:16,325 --> 03:22:18,260 >> DR. ZHU ANYTHING FOR 4917 03:22:18,260 --> 03:22:21,130 PARTICULAR FINDINGS TO A 4918 03:22:21,130 --> 03:22:24,166 NON-ECONOMIC AUDIENCE. 4919 03:22:24,166 --> 03:22:26,268 >> PRESENT COMPANY NOT INCLUDED, 4920 03:22:26,268 --> 03:22:28,137 ECONOMISTS ARE NOT KNOWN FOR 4921 03:22:28,137 --> 03:22:30,706 BEING OVERLY GREAT AT THIS BUT I 4922 03:22:30,706 --> 03:22:31,607 REALLY LIKE PICTURES. 4923 03:22:31,607 --> 03:22:32,875 I'M A BIG FAN OF PICTURE. 4924 03:22:32,875 --> 03:22:37,713 I THINK A PICTURE CAN CONVEY 4925 03:22:37,713 --> 03:22:38,648 1,000 WORDS. 4926 03:22:38,648 --> 03:22:44,353 I THINK THINKING ABOUT EXAMPLES 4927 03:22:44,353 --> 03:22:48,124 AND METHODS USED TO THINKING 4928 03:22:48,124 --> 03:22:50,092 ABOUT TWO STATES NAMING THEM AND 4929 03:22:50,092 --> 03:22:52,662 THIS IS WHAT THE ESTIMATOR IS 4930 03:22:52,662 --> 03:22:55,097 DOING AT ITS HEART AND 4931 03:22:55,097 --> 03:22:56,966 TRANSLATING IT TO THE EXTENT ONE 4932 03:22:56,966 --> 03:23:00,569 CAN INTO METRICS THAT ARE EASILY 4933 03:23:00,569 --> 03:23:03,739 DIGESTIBLE BE IT THROUGH 4934 03:23:03,739 --> 03:23:08,544 PICTURES OR TALKING ABOUT UNIT 4935 03:23:08,544 --> 03:23:10,613 MEASURES FOR THE PARTICULAR 4936 03:23:10,613 --> 03:23:13,582 AUDIENCE AND TRYING TO 4937 03:23:13,582 --> 03:23:14,483 DEEMPHASIZE THE TECHNICAL 4938 03:23:14,483 --> 03:23:16,352 ESTIMATE AND FOCUS ON WHAT IS 4939 03:23:16,352 --> 03:23:17,053 THE STORY. 4940 03:23:17,053 --> 03:23:21,290 I HAD A PREFERS WHO SAID IF YOU 4941 03:23:21,290 --> 03:23:26,395 CAN'T DRAW A SIMPLE GRAPH YOU 4942 03:23:26,395 --> 03:23:29,165 CAN'T COMMUNICATE AND THAT'S 4943 03:23:29,165 --> 03:23:29,665 GOOD FOR THE RESEARCHER 4944 03:23:29,665 --> 03:23:33,235 INVOLVED. 4945 03:23:33,235 --> 03:23:34,236 >> EXCELLENT POINT. 4946 03:23:34,236 --> 03:23:39,241 DR. ZHU, ANYTHING YOU'D LIKE TO 4947 03:23:39,241 --> 03:23:41,811 ADD ABOUT COMMUNICATION? 4948 03:23:41,811 --> 03:23:43,913 >> INCREASINGLY HAVING AN 4949 03:23:43,913 --> 03:23:44,747 INTERDISCIPLINARY TEAM IS 4950 03:23:44,747 --> 03:23:47,450 IMPORTANT TO THIS SORT OF WORK 4951 03:23:47,450 --> 03:23:49,652 NOT ONLY IN TERMS OF METHODOLOGY 4952 03:23:49,652 --> 03:23:52,655 AND SOLIDIFYING THAT BUT IN THE 4953 03:23:52,655 --> 03:23:55,591 MOST ROBUST WAY POSSIBLE BUT 4954 03:23:55,591 --> 03:23:56,258 MESSAGING AROUND COMMUNICATION 4955 03:23:56,258 --> 03:23:58,027 AND PRIORITIES. 4956 03:23:58,027 --> 03:24:01,430 I KNOW NIMHD FOR EXAMPLE HAS 4957 03:24:01,430 --> 03:24:05,568 BEEN INCREASING LY EMPHASIZING 4958 03:24:05,568 --> 03:24:08,337 ADVISORY COMMITTEES OR THOSE IN 4959 03:24:08,337 --> 03:24:09,705 THE POLICY WORLD THAT CAN 4960 03:24:09,705 --> 03:24:13,409 INTERPRET YOUR RESULTS IN A WAY 4961 03:24:13,409 --> 03:24:15,311 THAT'S RELEVANT TO REAL WORLD 4962 03:24:15,311 --> 03:24:15,611 SITUATIONS. 4963 03:24:15,611 --> 03:24:17,947 IN MY WORK THAT IS SOMETHING 4964 03:24:17,947 --> 03:24:23,219 THAT I BUILT IN INCREASING LY I 4965 03:24:23,219 --> 03:24:25,521 HAVING PEOPLE IN THE POLICY 4966 03:24:25,521 --> 03:24:26,989 WORLD OR PEOPLE WITH LIVED 4967 03:24:26,989 --> 03:24:29,825 EXPERIENCE OR OTHER CLINICIANS, 4968 03:24:29,825 --> 03:24:32,161 IF I'M STUDYING PSYCHIATRISTS, I 4969 03:24:32,161 --> 03:24:34,396 WANT A PSYCHIATRIST ON MY TEAM. 4970 03:24:34,396 --> 03:24:37,600 THAT'S IMPORTANT IN TERMS OF HOW 4971 03:24:37,600 --> 03:24:40,336 DO YOU INTERPRET AND MESSAGE 4972 03:24:40,336 --> 03:24:45,908 SOMETHING FROM YOUR RESULT IS 4973 03:24:45,908 --> 03:24:46,675 RELEVANT AND ACCURATE TO THE 4974 03:24:46,675 --> 03:24:47,910 PEOPLE IT'S GOING TO AFFECT. 4975 03:24:47,910 --> 03:24:53,816 >> TERRIFIC POINTS. 4976 03:24:53,816 --> 03:24:54,483 >> OKAY. 4977 03:24:54,483 --> 03:24:56,819 I THINK WE HAVE TIME FOR ONE 4978 03:24:56,819 --> 03:24:58,921 MORE QUESTION. 4979 03:24:58,921 --> 03:25:04,360 WE HAVE SOMEONE ASKING IN THE 4980 03:25:04,360 --> 03:25:06,095 RESEARCH WHERE WE'RE FOCUSSED ON 4981 03:25:06,095 --> 03:25:07,163 SPECIAL POPULATIONS IN 4982 03:25:07,163 --> 03:25:09,131 PARTICULAR SPECIFIC GROUPS AND 4983 03:25:09,131 --> 03:25:12,134 INDIVIDUALS, WHAT ARE SOME 4984 03:25:12,134 --> 03:25:14,870 IMPORTANT CONSIDERATIONS WHEN 4985 03:25:14,870 --> 03:25:15,471 CONDUCTING THE ECONOMIC 4986 03:25:15,471 --> 03:25:23,579 EVALUATIONS AND INTERVENTIONS? 4987 03:25:23,579 --> 03:25:25,114 WE'LL START WITH YOU, 4988 03:25:25,114 --> 03:25:25,981 DR. MURPHY. 4989 03:25:25,981 --> 03:25:30,252 >> SIMILAR TO WHAT DR. ZHU WAS 4990 03:25:30,252 --> 03:25:31,654 TALKING ABOUT MAKING SURE YOU 4991 03:25:31,654 --> 03:25:32,755 HAVE THE INTERDISCIPLINARY TEAM 4992 03:25:32,755 --> 03:25:39,161 AND MAKING YOU UNDERSTAND THE 4993 03:25:39,161 --> 03:25:42,298 ENVIRONMENT AND SPECIFIC 4994 03:25:42,298 --> 03:25:44,466 BARRIERS AND UNCERTAINTIES. 4995 03:25:44,466 --> 03:25:48,337 THAT DECISION MAKERS ARE BUMPING 4996 03:25:48,337 --> 03:25:56,579 UP AGAINST. 4997 03:25:56,579 --> 03:25:59,381 WE NEED TO UNDERSTAND THE 4998 03:25:59,381 --> 03:26:04,353 INFORMATION AND WHAT INFORMATION 4999 03:26:04,353 --> 03:26:07,423 CAN HELP FACILITATE THAT. 5000 03:26:07,423 --> 03:26:08,757 >> DR. MACLEAN. 5001 03:26:08,757 --> 03:26:11,994 >> I AGREE TALKING TO PEOPLE AND 5002 03:26:11,994 --> 03:26:13,996 HAVING PEOPLE ON YOUR TEAM AND I 5003 03:26:13,996 --> 03:26:16,232 LIKE WHAT DR. ZHU SAID HAVE A 5004 03:26:16,232 --> 03:26:19,902 TEAM AROUND YOU THAT IS GOING TO 5005 03:26:19,902 --> 03:26:21,670 BE ABLE TO UNDERSTAND THE AREAS 5006 03:26:21,670 --> 03:26:26,041 OF THE QUESTION YOU MAY NOT HAVE 5007 03:26:26,041 --> 03:26:33,682 SPECIFIC EXPERTISE AND EACH 5008 03:26:33,682 --> 03:26:35,718 MEMBER WILL KNOW VERY WELL A 5009 03:26:35,718 --> 03:26:38,354 SPECIFIC QUESTION AND PEOPLE WHO 5010 03:26:38,354 --> 03:26:39,855 HAVE DIFFERENT SKILLS AND LIVED 5011 03:26:39,855 --> 03:26:41,924 EXPERIENCES OR THINKING HOW 5012 03:26:41,924 --> 03:26:43,893 DECISION MAKERS ACTUALLY MAKE 5013 03:26:43,893 --> 03:26:44,760 STIGSES. 5014 03:26:44,760 --> 03:26:46,262 BRINGING ALL THOSE FOLKS 5015 03:26:46,262 --> 03:26:47,730 TOGETHER I THINK WILL BETTER 5016 03:26:47,730 --> 03:26:52,334 ALLOW YOU TO AVOID MISMAPS BY 5017 03:26:52,334 --> 03:26:53,702 UNDERSTANDING THE CONSIDERATION 5018 03:26:53,702 --> 03:26:55,838 OR NOT CONSIDERING BARRIERS 5019 03:26:55,838 --> 03:26:57,573 RELEVANT TO YOUR POPULATION. 5020 03:26:57,573 --> 03:26:59,275 >> REALLY GOOD POINTS. 5021 03:26:59,275 --> 03:27:01,143 AND DR. ZHU, WE'LL HAVE YOU 5022 03:27:01,143 --> 03:27:04,113 ROUND OUT THE QUESTIONS NOW. 5023 03:27:04,113 --> 03:27:06,048 ANY FINAL THOUGHTS ABOUT THOSE 5024 03:27:06,048 --> 03:27:07,082 IMPORTANT CONSIDERATIONS WHEN 5025 03:27:07,082 --> 03:27:08,350 DOING THIS TYPE OF ECONOMIC 5026 03:27:08,350 --> 03:27:13,155 ANALYSIS FOR SPECIAL GROUPS? 5027 03:27:13,155 --> 03:27:15,858 >> JUST REEMPHASIZING KEEPING 5028 03:27:15,858 --> 03:27:17,293 WHO WILL BE AFFECTED BY THESE 5029 03:27:17,293 --> 03:27:18,560 RESULTS AND WHO WILL BE AFFECTED 5030 03:27:18,560 --> 03:27:23,098 BY THE CENTER OF THE QUESTIONS 5031 03:27:23,098 --> 03:27:24,833 YOU'RE ASKING AND HOW YOU'RE 5032 03:27:24,833 --> 03:27:26,402 MARKETING AND MESSAGING IS GOING 5033 03:27:26,402 --> 03:27:29,805 TO BE THE MOST IMPORTANT. 5034 03:27:29,805 --> 03:27:32,741 WE DON'T WANT TO BE COMING IN 5035 03:27:32,741 --> 03:27:34,643 WITH THE RIGHT ANSWERS WITHOUT 5036 03:27:34,643 --> 03:27:37,046 BEING COGNITIVE AND FAMILIAR 5037 03:27:37,046 --> 03:27:39,815 WITH WHAT PEOPLE WANT IN THE 5038 03:27:39,815 --> 03:27:41,250 FIELD AND WHAT PATIENTS WANT. 5039 03:27:41,250 --> 03:27:44,787 IT'S ULTIMATELY THE ROLE OF 5040 03:27:44,787 --> 03:27:46,555 RESEARCHER IS TO MAKE THINGS 5041 03:27:46,555 --> 03:27:48,891 EASIER AND BETTER FOR THOSE 5042 03:27:48,891 --> 03:27:49,825 PATIENTS AND THOSE CENTERING 5043 03:27:49,825 --> 03:27:51,260 THAT IN ALL OF OUR WORK. 5044 03:27:51,260 --> 03:27:52,494 >> YEAH. 5045 03:27:52,494 --> 03:27:56,332 AND I THINK THAT'S AN ABSOLUTELY 5046 03:27:56,332 --> 03:27:57,566 TERRIFIC PLACE TO END. 5047 03:27:57,566 --> 03:27:59,768 THE PATIENT CENTERED FOCUS IS A 5048 03:27:59,768 --> 03:28:00,436 TESTAMENT TO THE RESEARCH YOU 5049 03:28:00,436 --> 03:28:03,005 ALL HAVE CONDUCTED. 5050 03:28:03,005 --> 03:28:05,274 WE APPRECIATE YOUR PRESENTATION 5051 03:28:05,274 --> 03:28:06,175 AND TERRIFIC WORK. 5052 03:28:06,175 --> 03:28:07,609 WE'LL PASS IT ON. 5053 03:28:07,609 --> 03:28:11,580 >> THANK YOU, BE SHANNON AND 5054 03:28:11,580 --> 03:28:13,682 THANK YOU FOR OUTSTANDING 5055 03:28:13,682 --> 03:28:14,283 PRESENTATIONS AND FOR YOUR 5056 03:28:14,283 --> 03:28:17,553 EXPERT FACILITATION OF THE 5057 03:28:17,553 --> 03:28:17,987 DISCUSSION. 5058 03:28:17,987 --> 03:28:24,093 NOW OVER TO OUR NEXT SESSION. 5059 03:28:24,093 --> 03:28:25,227 >> THANK YOU. 5060 03:28:25,227 --> 03:28:28,998 I SERVE AT THE NATIONAL 5061 03:28:28,998 --> 03:28:30,032 INSTITUTE OF MENTAL HEALTH AND 5062 03:28:30,032 --> 03:28:40,342 IT IS MY PLEASURE TO INTRODUCE 5063 03:28:40,342 --> 03:28:43,779 OUR PANELISTS. 5064 03:28:43,779 --> 03:28:48,350 AND CLARE McNUTT FOR THE HEALTH 5065 03:28:48,350 --> 03:28:50,719 SYSTEM INTEGRATION AT THE MENTAL 5066 03:28:50,719 --> 03:28:51,720 HEALTH POLICY INSTITUTE. 5067 03:28:51,720 --> 03:28:55,024 THANK YOU EVERYONE. 5068 03:28:55,024 --> 03:29:00,662 OVER TO YOU, KRISTIN AND CLARE. 5069 03:29:00,662 --> 03:29:02,398 >> WE'RE HAPPY TO BE HERE TO 5070 03:29:02,398 --> 03:29:05,534 TALK ABOUT INTEGRATED MENTAL 5071 03:29:05,534 --> 03:29:06,835 HEALTH AND SUBSTANCE USE 5072 03:29:06,835 --> 03:29:07,102 TREATMENT. 5073 03:29:07,102 --> 03:29:10,039 I'M SURE MANY ON THE CALL TRIED 5074 03:29:10,039 --> 03:29:12,841 TO ACCESS MENTAL HEALTH SERVICES 5075 03:29:12,841 --> 03:29:14,910 AND RUN INTO MULTIPLE ROAD 5076 03:29:14,910 --> 03:29:17,713 BLOCKS IN GETTING AN APPOINTMENT 5077 03:29:17,713 --> 03:29:20,015 AND INCREASES IN THE NEED AND 5078 03:29:20,015 --> 03:29:23,519 SHORTAGE FOR SUBSTANCE USE 5079 03:29:23,519 --> 03:29:23,786 PROVIDERS. 5080 03:29:23,786 --> 03:29:28,791 EARLIER WE HEARD AROUND THE 5081 03:29:28,791 --> 03:29:30,359 COLLABORATIVE CARE MODELS AND 5082 03:29:30,359 --> 03:29:31,326 EARLY INTERVENTION AND 5083 03:29:31,326 --> 03:29:31,760 CONVENTION. 5084 03:29:31,760 --> 03:29:33,729 THROUGH THIS PANEL WE'LL HAVE 5085 03:29:33,729 --> 03:29:34,496 PRESENTATIONS THAT ARE GOING TO 5086 03:29:34,496 --> 03:29:38,067 LOOK FORWARD TO A BETTER 5087 03:29:38,067 --> 03:29:39,902 UNDERSTANDING OF HEALTH ECONOMIC 5088 03:29:39,902 --> 03:29:40,436 BARRIERS. 5089 03:29:40,436 --> 03:29:42,938 CHALLENGES AND OPPORTUNITIES FOR 5090 03:29:42,938 --> 03:29:45,441 INTEGRATING SUBSTANCE USE AND 5091 03:29:45,441 --> 03:29:47,076 MENTAL HEALTH DISORDERS AS WELL 5092 03:29:47,076 --> 03:29:49,778 AS WITH PRIMARY CARE. 5093 03:29:49,778 --> 03:29:52,314 YOU'LL ALSO HEAR ABOUT THE 5094 03:29:52,314 --> 03:29:53,682 ACCESS TO CARE TODAY AS WELL. 5095 03:29:53,682 --> 03:29:56,318 I'LL TURN THIS BACK OVER TO 5096 03:29:56,318 --> 03:30:00,089 CLARE. 5097 03:30:00,089 --> 03:30:02,724 >> AS WE BEGIN THE PANEL, PLEASE 5098 03:30:02,724 --> 03:30:04,326 USE THE Q&A BOX TO SHARE 5099 03:30:04,326 --> 03:30:04,660 QUESTIONS. 5100 03:30:04,660 --> 03:30:08,330 IF YOU'RE NOT ABLE YOU MAY BE 5101 03:30:08,330 --> 03:30:09,865 ABLE TO E-MAIL QUESTIONS TO 5102 03:30:09,865 --> 03:30:11,300 CLARE AND WE'LL COLLECT THE 5103 03:30:11,300 --> 03:30:12,334 QUESTIONS AND RESPOND AFTER ALL 5104 03:30:12,334 --> 03:30:15,871 THE PRESENTATIONS ARE FINISHED. 5105 03:30:15,871 --> 03:30:19,141 NOW OUR FIRST SPEAKER FROM THE 5106 03:30:19,141 --> 03:30:21,243 UNIVERSITY OF UTAH SCHOOL OF 5107 03:30:21,243 --> 03:30:22,744 MEDICINE, DR. GORDON. 5108 03:30:22,744 --> 03:30:24,246 >> THANK YOU VERY MUCH. 5109 03:30:24,246 --> 03:30:26,148 I WANT TO THANK EVERYBODY FOR 5110 03:30:26,148 --> 03:30:27,983 ALLOWING ME TO PRESENT TODAY IN 5111 03:30:27,983 --> 03:30:30,352 A SHORT 10 MINUTES HERE. 5112 03:30:30,352 --> 03:30:33,722 FIRST, THANK YOU TO NIDA AND NIH 5113 03:30:33,722 --> 03:30:35,023 FOR FUNDING A LOT OF THIS WORK 5114 03:30:35,023 --> 03:30:37,993 AND THE DEPARTMENT OF VETERAN 5115 03:30:37,993 --> 03:30:39,194 AFFAIRS. 5116 03:30:39,194 --> 03:30:42,097 WE'LL TALK ABOUT HOW WE'RE 5117 03:30:42,097 --> 03:30:43,699 CHANGING HOW PEOPLE ARE 5118 03:30:43,699 --> 03:30:45,400 ACCESSING SUBSTANCE USE DISORDER 5119 03:30:45,400 --> 03:30:49,471 CARE AND PARTICULARLY OPIOID USE 5120 03:30:49,471 --> 03:30:50,606 DISORDER CARE AND OUR HEALTH 5121 03:30:50,606 --> 03:30:55,210 CARE SYSTEMS IN TRYING TO DERIVE 5122 03:30:55,210 --> 03:30:56,545 ADDICTION CARE WITHIN GENERAL 5123 03:30:56,545 --> 03:30:57,679 NORMAL HEALTH CARE SETTINGS. 5124 03:30:57,679 --> 03:31:01,216 I DO WORK WITH REGARD TO HEALTH 5125 03:31:01,216 --> 03:31:04,319 SYSTEM CHANGE AND IMPROVE 5126 03:31:04,319 --> 03:31:10,325 ADDITION ACCESS AND I'LL TALK 5127 03:31:10,325 --> 03:31:13,662 ABOUT ONE OF OUR PROJECTS WE'RE 5128 03:31:13,662 --> 03:31:18,934 DOING WITH REGARDS TO FORCING 5129 03:31:18,934 --> 03:31:21,003 THE CHANGE WITHIN DEPARTMENT OF 5130 03:31:21,003 --> 03:31:22,738 VETERANS AFFAIRS AND HOW PRIMARY 5131 03:31:22,738 --> 03:31:26,308 CARE MAY BE A BETTER COST 5132 03:31:26,308 --> 03:31:29,711 EFFECTIVE WAY TO TAKE CARE 5133 03:31:29,711 --> 03:31:32,781 PATIENTS WITH ADDITION AND 5134 03:31:32,781 --> 03:31:35,617 OPIOID USE DISORDER AND IS AS WE 5135 03:31:35,617 --> 03:31:38,187 THINK OF DIFFERENT MODELS OF 5136 03:31:38,187 --> 03:31:42,524 CARE THINKING WITH THE ECONOMIC 5137 03:31:42,524 --> 03:31:43,592 COST OF ADDITIONAL CARE MAY NOT 5138 03:31:43,592 --> 03:31:44,793 BE NEEDED. 5139 03:31:44,793 --> 03:31:48,630 WE MAY BE ABLE TO DO IT WITHIN A 5140 03:31:48,630 --> 03:31:53,202 PRIMARY CARE MODEL. 5141 03:31:53,202 --> 03:31:55,137 WE KNOW THE PARADIGMS HAVE 5142 03:31:55,137 --> 03:31:57,606 CHANGED IN THE LAST TWO DECADE. 5143 03:31:57,606 --> 03:32:01,510 WE'RE REALLY PULLING ADDICTION 5144 03:32:01,510 --> 03:32:04,112 CARE IN THE NORMAL HEALTH CARE 5145 03:32:04,112 --> 03:32:06,848 SETTINGS AND MAY MAY NOT BE 5146 03:32:06,848 --> 03:32:09,351 PEOPLE WHO ARE SPECIALTY 5147 03:32:09,351 --> 03:32:10,219 ADDICTION CARE. 5148 03:32:10,219 --> 03:32:13,689 IT COULD BE YOUR PRIMARY CARE 5149 03:32:13,689 --> 03:32:14,957 PROVIDER WITHIN THE CONFINES 5150 03:32:14,957 --> 03:32:16,291 WHERE YOU'RE SEEKING CARE ALL 5151 03:32:16,291 --> 03:32:19,228 THE TIME AND CAN POTENTIALLY 5152 03:32:19,228 --> 03:32:22,064 REDUCE STIGMA AND IMPROVE ACCESS 5153 03:32:22,064 --> 03:32:23,632 PARTICULARLY IN RESOURCE POOR 5154 03:32:23,632 --> 03:32:25,534 STUDIES LIKE RURAL HEALTH CARE 5155 03:32:25,534 --> 03:32:26,935 STUDIES WHERE A PRIMARY CARE 5156 03:32:26,935 --> 03:32:29,938 PROVIDER OR PHARMACIST MAY BE 5157 03:32:29,938 --> 03:32:32,274 ABLE TO ENGAGE WITH ADDITION 5158 03:32:32,274 --> 03:32:32,474 CARE. 5159 03:32:32,474 --> 03:32:35,611 IN MANY WAYS AS WE SWITCH THE 5160 03:32:35,611 --> 03:32:39,715 PARADIGM GETTING PROVIDERS TO 5161 03:32:39,715 --> 03:32:41,450 ACCEPT HOW TO DO THIS IN THE 5162 03:32:41,450 --> 03:32:44,319 SETTINGS IS AN IMPORTANT 5163 03:32:44,319 --> 03:32:52,894 CONSIDERATION. 5164 03:32:52,894 --> 03:32:54,630 WE'VE DONE WORK IN HEALTH CARE 5165 03:32:54,630 --> 03:32:57,866 SYSTEMS AND TALK ABOUT THE V.A. 5166 03:32:57,866 --> 03:32:58,100 SYSTEM. 5167 03:32:58,100 --> 03:33:00,335 THERE'S SYSTEM BARRIERS WITH 5168 03:33:00,335 --> 03:33:02,804 GETTING ADDITION CARE AND 5169 03:33:02,804 --> 03:33:03,939 THERE'S LACK OF EDUCATION, 5170 03:33:03,939 --> 03:33:05,907 THERE'S MAYBE ILL PERCEPTIONS 5171 03:33:05,907 --> 03:33:08,010 AND PERCEIVED LACK OF RESOURCES. 5172 03:33:08,010 --> 03:33:10,912 WHY SHOULD A PRIMARY CARE 5173 03:33:10,912 --> 03:33:14,116 PROVIDER DO THIS WHEN ADDICTION 5174 03:33:14,116 --> 03:33:17,386 CARE CLINIC MAY BE MORE RESOURCE 5175 03:33:17,386 --> 03:33:27,929 ED AND FACILITATORS WE LEARNED 5176 03:33:36,204 --> 03:33:38,340 IF YOU HAVE A CHAMPION, IF YOU 5177 03:33:38,340 --> 03:33:40,242 HAVE A PRIMARY CARE PERSON 5178 03:33:40,242 --> 03:33:41,376 WITHIN A LARGE HEALTH CARE 5179 03:33:41,376 --> 03:33:42,444 SYSTEM THE PRIMARY CARE 5180 03:33:42,444 --> 03:33:45,514 PROVIDERS AROUND THEM WILL 5181 03:33:45,514 --> 03:33:49,284 POTENTIALLY BE INTERESTED IN 5182 03:33:49,284 --> 03:33:52,988 DEALING WITH ADDITION CARE AND 5183 03:33:52,988 --> 03:33:54,923 DIRECTIVES HAVE BEEN IMPORTANT 5184 03:33:54,923 --> 03:33:56,058 COMPONENTS OF CHANGING LARGE 5185 03:33:56,058 --> 03:33:58,460 HEALTH CARE SYSTEMS AND THINK OF 5186 03:33:58,460 --> 03:34:02,464 ADDICTION CARE WITHIN MEDICAL 5187 03:34:02,464 --> 03:34:05,467 HEALTH SETTINGS. 5188 03:34:05,467 --> 03:34:07,336 WE'VE DONE WORK WITH DIRECTIVES 5189 03:34:07,336 --> 03:34:09,171 AND CRITERIA FOR USE. 5190 03:34:09,171 --> 03:34:09,471 ETCETERA. 5191 03:34:09,471 --> 03:34:13,809 THIS IS A SMATTERING OF A LOT OF 5192 03:34:13,809 --> 03:34:18,647 FORMALLY GUIDANCE WITH REGARD TO 5193 03:34:18,647 --> 03:34:22,884 BUPRENORPHINE AND GUIDANCE HAS 5194 03:34:22,884 --> 03:34:26,188 BEEN DIRECTED TO PRIMARY CARE 5195 03:34:26,188 --> 03:34:27,322 PROVIDERS NOT TO SUBSTANCE USE 5196 03:34:27,322 --> 03:34:32,327 DISORDER TREATMENT PROVIDERS BUT 5197 03:34:32,327 --> 03:34:34,629 THE AND THOSE WHO TAKE CARE OF 5198 03:34:34,629 --> 03:34:40,335 PATIENTS WITH ADDITION ON A 5199 03:34:40,335 --> 03:34:42,804 LONGITUDINAL BASIS. 5200 03:34:42,804 --> 03:34:46,641 AND THERE'S BEEN WORK ON 5201 03:34:46,641 --> 03:34:47,909 INCENTIVIZING PRIMARY CARE 5202 03:34:47,909 --> 03:34:49,077 PROVIDERS IN HOW TO DO THIS KIND 5203 03:34:49,077 --> 03:34:49,745 OF CARE. 5204 03:34:49,745 --> 03:34:52,114 THERE'S FINANCIAL INCENTIVES 5205 03:34:52,114 --> 03:34:55,450 SUCH AS EXTRA RESOURCES OR MONEY 5206 03:34:55,450 --> 03:35:02,190 ON A PAYCHECK OR BONUS PAY TO 5207 03:35:02,190 --> 03:35:04,025 PROVIDERS TO ENGAGE IN THIS 5208 03:35:04,025 --> 03:35:04,326 CARE. 5209 03:35:04,326 --> 03:35:05,427 THERE'S DIFFERENT TYPES OF 5210 03:35:05,427 --> 03:35:07,829 PROVIDERS WITH INCENTIVES. 5211 03:35:07,829 --> 03:35:10,265 IF YOU'RE A PHYSICIAN YOU MAY BE 5212 03:35:10,265 --> 03:35:12,801 INTERESTED IN MORE TIME WITH THE 5213 03:35:12,801 --> 03:35:16,338 PATIENT OR LESS CENSUS OF THE 5214 03:35:16,338 --> 03:35:19,007 PATIENT PANEL AND PROVIDE 5215 03:35:19,007 --> 03:35:19,674 BUPRENORPHINE IN THE PROVISION 5216 03:35:19,674 --> 03:35:21,743 OF THAT CARE. 5217 03:35:21,743 --> 03:35:23,311 INCENTIVES ARE AN IMPORTANT 5218 03:35:23,311 --> 03:35:26,181 COMPONENT THAT POTENTIALLY MAY 5219 03:35:26,181 --> 03:35:26,882 INCENTIVIZE PEOPLE TO PROVIDER 5220 03:35:26,882 --> 03:35:29,518 THIS TYPE OF CARE IN NORMAL 5221 03:35:29,518 --> 03:35:30,085 MEDICAL SETTINGS. 5222 03:35:30,085 --> 03:35:34,956 WE HAVE DONE A LOT OF WORK IN 5223 03:35:34,956 --> 03:35:38,260 THIS AREA LOOKING AT LARGE 5224 03:35:38,260 --> 03:35:40,729 SYSTEMS LIKE THE V.A. IS 5225 03:35:40,729 --> 03:35:44,332 PROVIDING THIS TYPE OF CARE AND 5226 03:35:44,332 --> 03:35:46,935 PARTICULARLY BUPRENORPHINE AND 5227 03:35:46,935 --> 03:35:50,071 THIS SLIDE SHOWS SINCE 2006 TO 5228 03:35:50,071 --> 03:35:51,940 2019 WE'VE HAD A STEADY INCREASE 5229 03:35:51,940 --> 03:35:56,344 IN THE AMOUNT OF PATIENTS 5230 03:35:56,344 --> 03:35:59,247 RECEIVING BUPRENORPHINE CARE AND 5231 03:35:59,247 --> 03:35:59,815 INITIATING TREATMENT WITHIN 5232 03:35:59,815 --> 03:36:03,018 VARIOUS HEALTH CARE SETTINGS. 5233 03:36:03,018 --> 03:36:05,620 THE PROBLEM WE FOUND EARLY ON IS 5234 03:36:05,620 --> 03:36:08,457 THAT EVEN IN A LARGE HEALTH CARE 5235 03:36:08,457 --> 03:36:11,693 SYSTEM WE SHUTTLE PEOPLE TO 5236 03:36:11,693 --> 03:36:15,130 SPECIALTY USE DISORDER CLINICS 5237 03:36:15,130 --> 03:36:22,504 WE NOTICED IN 2017 THOUGH WE'RE 5238 03:36:22,504 --> 03:36:33,048 DRIVING THIS IN THE SYSTEM AND 5239 03:36:34,983 --> 03:36:35,350 6% OF BUPRENORPHINE 5240 03:36:35,350 --> 03:36:36,184 PRESCRIPTIONS WERE PRESCRIBED BY 5241 03:36:36,184 --> 03:36:39,888 PRIMARY CARE PROVIDERS. 5242 03:36:39,888 --> 03:36:42,157 AS WE REDUCE THE COST OF 5243 03:36:42,157 --> 03:36:43,959 SPECIALTY CARE, HOW CAN WE 5244 03:36:43,959 --> 03:36:45,861 IMPROVE THE GENERALIST, THE 5245 03:36:45,861 --> 03:36:48,997 PRIMARY CARE PROVIDERS TO 5246 03:36:48,997 --> 03:36:52,200 PROVIDER THIS CARE TO REDUCE 5247 03:36:52,200 --> 03:36:54,936 COST AND POTENTIALLY IMPROVE 5248 03:36:54,936 --> 03:36:57,038 ACCESS OF CARE WHERE THERE MAY 5249 03:36:57,038 --> 03:37:05,814 NOT BE SUD CLINICS AROUND. 5250 03:37:05,814 --> 03:37:09,918 AND THERE WAS A STEP CARE 5251 03:37:09,918 --> 03:37:11,987 APPROACH SIMILAR TO THE CASCADE 5252 03:37:11,987 --> 03:37:15,390 OF CARE THROUGH THE NIH THE IDEA 5253 03:37:15,390 --> 03:37:17,092 WAS TO IMPROVE THE LEVELS OF 5254 03:37:17,092 --> 03:37:18,126 CARE AND TRANSITIONS FROM ONE 5255 03:37:18,126 --> 03:37:25,500 LEVEL OF CARE TO ANOTHER. 5256 03:37:25,500 --> 03:37:26,601 RECOGNIZING THE SUD SPECIALTY 5257 03:37:26,601 --> 03:37:34,175 AND IOPs AND RESIDENTIAL 5258 03:37:34,175 --> 03:37:36,077 TREATMENT PROGRAMS AND CAN WE 5259 03:37:36,077 --> 03:37:39,714 GET THE PRIMARY CARE PROVIDERS 5260 03:37:39,714 --> 03:37:41,616 AND PAIN CLINICAL PROVIDERS 5261 03:37:41,616 --> 03:37:45,053 PROVIDING CARE CAN WE HAVE THEM 5262 03:37:45,053 --> 03:37:49,624 ENGAGE IN TO ADDICTION CARE TO 5263 03:37:49,624 --> 03:37:54,496 IMPROVE ACCESS FOR THOSE 5264 03:37:54,496 --> 03:37:55,630 PATIENTS? 5265 03:37:55,630 --> 03:37:57,832 IN 2018 THERE WAS THE TRAIN THE 5266 03:37:57,832 --> 03:38:01,703 TRAINER TO TRY TO IMPROVE THE 5267 03:38:01,703 --> 03:38:04,339 ACCESS OF MEDICATION TREATMENT 5268 03:38:04,339 --> 03:38:06,408 FOR OPIOID USE DISORDER IN NON 5269 03:38:06,408 --> 03:38:07,976 SPECIALTY CARE SETTINGS. 5270 03:38:07,976 --> 03:38:12,147 PRIMARY CARE MENTAL HEALTH AND 5271 03:38:12,147 --> 03:38:15,684 PAIN CLINICS. 5272 03:38:15,684 --> 03:38:17,719 THROUGH FACILITATION METHODS, A 5273 03:38:17,719 --> 03:38:20,889 LOT OF EDUCATION STILL GOING ON 5274 03:38:20,889 --> 03:38:22,557 TODAY AS WELL AS AD HOC 5275 03:38:22,557 --> 03:38:25,961 CONSULTATIONS AND SITE VISITS WE 5276 03:38:25,961 --> 03:38:27,028 INITIATED THE SCOUT INITIATIVE 5277 03:38:27,028 --> 03:38:28,363 THROUGH 15 FACILITIES ACROSS THE 5278 03:38:28,363 --> 03:38:32,000 COUNTRY AND THIS IS CHANGING THE 5279 03:38:32,000 --> 03:38:33,635 CULTURE ASSOCIATED WITH HOW 5280 03:38:33,635 --> 03:38:36,671 WE'RE DRIVING FROM A 6% PRIMARY 5281 03:38:36,671 --> 03:38:38,173 CARE PROVISION OF BUPRENORPHINE 5282 03:38:38,173 --> 03:38:40,342 CARE TO WHAT WE'LL TALK ABOUT IN 5283 03:38:40,342 --> 03:38:47,515 THE NEXT SEVERAL SLIDES. 5284 03:38:47,515 --> 03:38:51,653 WE LEARNED EARLY ON IN THE FIRST 5285 03:38:51,653 --> 03:38:54,823 PHASE OF THIS PROJECT THAT BY 5286 03:38:54,823 --> 03:38:55,991 DOING THIS FACILITATION APPROACH 5287 03:38:55,991 --> 03:38:57,692 AND ENGAGING PROVIDERS IN 5288 03:38:57,692 --> 03:39:01,296 DIFFERENT FACILITIES WE'RE ABLE 5289 03:39:01,296 --> 03:39:05,400 TO INCREASE PROPORTIONALLY THOSE 5290 03:39:05,400 --> 03:39:06,635 RECEIVING CARE IN THE 5291 03:39:06,635 --> 03:39:09,771 NON-SPECIALTY CARE SETTINGS 5292 03:39:09,771 --> 03:39:12,340 EMBOLDENED TO EXPAND ACROSS THE 5293 03:39:12,340 --> 03:39:18,279 COUNTRY. 5294 03:39:18,279 --> 03:39:21,549 >> THIS IS THE TAKE HOME POINT 5295 03:39:21,549 --> 03:39:22,517 TO CHANGE THE SYSTEM TO DRIVE 5296 03:39:22,517 --> 03:39:25,320 THE CHANGE TO IMPROVE ACCESS 5297 03:39:25,320 --> 03:39:26,655 WITHIN NON-SPECIALTY CARE 5298 03:39:26,655 --> 03:39:26,921 SETTINGS. 5299 03:39:26,921 --> 03:39:30,325 IF YOU SEE ON THE SLIDE FROM 5300 03:39:30,325 --> 03:39:32,961 2016 TO 2024, THE BLUE BAR IS 5301 03:39:32,961 --> 03:39:35,497 THE SUD CLINICS AND THE 5302 03:39:35,497 --> 03:39:38,099 PROVISION OF ALL BUPRENORPHINE 5303 03:39:38,099 --> 03:39:40,568 SYSTEMS IN THE V.A. 5304 03:39:40,568 --> 03:39:43,638 YOU SEE THIS PROPORTIONATELY 5305 03:39:43,638 --> 03:39:46,408 DECLINED OVER TIME SUCH THAT IF 5306 03:39:46,408 --> 03:39:51,579 YOU SEE IN 2024, 56% OF ALL 5307 03:39:51,579 --> 03:39:53,281 PRESCRIPTIONS ARE WITHIN SUD 5308 03:39:53,281 --> 03:39:56,051 SPECIALTY CARE CLINICS AND THE 5309 03:39:56,051 --> 03:40:00,155 REST, 44% IN NON-SPECIALTY CARE 5310 03:40:00,155 --> 03:40:00,855 SETTING WITH INCREASING AMOUNT 5311 03:40:00,855 --> 03:40:05,326 OF PRIMARY CARE AND MENTAL 5312 03:40:05,326 --> 03:40:09,130 HEALTH CLINICS AND PROVIDER 5313 03:40:09,130 --> 03:40:12,667 LONGITUDINAL WRAP AROUND CARE 5314 03:40:12,667 --> 03:40:16,071 AND THE CHRONIC BRAIN DISEASE 5315 03:40:16,071 --> 03:40:16,971 TREATMENT WE KNOW SUD REQUIRE. 5316 03:40:16,971 --> 03:40:22,877 THE OTHER THING THAT WAS EXC 5317 03:40:22,877 --> 03:40:25,613 EXCITING WE FOUND ON THE PROJECT 5318 03:40:25,613 --> 03:40:31,786 IS WE'VE STARTED TO SEE MORE 5319 03:40:31,786 --> 03:40:36,791 INITIATIONS AND THE PRIMARY CARE 5320 03:40:36,791 --> 03:40:37,559 AND PAIN CLINIC PROVIDERS TAKE 5321 03:40:37,559 --> 03:40:46,835 OVER THE CARE OVER TIME. 5322 03:40:46,835 --> 03:40:49,170 AND THEY'RE INITIATING CARE SUCH 5323 03:40:49,170 --> 03:40:51,506 THAT IN 2023 WE HAD MORE 5324 03:40:51,506 --> 03:40:53,108 INITIATIONS OF EPISODES OF CARE 5325 03:40:53,108 --> 03:41:03,585 FOR BUPRENORPHINE CARE AND 5326 03:41:04,819 --> 03:41:08,890 EXCITING TO SEE IT HAPPEN 5327 03:41:08,890 --> 03:41:09,858 RAPIDLY. 5328 03:41:09,858 --> 03:41:10,492 WE'RE NOT GOING TO TALK ABOUT 5329 03:41:10,492 --> 03:41:13,061 ALL THE MODELS OF CARE. 5330 03:41:13,061 --> 03:41:19,300 WE TALK ABOUT INTEGRATIVE CARE 5331 03:41:19,300 --> 03:41:23,972 BUT IN A PRIMARY CARE MODEL YOU 5332 03:41:23,972 --> 03:41:25,440 CAN ENGAGE PROVIDERS IN THE 5333 03:41:25,440 --> 03:41:27,041 PROVISION OF THE CARE UNDER 5334 03:41:27,041 --> 03:41:27,675 NURSE MANAGEMENT OR PHARMACIST 5335 03:41:27,675 --> 03:41:37,986 OR SOCIAL WORKER. 5336 03:41:39,254 --> 03:41:41,289 AND YOU HAVE PHARMACISTS WORKING 5337 03:41:41,289 --> 03:41:42,957 ALONGSIDE PRESCRIBERS WHO ARE 5338 03:41:42,957 --> 03:41:45,360 DOING THE MONITORING AND 5339 03:41:45,360 --> 03:41:47,195 ENGAGEMENT AROUND DAY TO DAYCARE 5340 03:41:47,195 --> 03:41:51,266 FOR A PATIENT CURRENTLY ON 5341 03:41:51,266 --> 03:41:53,368 BUPRENORPHINE. 5342 03:41:53,368 --> 03:41:56,671 YOU CAN SEE WE'VE DONE WORK IN 5343 03:41:56,671 --> 03:42:00,175 UNDERSTANDING HOW PHARMACISTS CA 5344 03:42:00,175 --> 03:42:01,042 CAN PRESCRIBE BUPRENORPHINE IN 5345 03:42:01,042 --> 03:42:04,312 STATES THAT ALLOW THEM TO 5346 03:42:04,312 --> 03:42:05,980 PRESCRIBE AND A LOT OF 5347 03:42:05,980 --> 03:42:07,916 PHARMACISTS ARE INDEPENDENT IN 5348 03:42:07,916 --> 03:42:08,583 PROSCRIBING BUPRENORPHINE CARE 5349 03:42:08,583 --> 03:42:09,584 AND DOING A GOOD JOB. 5350 03:42:09,584 --> 03:42:13,655 THE RATE OF RETENTION IS ABOUT 5351 03:42:13,655 --> 03:42:14,889 87% AFTER A 90-DAY PERIOD. 5352 03:42:14,889 --> 03:42:17,926 VERY EXCITING TO SEE THAT. 5353 03:42:17,926 --> 03:42:22,330 OTHER HEALTH CARE PROVIDERS ARE 5354 03:42:22,330 --> 03:42:23,498 ABLE TO PROVIDE CARE IN A 5355 03:42:23,498 --> 03:42:24,899 MEDICAL HOME MODEL. 5356 03:42:24,899 --> 03:42:26,801 I DIDN'T TALK A LOT ABOUT THE 5357 03:42:26,801 --> 03:42:29,704 FINANCIAL COSTS SO WHAT WE'RE 5358 03:42:29,704 --> 03:42:31,706 SEEING WE CHANGED THIS AND 5359 03:42:31,706 --> 03:42:33,541 SPECIALTY CARE IS A LOT MORE 5360 03:42:33,541 --> 03:42:36,010 EXPENSIVE AND A METHADONE CLINIC 5361 03:42:36,010 --> 03:42:39,881 OR SPECIALTY CARE CLINIC IS MORE 5362 03:42:39,881 --> 03:42:48,289 EXPENSIVE THAN A PRIMARY CARE 5363 03:42:48,289 --> 03:42:52,126 CLINIC THIS ONE SHOWS DECREASED 5364 03:42:52,126 --> 03:42:55,296 UTILIZATION OF PATIENT AND 5365 03:42:55,296 --> 03:42:56,364 EMERGENCY ROOM USE DOES OCCUR 5366 03:42:56,364 --> 03:42:57,365 DURING THE MODEL AND DOWN STREAM 5367 03:42:57,365 --> 03:42:59,267 COSTS ARE LESS AND IT'S A GREAT 5368 03:42:59,267 --> 03:43:00,935 OPPORTUNITY TO SEE HOW WE EXPAND 5369 03:43:00,935 --> 03:43:02,470 TO HEALTH CARE SYSTEM AND SAVE 5370 03:43:02,470 --> 03:43:04,405 MONEY AND EVALUATE THE COST PER 5371 03:43:04,405 --> 03:43:09,577 TYPE OF PATIENT THAT COMES. 5372 03:43:09,577 --> 03:43:11,279 WITH THAT I'LL PASS IT OFF TO 5373 03:43:11,279 --> 03:43:11,846 THE NEXT PERSON. 5374 03:43:11,846 --> 03:43:16,718 THE LAST THING I'LL MENTION IS 5375 03:43:16,718 --> 03:43:17,785 THERE'S A LOT OF WAYS TO DO 5376 03:43:17,785 --> 03:43:21,189 HEALTH CARE FOR PATIENTS WITH 5377 03:43:21,189 --> 03:43:24,759 ADDITION AND ONE MODEL IS 5378 03:43:24,759 --> 03:43:26,995 INTEGRATED WITHIN NORMAL 5379 03:43:26,995 --> 03:43:28,396 SETTINGS AND THE RETENTION RATES 5380 03:43:28,396 --> 03:43:29,864 ARE SIMILAR TO SPECIALTY CARE 5381 03:43:29,864 --> 03:43:31,366 AND COSTS ARE LESS AND WE'RE 5382 03:43:31,366 --> 03:43:32,367 EXCITED TO CONTINUE THIS WORK 5383 03:43:32,367 --> 03:43:35,503 GOING FORWARD AND AGAIN I THANK 5384 03:43:35,503 --> 03:43:38,039 THE NIH AND DEPARTMENT OF 5385 03:43:38,039 --> 03:43:38,740 VETERANS FOR FUNDING THIS WORK. 5386 03:43:38,740 --> 03:43:46,180 THANK YOU. 5387 03:43:46,180 --> 03:43:50,551 >> NEXT IS DR. MARA FROM T.H. 5388 03:43:50,551 --> 03:43:53,454 CHAN SCHOOL OF PUBLIC HEALTH. 5389 03:43:53,454 --> 03:43:54,956 >> THANKS TO THE ORGANIZERS AND 5390 03:43:54,956 --> 03:43:56,357 PARTICIPANTS. 5391 03:43:56,357 --> 03:43:56,925 IT'S GREAT TO BE HERE. 5392 03:43:56,925 --> 03:44:07,402 I'VE TRIED TO TAKE CONTROL. 5393 03:44:12,907 --> 03:44:16,811 >> I WANT TO ACKNOWLEDGE THE 5394 03:44:16,811 --> 03:44:18,246 WORK IS REALLY THERE'S A LARGE 5395 03:44:18,246 --> 03:44:20,348 TEAM BEHIND THE WORK AND I'M 5396 03:44:20,348 --> 03:44:25,186 SUPER GRATEFUL FOR FUNDING FROM 5397 03:44:25,186 --> 03:44:28,389 NIDA AND NIMHD FOR SUPPORTING 5398 03:44:28,389 --> 03:44:38,566 THIS WORK. 5399 03:44:47,875 --> 03:44:51,312 IN WAY OF PUBLIC CONTRACTS SO 5400 03:44:51,312 --> 03:44:54,282 CONTRACTS WITH MEDICAID AND 5401 03:44:54,282 --> 03:44:55,850 MEDICARE AND PROVIDER 5402 03:44:55,850 --> 03:44:56,884 ORGANIZATIONS SERVE MANY 5403 03:44:56,884 --> 03:44:59,954 INDIVIDUALS WITH BEHAVIORAL 5404 03:44:59,954 --> 03:45:03,391 HEALTH DISORDERS THESE CONTRACTS 5405 03:45:03,391 --> 03:45:05,827 GIVE ORGANIZATIONS INCENTIVES TO 5406 03:45:05,827 --> 03:45:07,161 MEET SPENDING AND QUALITY 5407 03:45:07,161 --> 03:45:11,366 BENCHMARKS FOR A DESIGNATED 5408 03:45:11,366 --> 03:45:12,767 PATIENT POPULATION. 5409 03:45:12,767 --> 03:45:14,969 AND IT LEARN ABOUT FEATURES OF 5410 03:45:14,969 --> 03:45:19,407 THE CONTRACTS AND WHAT 5411 03:45:19,407 --> 03:45:21,376 ORGANIZATIONS ENTERING CONTRACTS 5412 03:45:21,376 --> 03:45:24,679 CAN DO WE SURVEYED ACO LEADERS 5413 03:45:24,679 --> 03:45:25,947 AND COMPLIMENTED THE WORK WITH 5414 03:45:25,947 --> 03:45:28,249 ANALYSES IN MEDICARE AND 5415 03:45:28,249 --> 03:45:29,417 MEDICAID CLAIMS. 5416 03:45:29,417 --> 03:45:33,554 TODAY I'LL FOCUS ON ONE PAPER. 5417 03:45:33,554 --> 03:45:36,591 I'LL PUT IT IN THE CONTEXT OF 5418 03:45:36,591 --> 03:45:37,225 THE LARGER RESEARCH AGENDA IN 5419 03:45:37,225 --> 03:45:41,662 THE SPIRIT OF THE SESSION ON 5420 03:45:41,662 --> 03:45:43,498 PROVISION AND DIGITAL 5421 03:45:43,498 --> 03:45:46,334 TECHNOLOGIES I'M LOOKING AT THE 5422 03:45:46,334 --> 03:45:49,103 FOLLOWING PAPER LED BY CHRIS 5423 03:45:49,103 --> 03:45:58,179 MILLER ROSALES. 5424 03:45:58,179 --> 03:46:00,181 SO THE BACKGROUND FOR THIS IS WE 5425 03:46:00,181 --> 03:46:02,850 ALL KNOW AND MENTIONED IN THE 5426 03:46:02,850 --> 03:46:04,419 INTRODUCTION THERE'S RELATIVELY 5427 03:46:04,419 --> 03:46:07,855 LOW USE OF MANY EVIDENCE-BASED 5428 03:46:07,855 --> 03:46:16,364 APPROACHES TO TREATING OPIOID 5429 03:46:16,364 --> 03:46:18,833 USE DISORDER AND REACH THE 5430 03:46:18,833 --> 03:46:20,968 DISORDER PARTICULARLY IN PLACES 5431 03:46:20,968 --> 03:46:24,072 THAT MIGHT OTHERWISE NOT HAVE AS 5432 03:46:24,072 --> 03:46:32,380 MANY RESOURCES OR PROVIDERS 5433 03:46:32,380 --> 03:46:42,557 AVAILABLE. 5434 03:46:43,791 --> 03:46:46,727 IN A SETTING OF ACO 5435 03:46:46,727 --> 03:46:48,362 PARTICIPATING ORGANIZATIONS SO 5436 03:46:48,362 --> 03:46:51,799 SURVEY RESPONDENTS OF THOSE, WE 5437 03:46:51,799 --> 03:46:53,835 ASKED ABOUT THESE FEATURES. 5438 03:46:53,835 --> 03:46:54,402 THAT'S WHAT I'LL BE TALKING 5439 03:46:54,402 --> 03:47:01,542 ABOUT TODAY. 5440 03:47:01,542 --> 03:47:09,917 THE NATIONAL SURVEY OF ACOs IN 5441 03:47:09,917 --> 03:47:12,353 THE 2021 HOLDING MEDICARE OR 5442 03:47:12,353 --> 03:47:14,422 MEDICAID ACO CONTRACTS WE ASKED 5443 03:47:14,422 --> 03:47:16,624 ABOUT THE STRUCTURE OF THE 5444 03:47:16,624 --> 03:47:18,559 ORGANIZATION, THE CONTRACTS AS 5445 03:47:18,559 --> 03:47:20,094 WELL AS CAPABILITIES ESPECIALLY 5446 03:47:20,094 --> 03:47:24,065 AS THEY RELATED TO TREATMENT OF 5447 03:47:24,065 --> 03:47:26,400 OPIOID USE DISORDER AND THE 5448 03:47:26,400 --> 03:47:27,001 RESPONDENTS' WHOLE LEADERSHIP 5449 03:47:27,001 --> 03:47:28,970 ROLES IN THE ORGANIZATIONS. 5450 03:47:28,970 --> 03:47:33,908 WE RECEIVED RESPONSES FROM 276 5451 03:47:33,908 --> 03:47:34,775 ORGANIZATIONS WHICH WAS ABOUT A 5452 03:47:34,775 --> 03:47:38,479 55% RESPONSE RATE. 5453 03:47:38,479 --> 03:47:41,749 SO IN THIS STUDY WE LOOKED AT 5454 03:47:41,749 --> 03:47:42,884 THREE DIGITAL HEALTH 5455 03:47:42,884 --> 03:47:44,385 TECHNOLOGIES FOR OPIOID USE 5456 03:47:44,385 --> 03:47:46,320 DISORDER, REMOTE MENTAL HEALTH 5457 03:47:46,320 --> 03:47:48,456 THERAPY AND TRACKING, PEER 5458 03:47:48,456 --> 03:47:50,558 RECOVERY SUPPORT PROGRAMS AND 5459 03:47:50,558 --> 03:47:53,528 DIGITAL RECOVERY SUPPORT FOR 5460 03:47:53,528 --> 03:47:55,763 ADJUVANT CBT. 5461 03:47:55,763 --> 03:47:59,767 TO GIVE A FLAVOR OF HOW WE ASKED 5462 03:47:59,767 --> 03:48:01,369 ORGANIZATIONS I WON'T GO THROUGH 5463 03:48:01,369 --> 03:48:05,907 THIS IN A DETAILED WAY BUT 5464 03:48:05,907 --> 03:48:08,209 BASICALLY ASKED DO CLINICIANS 5465 03:48:08,209 --> 03:48:10,178 USE THESE TO INTEGRATE TREATMENT 5466 03:48:10,178 --> 03:48:14,448 OR OUD OR MENTAL ILLNESS OR ARE 5467 03:48:14,448 --> 03:48:22,156 YOU JUST USING THE TOOLS. 5468 03:48:22,156 --> 03:48:26,160 AND YOU CAN THINK OF THINGS LIKE 5469 03:48:26,160 --> 03:48:27,461 BETTER HEALTH AND SIMILAR TOOLS 5470 03:48:27,461 --> 03:48:34,068 AND PEER RECOVERY SUPPORT AND 5471 03:48:34,068 --> 03:48:35,937 SMART RECOVERY GROUPS AND THEN 5472 03:48:35,937 --> 03:48:38,039 THE FINAL ONE INCLUDES 5473 03:48:38,039 --> 03:48:39,373 TECHNOLOGIES LIKE RESET O WHICH 5474 03:48:39,373 --> 03:48:43,377 HAS BOTH APPROVED BY THE FDA FOR 5475 03:48:43,377 --> 03:48:45,313 USE AND HAS SOME EVIDENCE OF 5476 03:48:45,313 --> 03:48:47,181 IMPROVING ADHERENCE AND 5477 03:48:47,181 --> 03:48:50,518 TREATMENT OF OUD BUT THIS IS 5478 03:48:50,518 --> 03:48:55,223 REALLY TO HELP FOLKS GET CBT IN 5479 03:48:55,223 --> 03:49:02,730 ADDITION TO THERAPY FOR OUD. 5480 03:49:02,730 --> 03:49:04,265 DESCRIPTIVELY WHAT DID WE LEARN 5481 03:49:04,265 --> 03:49:05,800 FROM ORGANIZATIONS ABOUT 5482 03:49:05,800 --> 03:49:06,701 REPORTING USE OF IT. 5483 03:49:06,701 --> 03:49:08,736 ACTUALLY A THIRD OF 5484 03:49:08,736 --> 03:49:09,403 ORGANIZATIONS REPORTED USING AT 5485 03:49:09,403 --> 03:49:10,972 LEAST ONE OF THESE. 5486 03:49:10,972 --> 03:49:12,340 THE MOST COMMON BEING THE MENTAL 5487 03:49:12,340 --> 03:49:14,642 HEALTH THERAPY AND TRACKING. 5488 03:49:14,642 --> 03:49:16,377 THE LEAST COMMON THE DIGITAL 5489 03:49:16,377 --> 03:49:18,879 RECOVERY SUPPORT. 5490 03:49:18,879 --> 03:49:22,316 AND SO THAT WAS NOTABLE TO US. 5491 03:49:22,316 --> 03:49:23,784 WE WEREN'T SURE HOW OFTEN THEY 5492 03:49:23,784 --> 03:49:24,485 WOULD BE USED. 5493 03:49:24,485 --> 03:49:28,155 THE SECOND PART TO ANSWER THE 5494 03:49:28,155 --> 03:49:30,958 SECOND PIECE OF THIS QUESTION 5495 03:49:30,958 --> 03:49:32,159 WOE WANTED TO ESTIMATE USE OF 5496 03:49:32,159 --> 03:49:34,795 THESE THERAPIES OR ANY OF THE 5497 03:49:34,795 --> 03:49:37,498 THREE. 5498 03:49:37,498 --> 03:49:40,334 AS A FUNCTION OF WHETHER 5499 03:49:40,334 --> 03:49:42,670 ORGANIZATIONS REPORTED HAVING 5500 03:49:42,670 --> 03:49:44,372 DIFFERENT TRADITIONAL SUD 5501 03:49:44,372 --> 03:49:49,243 TREATMENT RESOURCES. 5502 03:49:49,243 --> 03:49:52,947 AND WE EXPECT A POSITIVE 5503 03:49:52,947 --> 03:50:03,491 RELATIONSHIP BETWEEN SUBSTANCE 5504 03:50:09,497 --> 03:50:13,267 USE DISORDER AND WE'LL ACCOUNT 5505 03:50:13,267 --> 03:50:16,771 FOR OTHER CHARACTERISTICS. 5506 03:50:16,771 --> 03:50:21,876 THE SUD AND DOES YOUR 5507 03:50:21,876 --> 03:50:23,311 ORGANIZATION INCLUDE AN 5508 03:50:23,311 --> 03:50:27,682 ADDICTION MEDICINE SPECIALIST? 5509 03:50:27,682 --> 03:50:29,283 DO YOU BELIEVE YOU HAVE 5510 03:50:29,283 --> 03:50:30,184 SUFFICIENT STAFF TO TREAT? 5511 03:50:30,184 --> 03:50:34,855 DO YOU OFFER MEDICATIONS FOR 5512 03:50:34,855 --> 03:50:35,323 OPIOID USE DISORDER? 5513 03:50:35,323 --> 03:50:43,764 DOES YOUR LARGEST ACO HAVE OUT 5514 03:50:43,764 --> 03:50:50,004 PATIENT OR IN PATIENT OR 5515 03:50:50,004 --> 03:50:53,374 RESIDENTIAL AND DO YOU USE 5516 03:50:53,374 --> 03:50:55,376 DASHBOARDS TO FACILITATE OPIOID 5517 03:50:55,376 --> 03:50:55,710 USE DISORDER. 5518 03:50:55,710 --> 03:50:58,546 THE OTHER CHARACTERISTICS ARE 5519 03:50:58,546 --> 03:51:01,649 THE ORGANIZATION TYPE OF THE 5520 03:51:01,649 --> 03:51:03,784 RESPONDENT AND WHAT THE 5521 03:51:03,784 --> 03:51:05,052 RESPONDER REPORTS ABOUT 5522 03:51:05,052 --> 03:51:06,620 STAFFING, SPECIALIZED TRAINING 5523 03:51:06,620 --> 03:51:10,424 OR OTHER COSTS AS BARRIERS TO 5524 03:51:10,424 --> 03:51:11,559 DELIVERING MENTAL HEALTH AND 5525 03:51:11,559 --> 03:51:12,493 SUBSTANCE USE TREATMENT. 5526 03:51:12,493 --> 03:51:16,697 WHETHER THEY HAD A MANAGEMENT 5527 03:51:16,697 --> 03:51:16,931 PARTNER. 5528 03:51:16,931 --> 03:51:19,066 THINK OF CARAVAN THAT HELPS WITH 5529 03:51:19,066 --> 03:51:24,305 THE ACO CONTRACTFY FEATURE 5530 03:51:26,040 --> 03:51:26,874 CONTRACT FEATURES AND HOW THEY 5531 03:51:26,874 --> 03:51:27,675 TOOK THE SURVEY. 5532 03:51:27,675 --> 03:51:29,610 WHAT DID WE LEARN? 5533 03:51:29,610 --> 03:51:31,679 WE LEARNED LOGISTIC REGRESSIONS 5534 03:51:31,679 --> 03:51:32,680 WHAT WE'RE REPORTING ARE 5535 03:51:32,680 --> 03:51:34,281 MARGINAL AFFECTS. 5536 03:51:34,281 --> 03:51:38,486 THAT MEANS LOOKING AT THIS FIRST 5537 03:51:38,486 --> 03:51:40,554 COLUMN IT'S A PERCENTAGE POINT 5538 03:51:40,554 --> 03:51:40,788 CHANGE. 5539 03:51:40,788 --> 03:51:44,759 IF YOU REPORTED YOUR 5540 03:51:44,759 --> 03:51:46,327 ORGANIZATION HAD AN ADDITION 5541 03:51:46,327 --> 03:51:48,729 SPECIALIST YOU WERE 44 5542 03:51:48,729 --> 03:51:51,699 PERCENTAGE POINTS MORE LIKELY TO 5543 03:51:51,699 --> 03:51:53,234 USE A DIGITAL TECHNOLOGY ON A 5544 03:51:53,234 --> 03:51:54,568 BASELINE OF 23%. 5545 03:51:54,568 --> 03:52:04,979 SO A PRETTY BIG EFFECT. 5546 03:52:08,916 --> 03:52:12,787 AND THE PATTERN IS SIMILAR NO 5547 03:52:12,787 --> 03:52:13,854 MATTER THE TECHNOLOGY. 5548 03:52:13,854 --> 03:52:15,489 THERE'S A LITTLE BIT LESS OF A 5549 03:52:15,489 --> 03:52:16,924 LARGER EFFECT WHEN YOU'RE 5550 03:52:16,924 --> 03:52:18,025 LOOKING AT SOMETHING LIKE 5551 03:52:18,025 --> 03:52:27,535 DIGITAL RECOVERY SUPPORT. 5552 03:52:27,535 --> 03:52:31,806 AND I WANT TO POINT OUT OTHER 5553 03:52:31,806 --> 03:52:41,248 CHARACTERISTICS OF ACO 5554 03:52:41,248 --> 03:52:42,483 ORGANIZATIONS AND HEALTH SYSTEMS 5555 03:52:42,483 --> 03:52:43,951 OR PHYSICIAN OR MEDICAL LED 5556 03:52:43,951 --> 03:52:45,052 ORGANIZATIONS ARE ME MOST LIKELY 5557 03:52:45,052 --> 03:52:46,787 TO ADOPT EACH OF THESE THERAPIES 5558 03:52:46,787 --> 03:52:51,225 AND IF YOU LOOK AT SAVED A NET 5559 03:52:51,225 --> 03:52:52,860 ORGANIZATIONS THEY'RE LESS 5560 03:52:52,860 --> 03:52:54,829 LIKELY TO ADOPT SOMETHING LIKE 5561 03:52:54,829 --> 03:52:56,363 REMOTE MENTAL HEALTH THERAPY AND 5562 03:52:56,363 --> 03:53:03,737 TRACKING. 5563 03:53:03,737 --> 03:53:04,939 THAT STOOD OUT TO US. 5564 03:53:04,939 --> 03:53:14,982 FROM THIS STUDY WE FOUND ABOUT 5565 03:53:14,982 --> 03:53:19,420 ONE-THIRD OF ACOS USE THESE AND 5566 03:53:19,420 --> 03:53:20,554 THEY'RE COMPLEMENTS TO OTHER SUD 5567 03:53:20,554 --> 03:53:21,288 RESOURCES. 5568 03:53:21,288 --> 03:53:23,123 THE ORGANIZATIONS WITH ADDICTION 5569 03:53:23,123 --> 03:53:24,758 SPECIALIST USING REGISTRIES WERE 5570 03:53:24,758 --> 03:53:31,765 THE ONES MOST LIKELY TO ADOPTS 5571 03:53:31,765 --> 03:53:34,768 SOMETHING LIKE SAFETY NET 5572 03:53:34,768 --> 03:53:37,838 ORGANIZATIONS OR INCLUDING A 5573 03:53:37,838 --> 03:53:42,276 SAFETY NET HOSPITAL OR RQFDs 5574 03:53:42,276 --> 03:53:44,211 WERE LESS LIKELY TO USE THE 5575 03:53:44,211 --> 03:53:44,545 TECHNOLOGIES. 5576 03:53:44,545 --> 03:53:46,046 SO I JUST WANTED TO USE THIS TO 5577 03:53:46,046 --> 03:53:49,884 PUT IT IN THE CONTEXT OF WHAT 5578 03:53:49,884 --> 03:53:53,554 WE'VE BEEN LEARNING ABOUT THESE 5579 03:53:53,554 --> 03:53:57,892 PAYMENT AND DELIVERY MODELS OF 5580 03:53:57,892 --> 03:53:59,093 ACOS IN THE CONTEXT OF 5581 03:53:59,093 --> 03:53:59,660 BEHAVIORAL HEALTH. 5582 03:53:59,660 --> 03:54:02,096 EVEN IN THE ORGANIZATIONS OF ACO 5583 03:54:02,096 --> 03:54:04,365 PARTICIPANTS MORE FOCUSSED ON 5584 03:54:04,365 --> 03:54:06,734 POPULATION HEALTH THAN OTHERS, 5585 03:54:06,734 --> 03:54:08,369 THE EVIDENCE-BASED BEHAVIORAL 5586 03:54:08,369 --> 03:54:10,371 HEALTH APPROACHES ARE USED AT 5587 03:54:10,371 --> 03:54:10,971 LOWER RATES THAN HOPED. 5588 03:54:10,971 --> 03:54:12,873 THAT'S TRUE FOR COLLABORATIVE 5589 03:54:12,873 --> 03:54:17,711 CARE AND IMMUNOINTEGRATION OF 5590 03:54:17,711 --> 03:54:21,148 BEHAVIORAL HEALTH AND TRUE FOR 5591 03:54:21,148 --> 03:54:22,516 MEDICATIONS FOR OPIOID USE 5592 03:54:22,516 --> 03:54:23,250 DISORDER. 5593 03:54:23,250 --> 03:54:26,420 THE ADOPTION OF MOUD IS 5594 03:54:26,420 --> 03:54:36,497 IMPROVING OVER TIME. 5595 03:54:36,497 --> 03:54:38,832 AND AFTER ENTERING AN AC SCRO 5596 03:54:38,832 --> 03:54:40,501 CONTRACT, SPENDING DOESN'T RISE 5597 03:54:40,501 --> 03:54:46,507 BUT QUALITY TENDS TO IMPROVE AND 5598 03:54:46,507 --> 03:54:48,642 WE FOUND FEATURES WITH 5599 03:54:48,642 --> 03:54:50,377 INTEGRATION AND QUALITY 5600 03:54:50,377 --> 03:54:52,813 MEASURES, BEHAVIORAL HEALTH 5601 03:54:52,813 --> 03:54:54,481 INTEGRATION OF BEHAVIORAL HEALTH 5602 03:54:54,481 --> 03:55:04,992 PROVIDERS IN YOUR ACO AND I'M 5603 03:55:05,759 --> 03:55:08,228 OUT OF TIME BUT ESSENTIALLY AS 5604 03:55:08,228 --> 03:55:12,232 WITH OTHER PRACTICES ADOPTION OF 5605 03:55:12,232 --> 03:55:14,168 THESE TECHNOLOGIES IS LOW. 5606 03:55:14,168 --> 03:55:17,504 WE MAY NEED TO SUPPORT 5607 03:55:17,504 --> 03:55:19,640 ORGANIZATIONS OR PEOPLE WITH 5608 03:55:19,640 --> 03:55:21,675 LOWER RESOURCE TO ADOPT NEW 5609 03:55:21,675 --> 03:55:23,677 TECHNOLOGIES AND WE CONTINUE TO 5610 03:55:23,677 --> 03:55:24,545 LOOK AT HOW THEY OPERATE IN THE 5611 03:55:24,545 --> 03:55:24,812 COMMUNITY. 5612 03:55:24,812 --> 03:55:32,720 THANK YOU. 5613 03:55:32,720 --> 03:55:35,990 >> NEXT WE HAVE DR. JOHNSON FROM 5614 03:55:35,990 --> 03:55:36,523 WASHINGTON UNIVERSITY IN 5615 03:55:36,523 --> 03:55:36,991 ST. LOUIS. 5616 03:55:36,991 --> 03:55:40,761 >> THANK YOU. 5617 03:55:40,761 --> 03:55:42,596 THANKS FOR TAKING TIME TO TUNE 5618 03:55:42,596 --> 03:55:43,664 INTO MY TALK TODAY. 5619 03:55:43,664 --> 03:55:46,166 I'M GOING TO TALK ABOUT MENTAL 5620 03:55:46,166 --> 03:55:46,967 HEALTH CARE AND RISK BASED 5621 03:55:46,967 --> 03:55:49,603 PAYMENT FOR PATIENTS WITH 5622 03:55:49,603 --> 03:55:57,344 DEPRESSION-ANXIETY DISORDERS. 5623 03:55:57,344 --> 03:56:00,814 I WANT TO ACKNOWLEDGE MY TEAM OF 5624 03:56:00,814 --> 03:56:01,515 CO-INVESTIGATORS THAT ARE 5625 03:56:01,515 --> 03:56:02,750 WONDERFUL TO WORK WITH AND 5626 03:56:02,750 --> 03:56:04,218 SUPPORT FOR THE RESEARCH FROM 5627 03:56:04,218 --> 03:56:05,386 THE NIMHD. 5628 03:56:05,386 --> 03:56:07,221 THE CONTENT I'M GOING TO 5629 03:56:07,221 --> 03:56:11,825 REPRESENT ARE MY OWN VIEWS AND 5630 03:56:11,825 --> 03:56:16,230 CO-AUTHORS AND NOT OFFICIAL 5631 03:56:16,230 --> 03:56:18,399 VIEWS OF THE NIH. 5632 03:56:18,399 --> 03:56:19,400 A QUICK AGENDA. 5633 03:56:19,400 --> 03:56:24,371 FIRST I WANT TO TEE UP WHY RISK 5634 03:56:24,371 --> 03:56:25,806 BASED PAYMENT IS IMPORTANT AND 5635 03:56:25,806 --> 03:56:28,442 DELVE INTO OUR EARLY RESEARCH ON 5636 03:56:28,442 --> 03:56:30,277 RISK ADJUSTMENT AND COST 5637 03:56:30,277 --> 03:56:31,812 PREDICTION FOR BENEFICIARIES 5638 03:56:31,812 --> 03:56:34,815 WITH DEPRESSION AND ANXIETY AND 5639 03:56:34,815 --> 03:56:36,350 WHAT THIS MIGHT MEAN FOR PAYMENT 5640 03:56:36,350 --> 03:56:39,119 OF PRACTICES, PAYMENT OF ACOS 5641 03:56:39,119 --> 03:56:47,728 AND MEDICARE ADVANTAGE PLANS. 5642 03:56:47,728 --> 03:56:48,829 WHY IS RISK BASED PAYMENT 5643 03:56:48,829 --> 03:56:49,830 IMPORTANT IN MEDICARE? 5644 03:56:49,830 --> 03:56:51,598 I THINK THE MOST SIMPLE REASON 5645 03:56:51,598 --> 03:56:56,136 IS FOUR IN FIVE MEDICARE 5646 03:56:56,136 --> 03:56:58,038 BENEFICIARY NOW UNDER SOME FORM 5647 03:56:58,038 --> 03:56:59,306 OF RISK BASED PAYMENT. 5648 03:56:59,306 --> 03:57:01,909 MORE THAN HALF OF ALL 5649 03:57:01,909 --> 03:57:02,843 BENEFICIARIES IN THE MEDICARE 5650 03:57:02,843 --> 03:57:05,179 PROGRAM ARE ENROLLED IN MEDICARE 5651 03:57:05,179 --> 03:57:08,315 ADVANTAGE PLANS WHICH ARE PAID 5652 03:57:08,315 --> 03:57:11,752 UNDER CAPITATION, INSURANCE 5653 03:57:11,752 --> 03:57:15,055 PLANS AND SO THAT IS BASED ON 5654 03:57:15,055 --> 03:57:18,425 THE RISK PROFILE AND BENEFI 5655 03:57:18,425 --> 03:57:20,194 BENEFICIARIES THEY ENSURE. 5656 03:57:20,194 --> 03:57:21,562 IN THE ORIGINAL FEE FOR SERVICE 5657 03:57:21,562 --> 03:57:23,931 MEDICARE PROGRAM, CURRENTLY OVER 5658 03:57:23,931 --> 03:57:27,901 HALF OF MEDICARE BENEFICIARIES 5659 03:57:27,901 --> 03:57:29,069 ARE ALSO ENROLLED IN ACCOUNTABLE 5660 03:57:29,069 --> 03:57:30,537 CARE ORGANIZATIONS. 5661 03:57:30,537 --> 03:57:34,408 AND THEY'RE ALL PAID UNDER SOME 5662 03:57:34,408 --> 03:57:40,748 FORM OF RISK BASED PAYMENT. 5663 03:57:40,748 --> 03:57:42,583 THERE'S PAYMENT AND LOSSES AND 5664 03:57:42,583 --> 03:57:44,485 BENCHMARKS AND REGIONAL AND 5665 03:57:44,485 --> 03:57:46,687 HISTORIC BENCHMARKS BUT THEY'RE 5666 03:57:46,687 --> 03:57:50,257 BASED ON RISK ADJUSTED COST AND 5667 03:57:50,257 --> 03:57:52,359 THE RANGE OF RISK CAN VERY FROM 5668 03:57:52,359 --> 03:57:53,594 VERY LITTLE TO MORE AND MORE 5669 03:57:53,594 --> 03:57:56,130 WHICH IS INCREASINGLY THE CASE 5670 03:57:56,130 --> 03:57:57,464 SHARED LOSSES AND TAKING ON A 5671 03:57:57,464 --> 03:58:00,634 LOT OF RISK AS IN THE CASE OF 5672 03:58:00,634 --> 03:58:04,538 SOME ACOs IN THE REACH PROGRAM. 5673 03:58:04,538 --> 03:58:11,945 THE OTHER THING I'LL ADD AND MID 5674 03:58:11,945 --> 03:58:18,085 CARE ADVANTAGE PLANS AND ACC 5675 03:58:18,085 --> 03:58:23,824 ACCOS -- ACOS. 5676 03:58:23,824 --> 03:58:25,826 CONCEPTUALLY THE REASON IT'S 5677 03:58:25,826 --> 03:58:27,694 IMPORTANT WHEN IT CO MZ TO 5678 03:58:27,694 --> 03:58:29,563 PAYING ENTITIES THAT BEAR RISK 5679 03:58:29,563 --> 03:58:31,799 IS WE'RE NOT IN A SITUATION 5680 03:58:31,799 --> 03:58:34,635 WHERE ONE INSURER INSURES THE 5681 03:58:34,635 --> 03:58:36,670 ENTIRE COMMUNITY LIKE USED TO BE 5682 03:58:36,670 --> 03:58:39,206 THE CASE WITH BLUE CROSS, BLUE 5683 03:58:39,206 --> 03:58:42,643 SHIELD OR GOING UP TO CANADA 5684 03:58:42,643 --> 03:58:48,348 WITH THE PROVIDENCE OF ONTARIO 5685 03:58:48,348 --> 03:58:50,284 AND EACH ACO HAS A SEPARATE 5686 03:58:50,284 --> 03:58:53,086 GROUP OF PATIENTS WITH THEIR OWN 5687 03:58:53,086 --> 03:58:55,823 UNIQUE SET OF SOCIAL AND MENTAL 5688 03:58:55,823 --> 03:58:56,924 AND MEDICAL RISK FACTORS. 5689 03:58:56,924 --> 03:59:00,961 BASED ON THAT PANEL OF PATIENTS, 5690 03:59:00,961 --> 03:59:04,164 THE ACO'S PANEL OR PATIENT PANEL 5691 03:59:04,164 --> 03:59:05,332 WILL NEED CERTAIN HEALTH CARE 5692 03:59:05,332 --> 03:59:05,599 RESOURCES. 5693 03:59:05,599 --> 03:59:08,368 THOSE ARE LARGELY DRIVEN BY THE 5694 03:59:08,368 --> 03:59:12,372 RISK FACTORS. 5695 03:59:12,372 --> 03:59:13,407 THEY'LL RESULT IN DIFFERENT 5696 03:59:13,407 --> 03:59:15,108 HEALTH CARE RESOURCES USED AND 5697 03:59:15,108 --> 03:59:18,212 DIFFERENT COSTS INCURRED BY 5698 03:59:18,212 --> 03:59:18,478 PATIENTS. 5699 03:59:18,478 --> 03:59:21,648 IT'S IMPORTANT TO ADJUST FOR THE 5700 03:59:21,648 --> 03:59:23,350 UNDERLYING RISK FACTORS WHEN 5701 03:59:23,350 --> 03:59:27,287 PAYING ENTITIES THAT BEAR RISK 5702 03:59:27,287 --> 03:59:29,723 WHETHER THAT'S INSURANCE PLANS 5703 03:59:29,723 --> 03:59:31,925 OR ACOs AT LEAST PARTIALLY IN 5704 03:59:31,925 --> 03:59:32,459 THE TRADITIONAL MEDICARE 5705 03:59:32,459 --> 03:59:39,867 PROGRAM. 5706 03:59:39,867 --> 03:59:43,971 THE WAY RISK ADJUSTMENT IS DONE 5707 03:59:43,971 --> 03:59:46,607 IS THE HIERARCHICAL RISK 5708 03:59:46,607 --> 03:59:47,574 ADJUSTMENT CATEGORIES MODEL. 5709 03:59:47,574 --> 03:59:50,077 WE COULD HAVE A NERDY ARGUMENT 5710 03:59:50,077 --> 03:59:52,346 ALL DAY ABOUT THE MODEL BUT TO 5711 03:59:52,346 --> 03:59:58,318 SPEAR -- SPARE YOU THAT BUT THIS 5712 03:59:58,318 --> 04:00:01,688 IS BASED ON THE AGE, SEX, 5713 04:00:01,688 --> 04:00:05,692 MEDICARE ENTITLEMENT, MEDICAID 5714 04:00:05,692 --> 04:00:09,263 ENROLLMENT AND 5715 04:00:09,263 --> 04:00:19,773 INSTITUTIONALIZATION AND 115 5716 04:00:20,207 --> 04:00:24,344 COMORBIDITIES AND LOOK AT THE 5717 04:00:24,344 --> 04:00:27,848 CLAIMS REFLECTED IN THE 115 5718 04:00:27,848 --> 04:00:28,548 COMORBI 5719 04:00:28,548 --> 04:00:28,882 COMORBIDITIES. 5720 04:00:28,882 --> 04:00:32,352 MANY DEPRESSION AND ALL ANXIETY 5721 04:00:32,352 --> 04:00:34,388 DIAGNOSES ARE NOT INCLUDED IN 5722 04:00:34,388 --> 04:00:44,564 THE MODEL. 5723 04:00:49,469 --> 04:00:51,104 AND THE DIAGNOSES CONSIDERED 5724 04:00:51,104 --> 04:00:52,239 DISCRETIONARY BY SOME ARE 5725 04:00:52,239 --> 04:00:55,309 TYPICALLY EXCLUDED FROM THE 5726 04:00:55,309 --> 04:00:58,011 MODEL AND RIGHT NOW CMS 5727 04:00:58,011 --> 04:00:59,346 CONSIDERS MILDER FORMS OF 5728 04:00:59,346 --> 04:01:02,582 DEPRESSION AND ANXIETY TO BE 5729 04:01:02,582 --> 04:01:03,583 DISCRETIONARY DIAGNOSIS. 5730 04:01:03,583 --> 04:01:04,251 PREVIOUSLY THIS WAS ALSO TRUE OF 5731 04:01:04,251 --> 04:01:11,425 DEMENTIA. 5732 04:01:11,425 --> 04:01:13,994 WITHIN WAY TO THINK OF IT AS A 5733 04:01:13,994 --> 04:01:16,463 RISK MODEL IS COST PREDICTIVE 5734 04:01:16,463 --> 04:01:19,032 MODEL. 5735 04:01:19,032 --> 04:01:22,035 IT PREDICTS COST AT THE 5736 04:01:22,035 --> 04:01:22,903 BENEFICIARY LEVEL AND HOW 5737 04:01:22,903 --> 04:01:24,438 ACCURATELY THEY'RE PREDICTED IN 5738 04:01:24,438 --> 04:01:26,239 WHOLE GROUPS OF PEOPLE. 5739 04:01:26,239 --> 04:01:30,644 IT'S IMPOSSIBLE TO ACCURATELY 5740 04:01:30,644 --> 04:01:33,113 PREDICT COST S COSTS AT THE BENY 5741 04:01:33,113 --> 04:01:33,413 LEVEL. 5742 04:01:33,413 --> 04:01:34,848 THAT'S WHY WE HAVE INSURANCE IN 5743 04:01:34,848 --> 04:01:35,749 THE FIRST PLACE. 5744 04:01:35,749 --> 04:01:38,018 WHAT MATTERS IS HOW ACCURATE THE 5745 04:01:38,018 --> 04:01:39,820 MODEL IS IN PREDICTING COST IN 5746 04:01:39,820 --> 04:01:41,154 LARGE GROUPS OF PATIENTS. 5747 04:01:41,154 --> 04:01:44,224 WE CAN UNDERSTAND THIS BY 5748 04:01:44,224 --> 04:01:45,559 COMPARING PATIENTS ACTUAL 5749 04:01:45,559 --> 04:01:46,493 OBSERVE COST TO WHAT THEY WERE 5750 04:01:46,493 --> 04:01:51,064 EXPECTED TO BE. 5751 04:01:51,064 --> 04:01:52,566 IT'S IMPORTANT THE COSTS AND 5752 04:01:52,566 --> 04:01:54,434 EXPECTED COSTS ARE CLOSE IN 5753 04:01:54,434 --> 04:01:57,738 LARGE SUB GROUPS OF PATIENTS 5754 04:01:57,738 --> 04:01:58,705 DEFINED BY DIFFERENT CONDITIONS 5755 04:01:58,705 --> 04:02:01,274 THAT DRIVE COSTS. 5756 04:02:01,274 --> 04:02:03,043 FOR EXAMPLE, PATIENTS WITH HEART 5757 04:02:03,043 --> 04:02:04,277 FAILURE ARE GOING TO COST MORE 5758 04:02:04,277 --> 04:02:07,647 ON AVERAGE THAN YOUR TYPICAL 5759 04:02:07,647 --> 04:02:08,115 PATIENT. 5760 04:02:08,115 --> 04:02:10,450 WE WANT TO OBSERVE POST AND 5761 04:02:10,450 --> 04:02:12,352 EQUAL EXPECTED COST ON AVERAGE. 5762 04:02:12,352 --> 04:02:16,156 IF THEY DON'T, THIS CREATES 5763 04:02:16,156 --> 04:02:18,325 INCENTIVES FOR INSURED RISK 5764 04:02:18,325 --> 04:02:25,399 BEARING ENTITY TO AVOID INSURING 5765 04:02:25,399 --> 04:02:27,567 PATIENTS LIKE THAT OR SKIMP ON 5766 04:02:27,567 --> 04:02:31,905 TREATMENT BECAUSE THEY'LL LOSE 5767 04:02:31,905 --> 04:02:33,673 MONEY AND THERE'S BEEN ONGOING 5768 04:02:33,673 --> 04:02:35,675 RESEARCH AND TENDS TO UNDER 5769 04:02:35,675 --> 04:02:36,910 PREDICT COST FOR CERTAIN GROUPS 5770 04:02:36,910 --> 04:02:37,444 OF PATIENTS. 5771 04:02:37,444 --> 04:02:40,614 THE GRAPHIC SHOWING A PRIOR 5772 04:02:40,614 --> 04:02:43,016 STUDY SHOWING COSTS FOR PATIENTS 5773 04:02:43,016 --> 04:02:53,026 WITH HIGHER LEVELS OF FRAILTY. 5774 04:02:53,026 --> 04:02:55,595 I'LL LOOK AT RISK ADJUSTMENT AND 5775 04:02:55,595 --> 04:02:59,800 PREDICTION FOR DEPRESSION AND 5776 04:02:59,800 --> 04:03:00,367 ANXI 5777 04:03:00,367 --> 04:03:00,600 ANXIETY. 5778 04:03:00,600 --> 04:03:04,037 DEPRESSION AND ANXIETY ARE 5779 04:03:04,037 --> 04:03:05,238 PREVALENT AND BURDENSOME AND 5780 04:03:05,238 --> 04:03:05,939 COSTLY. 5781 04:03:05,939 --> 04:03:09,543 UP TO 30% OF MEDICARE 5782 04:03:09,543 --> 04:03:10,710 BENEFICIARIES HAVE AT LEAST ONE 5783 04:03:10,710 --> 04:03:12,312 OF THESE CONDITIONS. 5784 04:03:12,312 --> 04:03:16,349 THE PER CAPITA SPENDING TENDS TO 5785 04:03:16,349 --> 04:03:17,451 BE SUBSTANTIALLY HIGHER THAN 5786 04:03:17,451 --> 04:03:19,119 PATIENTS WITHOUT THE CONDITIONS. 5787 04:03:19,119 --> 04:03:20,554 THE OTHER IMPORTANT THING TO 5788 04:03:20,554 --> 04:03:22,823 NOTE IS DEPRESSION AND ANXIETY 5789 04:03:22,823 --> 04:03:28,395 ARE UNDER DIAGNOSED AND TREATED 5790 04:03:28,395 --> 04:03:30,497 AND MORE THAN HALF ARE NOT 5791 04:03:30,497 --> 04:03:31,398 RECEIVING ANY TREATMENT. 5792 04:03:31,398 --> 04:03:33,834 THAT'S PARTLY BECAUSE OF ACCESS 5793 04:03:33,834 --> 04:03:35,268 TO MENTAL HEALTH CARE AND THE 5794 04:03:35,268 --> 04:03:38,038 LACK OF ACCESS IS A NATIONAL 5795 04:03:38,038 --> 04:03:39,573 CRISIS IN MEDICARE AND 5796 04:03:39,573 --> 04:03:39,840 ELSEWHERE. 5797 04:03:39,840 --> 04:03:43,610 HERE WE HAVE TWO QUESTIONS WE 5798 04:03:43,610 --> 04:03:46,313 LOOKED AT SO FAR WHICH ONE ARE 5799 04:03:46,313 --> 04:03:47,914 DEPRESSION AND ANXIETY DISORDERS 5800 04:03:47,914 --> 04:03:51,318 ASSOCIATED WITH MEDICARE COSTS 5801 04:03:51,318 --> 04:03:52,819 UNEXPLAINED BY MEDICARE'S RISK 5802 04:03:52,819 --> 04:03:54,121 ADJUSTMENT MODEL. 5803 04:03:54,121 --> 04:03:56,790 TWO, DOES THE MODEL SYSTEMICALLY 5804 04:03:56,790 --> 04:03:58,959 OVER OR UNDER PREDICT COSTS FOR 5805 04:03:58,959 --> 04:04:02,662 BIG SUB GROUPS OF BENEFICIARIES 5806 04:04:02,662 --> 04:04:09,469 WITH AND WITHOUT THE DISORDERS. 5807 04:04:09,469 --> 04:04:14,641 WE FOCUSSED ON ALL COMMUNITY 5808 04:04:14,641 --> 04:04:16,343 DWELLING MEDICARE FEE FOR 5809 04:04:16,343 --> 04:04:18,044 SERVICE USING THE CHRONIC 5810 04:04:18,044 --> 04:04:19,079 UKRAINE WAREHOUSE. 5811 04:04:19,079 --> 04:04:21,815 WE FOCUSSED ON THOSE 5812 04:04:21,815 --> 04:04:22,849 CONTINUOUSLY ENROLLED IN 5813 04:04:22,849 --> 04:04:25,719 TRADITIONAL MEDICARE IN 2022 AT 5814 04:04:25,719 --> 04:04:29,456 LEAST UP TO DEATH AND A FULL 5815 04:04:29,456 --> 04:04:33,493 YEAR OF BASELINE 2021 ENROLLMENT 5816 04:04:33,493 --> 04:04:37,197 ELIGIBLE FOR ACO DISTRIBUTION. 5817 04:04:37,197 --> 04:04:40,100 WE USED THE CHRONIC CONDITION 5818 04:04:40,100 --> 04:04:42,068 FLAGS AT BASELINE AT YEAR 2021 5819 04:04:42,068 --> 04:04:44,237 TO IDENTIFY PATIENTS WITH 5820 04:04:44,237 --> 04:04:45,238 DEPRESSION AND/OR ANXIETY AND 5821 04:04:45,238 --> 04:04:48,341 THE PREVALENCE RATE IN THIS 5822 04:04:48,341 --> 04:04:50,977 STUDY POPULATION JUST UNDER 23 5823 04:04:50,977 --> 04:04:52,245 MILLION BENEFICIARIES WAS 26%. 5824 04:04:52,245 --> 04:04:54,381 AND FROM THIS WE CREATED FOUR 5825 04:04:54,381 --> 04:04:56,583 GROUPS. 5826 04:04:56,583 --> 04:05:04,357 THOSE WITH DEPRESSION AND NO 5827 04:05:04,357 --> 04:05:08,161 ANXIETY AND ANXIETY AND 5828 04:05:08,161 --> 04:05:08,895 DEPRESSION AND NONE. 5829 04:05:08,895 --> 04:05:13,200 WHEN WE LOOKED AT THE GROUPS 5830 04:05:13,200 --> 04:05:15,402 DESCRIPTIVELY JUST BY THEIR 5831 04:05:15,402 --> 04:05:18,238 TOTAL COST OF CARE, PART A AND B 5832 04:05:18,238 --> 04:05:21,675 PAID COSTS BY MEDICARE. 5833 04:05:21,675 --> 04:05:23,777 WHAT WE FOUND IS THOSE IN THE 5834 04:05:23,777 --> 04:05:27,447 THREE DEPRESSION AND/OR ANXIETY 5835 04:05:27,447 --> 04:05:31,618 GROUPS COST 31% TO 99% HIGHER ON 5836 04:05:31,618 --> 04:05:32,485 AVERAGE COMPARED TO 5837 04:05:32,485 --> 04:05:35,822 BENEFICIARIES WITHOUT THESE 5838 04:05:35,822 --> 04:05:38,925 CONDITIONS. 5839 04:05:38,925 --> 04:05:40,460 WE COMPUTED THEIR RISK SCORES 5840 04:05:40,460 --> 04:05:46,399 BASED ON THE MOST RECENT VERSION 5841 04:05:46,399 --> 04:05:48,368 WITH CMS AND FOUND BENEFICIARIES 5842 04:05:48,368 --> 04:05:50,704 WITH DEPRESSION AND ANXIETY HAD 5843 04:05:50,704 --> 04:05:53,974 APPROXIMATELY 23% TO 74% HIGHER 5844 04:05:53,974 --> 04:05:55,775 MEAN RISK SCORES WHICH REFLECTS 5845 04:05:55,775 --> 04:05:59,846 THEIR UNDERLYING BURDEN OF ANY 5846 04:05:59,846 --> 04:06:01,648 COMORBIDITIES THE RISK SCORES 5847 04:06:01,648 --> 04:06:01,881 MEASURE. 5848 04:06:01,881 --> 04:06:04,351 THE BENEFICIARIES ARE ALSO MORE 5849 04:06:04,351 --> 04:06:07,020 LIKELY TO BE DULY ENROLLED IN 5850 04:06:07,020 --> 04:06:07,387 MEDICAID. 5851 04:06:07,387 --> 04:06:10,957 MORE LIKELY TO HAVE DISABILITY 5852 04:06:10,957 --> 04:06:18,131 VERSUS AGE ENTITLEMENT IN 5853 04:06:18,131 --> 04:06:28,308 MEDICARE. 5854 04:06:34,547 --> 04:06:36,349 WE LOOKED AT THE RESIDUAL AMOUNT 5855 04:06:36,349 --> 04:06:37,183 BY THE MODEL. 5856 04:06:37,183 --> 04:06:41,755 THESE ARE THE UNEXPLAINED COSTS 5857 04:06:41,755 --> 04:06:46,126 AND USE THOSE AS DEPENDENT 5858 04:06:46,126 --> 04:06:48,194 VARIABLES REGRESSING THOSE AS 5859 04:06:48,194 --> 04:06:50,130 INDICATORS AT THE BENEFICIARY 5860 04:06:50,130 --> 04:06:51,298 LEVEL WHETHER PEOPLE HAD 5861 04:06:51,298 --> 04:06:52,766 DEPRESSION WITHOUT ANXIETY, 5862 04:06:52,766 --> 04:06:54,267 ANXIETY WITHOUT DEPRESSION OR 5863 04:06:54,267 --> 04:06:55,935 BOTH DEPRESSION AND ANXIETY. 5864 04:06:55,935 --> 04:07:00,273 AND WHAT WE FOUND IS THAT THESE 5865 04:07:00,273 --> 04:07:02,609 CONDITIONS ARE ASSOCIATED WITH 5866 04:07:02,609 --> 04:07:04,244 SUBSTANTIAL RESIDUAL COST NOT 5867 04:07:04,244 --> 04:07:07,781 EXPLAINED BY THE RISK FACTORS IN 5868 04:07:07,781 --> 04:07:08,948 THE STANDARD CMS MODEL AND 5869 04:07:08,948 --> 04:07:12,218 COMPARE THIS VERSUS WHAT THE 5870 04:07:12,218 --> 04:07:17,424 AVERAGE COST BENEFICIARY OF 5871 04:07:17,424 --> 04:07:20,360 COSTLY $12,082 AND THE UNDER 5872 04:07:20,360 --> 04:07:23,363 PREDICTION RANGED FROM 88.3% FOR 5873 04:07:23,363 --> 04:07:24,597 THOSE WITH ANXIETY AND 5874 04:07:24,597 --> 04:07:33,039 DEPRESSION TO 24% FOR THOSE WITH 5875 04:07:33,039 --> 04:07:33,540 BOTH CONDITIONS. 5876 04:07:33,540 --> 04:07:36,276 THE SECOND PART OF OUR QUESTION 5877 04:07:36,276 --> 04:07:37,544 IS IS THE MODEL SYSTEMICALLY 5878 04:07:37,544 --> 04:07:42,148 UNDER OR OVER PREDICT COSTING 5879 04:07:42,148 --> 04:07:44,184 WITH AND WITHOUT THE CONDITIONS. 5880 04:07:44,184 --> 04:07:49,356 WE COMPUTED THE OBSERVED MINUS 5881 04:07:49,356 --> 04:07:50,123 EXPECTED COSTS FOR DIFFERENT 5882 04:07:50,123 --> 04:07:52,158 GROUPS OF BENEFICIARIES. 5883 04:07:52,158 --> 04:07:55,762 AGAIN IF YOU'RE OBSERVED COST 5884 04:07:55,762 --> 04:07:58,131 MORE THAN YOUR EXPECTS COSTS. 5885 04:07:58,131 --> 04:08:00,367 IF YOU'RE ENSURING THE 5886 04:08:00,367 --> 04:08:03,970 BENEFICIARIES WILL LOSE MONEY 5887 04:08:03,970 --> 04:08:06,473 BUT IF YOU'RE OBSERVED COSTS ARE 5888 04:08:06,473 --> 04:08:08,274 LESS YOU'LL MAKE MONEY AS A RISK 5889 04:08:08,274 --> 04:08:10,610 BEARING ENTITY. 5890 04:08:10,610 --> 04:08:11,811 WHAT WE FOUND IS THE MODEL IS 5891 04:08:11,811 --> 04:08:15,815 OVER PREDICTING COSTS FOR 5892 04:08:15,815 --> 04:08:16,649 BENEFICIARIES WITHOUT DEPRESSION 5893 04:08:16,649 --> 04:08:19,619 AND ANXIETY AND COST $466 THAN 5894 04:08:19,619 --> 04:08:21,755 THEY'RE EXPECTED TO AND THE 5895 04:08:21,755 --> 04:08:23,022 MODELS UNDER PRE DICTING COSTS 5896 04:08:23,022 --> 04:08:26,793 FOR BENEFICIARIES WITH 5897 04:08:26,793 --> 04:08:28,228 DEPRESSION AND ANXIETY. 5898 04:08:28,228 --> 04:08:31,531 THE UNDER PREDICTION RANGES FROM 5899 04:08:31,531 --> 04:08:33,266 $479 ON AVERAGE FOR THOSE WITH 5900 04:08:33,266 --> 04:08:37,036 ANXIETY AND NO DEPRESSION TO 5901 04:08:37,036 --> 04:08:40,573 $910 FOR DEPRESSION AND NO 5902 04:08:40,573 --> 04:08:44,244 ANXIETY AND $1271 WITH 5903 04:08:44,244 --> 04:08:47,280 DEPRESSION AND ANXIETY. 5904 04:08:47,280 --> 04:08:50,016 WE ALSO LOOKED AT THESE -- 5905 04:08:50,016 --> 04:08:51,618 >> WE NEED TO JUMP AHEAD A 5906 04:08:51,618 --> 04:08:51,951 LITTLE BIT. 5907 04:08:51,951 --> 04:08:56,356 >> LET'S GO TO THE LAST SLIDE, 5908 04:08:56,356 --> 04:08:57,524 THE TAKEAWAYS. 5909 04:08:57,524 --> 04:09:00,860 THE BASIC TAKEAWAY THERE APPEARS 5910 04:09:00,860 --> 04:09:09,135 TO BE SOME COST IS UNDER 5911 04:09:09,135 --> 04:09:10,870 PREDICTED AND THAT CAN IMPACT 5912 04:09:10,870 --> 04:09:12,372 PRIMARY CARE PRACTICES WHERE A 5913 04:09:12,372 --> 04:09:15,008 LOT OF THESE PATIENTS ARE CARED 5914 04:09:15,008 --> 04:09:16,876 FOR. 5915 04:09:16,876 --> 04:09:20,980 IF A PRACTICE HAS A HIGH CASE 5916 04:09:20,980 --> 04:09:22,482 LOAD OF PATIENTS LIKE THIS 5917 04:09:22,482 --> 04:09:28,121 THEY'LL BE LESS ATTRACTIVE FOR 5918 04:09:28,121 --> 04:09:30,323 AN ACO TO CONTRACT WITH OR 5919 04:09:30,323 --> 04:09:37,230 INCLUDE IN THEIR ACO. 5920 04:09:37,230 --> 04:09:40,400 AND MEDICARE INCREASINGLY MOVES 5921 04:09:40,400 --> 04:09:43,269 TO RISK-BASED PAYMENT. 5922 04:09:43,269 --> 04:09:50,543 THANKS A LOT. 5923 04:09:50,543 --> 04:09:51,010 >> THANK YOU. 5924 04:09:51,010 --> 04:09:56,416 OUR FINAL PRESENTER IS DR 5925 04:09:56,416 --> 04:09:59,719 DR. MEHROTRA FROM BROWN 5926 04:09:59,719 --> 04:10:00,220 UNIVERSITY. 5927 04:10:00,220 --> 04:10:02,021 >> THANK YOU EVERYONE WHO 5928 04:10:02,021 --> 04:10:03,456 ORGANIZED THE PANEL AND THE DAY 5929 04:10:03,456 --> 04:10:04,057 AS A WHOLE. 5930 04:10:04,057 --> 04:10:05,992 I'M EXCITED TO PRESENT ONE PAPER 5931 04:10:05,992 --> 04:10:10,930 IN A LARGER BODY OF WORK ON 5932 04:10:10,930 --> 04:10:13,399 TELEMEDICINE AND ITS ROLE IN 5933 04:10:13,399 --> 04:10:15,401 TREATING PATIENTS WITH MENTAL 5934 04:10:15,401 --> 04:10:18,204 ILLNESS AND SUBSTANCE USE 5935 04:10:18,204 --> 04:10:18,638 DISORDER. 5936 04:10:18,638 --> 04:10:21,374 WHEN PEOPLE SAW THE RAPID GROWTH 5937 04:10:21,374 --> 04:10:23,810 OF TELE MEDICINE WAS CONSIDERED 5938 04:10:23,810 --> 04:10:26,379 A SILVER LINING OF THE PANDEMIC. 5939 04:10:26,379 --> 04:10:28,381 WHEN PEOPLE THOUGHT OF 5940 04:10:28,381 --> 04:10:29,148 TELEMEDICINE THEY SAID IT COULD 5941 04:10:29,148 --> 04:10:32,352 BE MORE PATIENT CENTRIC AND 5942 04:10:32,352 --> 04:10:33,753 IMPROVE OUTCOMES FOR CHRONIC 5943 04:10:33,753 --> 04:10:35,622 ILLNESS AND SAVE US MONEY AND 5944 04:10:35,622 --> 04:10:36,856 MAYBE MOST IMPORTANTLY OR WHERE 5945 04:10:36,856 --> 04:10:38,424 THE FOCUS WAS THIS CAN IMPROVE 5946 04:10:38,424 --> 04:10:40,360 ACCESS TO THOSE WHO REALLY 5947 04:10:40,360 --> 04:10:42,161 STRUGGLE TO GET CARE. 5948 04:10:42,161 --> 04:10:46,132 THIS CAME UP RECENTLY IN 5949 04:10:46,132 --> 04:10:50,737 DR. OZ'S CONFIRMATION HEARING 5950 04:10:50,737 --> 04:10:53,139 WHEN SENATOR HAINES ASKED HOW TO 5951 04:10:53,139 --> 04:10:55,508 IMPROVE ACCESS, DR. OZ SAID WE 5952 04:10:55,508 --> 04:10:57,076 CAN USE TELEMEDICINE TO IMPROVE 5953 04:10:57,076 --> 04:10:59,112 ACCESS TO CARE TO PEOPLE IN 5954 04:10:59,112 --> 04:11:00,547 RURAL COMMUNITIES IN MONTANA. 5955 04:11:00,547 --> 04:11:01,648 IN PARTICULAR FOR MENTAL 5956 04:11:01,648 --> 04:11:11,791 ILLNESS. 5957 04:11:12,992 --> 04:11:15,094 AND HE HIGHLIGHTED WIDE 5958 04:11:15,094 --> 04:11:16,896 DISPARITIES IN MENTAL HEALTH USE 5959 04:11:16,896 --> 04:11:19,832 BETWEEN URBAN AND RURAL AREA AND 5960 04:11:19,832 --> 04:11:22,001 PARTLY DRIVEN BY SUPPLY. 5961 04:11:22,001 --> 04:11:23,336 MANY IN RURAL COMMUNITIES DON'T 5962 04:11:23,336 --> 04:11:25,838 HAVE A PSYCHIATRIST OR OTHER 5963 04:11:25,838 --> 04:11:27,907 MENTAL HEALTH PROFESSIONAL IN 5964 04:11:27,907 --> 04:11:29,242 THEIR COMMUNITY AND MAYBE 5965 04:11:29,242 --> 04:11:31,177 TELEMEDICINE CAN BE PART OF THE 5966 04:11:31,177 --> 04:11:35,782 SOLUTION AND MENTAL ILLNESS IS 5967 04:11:35,782 --> 04:11:38,117 WELL SUITED AND A CLINICIAN FROM 5968 04:11:38,117 --> 04:11:39,786 A CITY COULD NOW TREAT A PATIENT 5969 04:11:39,786 --> 04:11:41,621 IN A RURAL AREA. 5970 04:11:41,621 --> 04:11:42,288 THAT'S BEEN THE HOPE. 5971 04:11:42,288 --> 04:11:44,090 THAT'S WHAT I'VE BEEN EXCITED 5972 04:11:44,090 --> 04:11:44,357 ABOUT. 5973 04:11:44,357 --> 04:11:48,361 THE QUESTION WE'LL ANSWER IN 5974 04:11:48,361 --> 04:11:53,333 THIS PAPER IS HAS THAT HAPPENED. 5975 04:11:53,333 --> 04:11:56,703 HOW WILL WE ANSWER THIS 5976 04:11:56,703 --> 04:11:56,970 QUESTION? 5977 04:11:56,970 --> 04:12:02,241 WE'LL TAKE ROUGHLY 18,000 MENTAL 5978 04:12:02,241 --> 04:12:04,777 HEALTH SPECIALISTS CARING FOR 5979 04:12:04,777 --> 04:12:08,681 PATIENTS OVER THIS SIX-YEAR TIME 5980 04:12:08,681 --> 04:12:16,356 HORIZON. 5981 04:12:16,356 --> 04:12:18,625 THE 18,000 MENTAL HEALTH 5982 04:12:18,625 --> 04:12:21,461 CLINICIANS WE'LL DIVIDE INTO 5983 04:12:21,461 --> 04:12:22,295 QUARTILES BASED ON HOW MUCH 5984 04:12:22,295 --> 04:12:23,830 TELEMEDICINE THEY USED IN 2021 5985 04:12:23,830 --> 04:12:26,199 FROM THE HIGHEST QUARTILE LOVING 5986 04:12:26,199 --> 04:12:28,601 THE TELEMEDICINE TO THOSE IN THE 5987 04:12:28,601 --> 04:12:31,671 LOWEST QUARTILE. 5988 04:12:31,671 --> 04:12:34,040 THEN COMPARE THEIR CARE PATTERNS 5989 04:12:34,040 --> 04:12:37,343 AND PATIENTS TREATED IN 2018 AND 5990 04:12:37,343 --> 04:12:40,780 '19 AND WHAT VISITS THEY HAVE IN 5991 04:12:40,780 --> 04:12:41,914 '22 AND '23. 5992 04:12:41,914 --> 04:12:46,185 THE HYPOTHESIS IS THOSE WHO 5993 04:12:46,185 --> 04:12:47,153 EMBRACED TELEMEDICINE WILL BE 5994 04:12:47,153 --> 04:12:50,156 CARING FOR MORE PATIENTS IN 5995 04:12:50,156 --> 04:12:50,790 RURAL COMMUNITIES DISTANT FROM 5996 04:12:50,790 --> 04:12:57,730 THEM. 5997 04:12:57,730 --> 04:12:59,532 I'M TALKING ABOUT PSYCHIATRIST 5998 04:12:59,532 --> 04:13:01,000 AND SOCIAL WORKERS AND 5999 04:13:01,000 --> 04:13:02,435 PSYCHIATRIC NURSE PRACTITIONERS 6000 04:13:02,435 --> 04:13:07,206 AND IDENTIFYING THEIR VISITS 6001 04:13:07,206 --> 04:13:09,142 USING CPT CODES ONE VISIT A DAY. 6002 04:13:09,142 --> 04:13:11,244 WE'RE NOT GOING TO LOOK AT ALL 6003 04:13:11,244 --> 04:13:15,014 MENTAL HEALTH SPECIALISTS. 6004 04:13:15,014 --> 04:13:20,053 WE'LL EXCLUDE THOSE LOW VOLUME 6005 04:13:20,053 --> 04:13:23,122 OR MOVED WHAT PRACTICE THEY WERE 6006 04:13:23,122 --> 04:13:26,926 IN OR GEOGRAPHIC LOCATION OR 6007 04:13:26,926 --> 04:13:37,470 USING TELEMEDICINE BEFORE 2020. 6008 04:13:43,576 --> 04:13:46,679 THEY'VE BECOME TELEMEDICINE 6009 04:13:46,679 --> 04:13:48,347 HEALTH SPECIALISTS AND THESE 6010 04:13:48,347 --> 04:13:48,881 MENTAL HEALTH ARE USING 6011 04:13:48,881 --> 04:13:57,290 TELEMEDICINE TO SOME DEGREE. 6012 04:13:57,290 --> 04:13:59,158 HOW DO YOU OPERATIONALIZE 6013 04:13:59,158 --> 04:13:59,559 GEOGRAPHIC REACH? 6014 04:13:59,559 --> 04:14:02,729 WE'RE LOOK AT PRIMARY OUTCOMES. 6015 04:14:02,729 --> 04:14:04,063 WE'LL LOOK AT WHAT TRACTION OF 6016 04:14:04,063 --> 04:14:06,966 THEIR VISITS ARE FOR PATIENTS IN 6017 04:14:06,966 --> 04:14:10,169 COUNTIES WITH NO PRACTICING 6018 04:14:10,169 --> 04:14:11,504 PSYCHIATRISTS AND PUBLIC HEALTH 6019 04:14:11,504 --> 04:14:12,839 SHORTAGE AREA AND PATIENTS IN 6020 04:14:12,839 --> 04:14:13,973 RURAL COMMUNITIES AND PATIENTS 6021 04:14:13,973 --> 04:14:16,342 WITH A DIFFERENT STATE OR FAR 6022 04:14:16,342 --> 04:14:18,177 AWAY AND WE'RE USING AN 6023 04:14:18,177 --> 04:14:19,712 ARBITRARY CUT OFF OF 20 MILES 6024 04:14:19,712 --> 04:14:21,848 AND LOOKED AT OTHER CUT-OFFS AND 6025 04:14:21,848 --> 04:14:22,548 RESULTS WERE SIMILAR. 6026 04:14:22,548 --> 04:14:25,718 AS A SECONDARY OUTCOME, WHAT 6027 04:14:25,718 --> 04:14:27,253 WE'RE HOPING IS NEW PATIENTS 6028 04:14:27,253 --> 04:14:28,221 FROM RURAL COMMUNITIES WILL BE 6029 04:14:28,221 --> 04:14:29,555 ENTERING THE PRACTICES. 6030 04:14:29,555 --> 04:14:31,791 WE NEED TO KNOW HOW MANY NEW 6031 04:14:31,791 --> 04:14:33,226 PATIENT SLOTS ARE THERE. 6032 04:14:33,226 --> 04:14:34,727 WE'LL LOOK AT WHAT FRACTION OF 6033 04:14:34,727 --> 04:14:36,329 VISITS IN A GIVEN TIME PERIOD 6034 04:14:36,329 --> 04:14:46,472 ARE FOR NEW PATIENTS. 6035 04:14:46,472 --> 04:14:47,840 LET'S SAY I HAVE MORE PATIENTS 6036 04:14:47,840 --> 04:14:51,277 FROM ANOTHER STATE. 6037 04:14:51,277 --> 04:14:57,083 IS THAT BECAUSE SEEING A NEW 6038 04:14:57,083 --> 04:14:59,018 PATIENT FROM ANOTHER SCAPE OR 6039 04:14:59,018 --> 04:15:00,019 MAYBE BECAUSE MY EXISTING 6040 04:15:00,019 --> 04:15:03,256 PATIENT MOVED CLOSER TO FAMILY 6041 04:15:03,256 --> 04:15:03,656 AND SO FORTH. 6042 04:15:03,656 --> 04:15:05,725 IS IT A REFLECTION OF CONTINUITY 6043 04:15:05,725 --> 04:15:05,992 MUCH CARE. 6044 04:15:05,992 --> 04:15:10,563 IN A SECONDARY ANALYSIS WE'LL 6045 04:15:10,563 --> 04:15:12,799 KEEP PATIENTS' LOCATIONS FIXED 6046 04:15:12,799 --> 04:15:14,734 AS A WAY TO DISENTANGLE THIS 6047 04:15:14,734 --> 04:15:15,902 EVENT. 6048 04:15:15,902 --> 04:15:20,339 NOW, THESE ARE THE 6049 04:15:20,339 --> 04:15:23,276 CHARACTERISTICS FOUR FROM LOWEST 6050 04:15:23,276 --> 04:15:26,579 TELEMEDICINE USE TO HIGHEST. 6051 04:15:26,579 --> 04:15:30,449 I WANT TO HIGHLIGHT DIFFERENCES 6052 04:15:30,449 --> 04:15:30,650 HERE. 6053 04:15:30,650 --> 04:15:37,990 THE HIGH ONES ARE MORE LIKELY TO 6054 04:15:37,990 --> 04:15:39,859 BE IN URBAN AREAS AND IN THE 6055 04:15:39,859 --> 04:15:41,127 NORTHEAST AND LESS LIKELY TO 6056 04:15:41,127 --> 04:15:42,028 CARE FOR PATIENTS WITH 6057 04:15:42,028 --> 04:15:46,365 DISABILITY OR LOW INCOME. 6058 04:15:46,365 --> 04:15:47,767 THESE DIFFERENCE REFLECTED IN 6059 04:15:47,767 --> 04:15:48,501 SOME OF THE OUTCOMES. 6060 04:15:48,501 --> 04:15:51,771 THIS IS THE FIRST OUTCOME. 6061 04:15:51,771 --> 04:15:53,039 WHAT FRACTION OF THE PATIENT 6062 04:15:53,039 --> 04:15:54,874 VISITS ARE FOR PATIENTS LIVING 6063 04:15:54,874 --> 04:15:56,876 IN A MENTAL HEALTH SHORTAGE AREA 6064 04:15:56,876 --> 04:15:59,045 WHERE THERE'S NO PSYCHIATRISTS. 6065 04:15:59,045 --> 04:16:01,180 ON THE X AXIS IS THE TIME PERIOD 6066 04:16:01,180 --> 04:16:04,817 FROM 2018 TO 2023. 6067 04:16:04,817 --> 04:16:08,354 AND THE DIFFERENT COLORS THE 6068 04:16:08,354 --> 04:16:09,589 HIGHEST TELEMEDICINE CLINICIANS 6069 04:16:09,589 --> 04:16:12,859 AT THE BASELINE WERE SEEING 6070 04:16:12,859 --> 04:16:14,794 FEWER PATIENTS FROM SHORTAGE 6071 04:16:14,794 --> 04:16:17,697 AREAS IN CONTRAST TO THE HIGHEST 6072 04:16:17,697 --> 04:16:20,967 UP ON THE TOP THE LOWEST 6073 04:16:20,967 --> 04:16:22,101 TELEMEDICINE GROUP. 6074 04:16:22,101 --> 04:16:23,236 CHANGES OVER TIME. 6075 04:16:23,236 --> 04:16:26,973 THAT'S HARD IT SEE LOOKING AT 6076 04:16:26,973 --> 04:16:27,506 THESE GRAPHS. 6077 04:16:27,506 --> 04:16:29,976 IF YOU CLICK ONCE WHAT WE'RE 6078 04:16:29,976 --> 04:16:32,345 DOING HERE IS NOW CHANGING THIS 6079 04:16:32,345 --> 04:16:34,080 RELATIVE TO THEIR BASELINE RATE 6080 04:16:34,080 --> 04:16:34,580 IN 2018. 6081 04:16:34,580 --> 04:16:37,583 WHEN YOU LOOK AT IT FROM THIS 6082 04:16:37,583 --> 04:16:39,252 WAY, YOU CAN SEE OVER TIME WE 6083 04:16:39,252 --> 04:16:41,254 REALLY HAVEN'T SEEN ANY CHANGE 6084 04:16:41,254 --> 04:16:42,989 IN THE FRACTION ACROSS THE 6085 04:16:42,989 --> 04:16:46,392 QUARTILES AND THE PATIENTS 6086 04:16:46,392 --> 04:16:48,361 COMING FROM MENTAL HEALTH 6087 04:16:48,361 --> 04:16:51,998 SHORTAGE AREAS. 6088 04:16:51,998 --> 04:16:53,499 LET'S LOOK AT ANOTHER OUTCOME. 6089 04:16:53,499 --> 04:16:56,002 RURAL PATIENTS. 6090 04:16:56,002 --> 04:16:57,937 HIGHEST TELEMEDICINE. 6091 04:16:57,937 --> 04:16:59,538 CLINICIANS WHO EMBRACED IT MOST 6092 04:16:59,538 --> 04:17:02,942 WERE LEAST LIKELY TO CARE FOR 6093 04:17:02,942 --> 04:17:06,012 RURAL PATIENTS AT BASELINE. 6094 04:17:06,012 --> 04:17:07,113 OVER TIME WE SEE A LITTLE 6095 04:17:07,113 --> 04:17:09,081 INCREASE IN THEIR LIKELIHOOD OF 6096 04:17:09,081 --> 04:17:10,349 CARING FOR THEM RELATIVE TO 6097 04:17:10,349 --> 04:17:12,051 OTHER GROUPS BUT THE DIFFERENCES 6098 04:17:12,051 --> 04:17:12,985 ARE SMALL. 6099 04:17:12,985 --> 04:17:15,655 IF YOU LOOK AT THE Y AXIS THESE 6100 04:17:15,655 --> 04:17:17,290 ARE PERCENTAGE POINT 6101 04:17:17,290 --> 04:17:17,590 DIFFERENCES. 6102 04:17:17,590 --> 04:17:22,962 THE DIFFERENCE IS QUITE SMALL. 6103 04:17:22,962 --> 04:17:24,163 THIRD OUTCOME WERE PATIENTS WERE 6104 04:17:24,163 --> 04:17:25,598 FURTHER AWAY. 6105 04:17:25,598 --> 04:17:27,300 HERE WE START TO SEE A LITTLE 6106 04:17:27,300 --> 04:17:28,134 BIT OF A DIFFERENCE. 6107 04:17:28,134 --> 04:17:31,704 THE CLINICIAN WHO EMBRACED 6108 04:17:31,704 --> 04:17:33,072 TELEMEDICINE START TO SEE MORE 6109 04:17:33,072 --> 04:17:34,573 PATIENTS FROM FURTHER AWAY 6110 04:17:34,573 --> 04:17:36,809 COMPARED TO THOSE WHO EMBRACED 6111 04:17:36,809 --> 04:17:39,879 TELEMEDICINE TO A LESSER DEGREE. 6112 04:17:39,879 --> 04:17:41,580 AGAIN THE DIFFERENCES IN TERMS 6113 04:17:41,580 --> 04:17:44,350 OF PERCENTAGE POINT IS 6114 04:17:44,350 --> 04:17:48,955 RELATIVELY MODEST. 6115 04:17:48,955 --> 04:17:50,456 HERE WE SEE A SMALL DIFFERENCE 6116 04:17:50,456 --> 04:17:53,526 IN STATES WITH THE HIGHEST 6117 04:17:53,526 --> 04:17:54,293 TELEMEDICINE GROUP SEEING MORE 6118 04:17:54,293 --> 04:18:03,369 PATIENT FROM A DIFFERENT STATE. 6119 04:18:03,369 --> 04:18:05,771 WE'LL SHOW THE SAME RESULT. 6120 04:18:05,771 --> 04:18:08,874 COMPARED TO 2018 AND THE LOW 6121 04:18:08,874 --> 04:18:09,475 TELEMEDICINE GROUPS WE'RE 6122 04:18:09,475 --> 04:18:10,876 SHOWING THE RELATIVE CHANGE OVER 6123 04:18:10,876 --> 04:18:11,277 TIME. 6124 04:18:11,277 --> 04:18:20,286 IF YOU CAN FOCUS JUST ON THE 6125 04:18:20,286 --> 04:18:22,788 CYAN OR TURQUOISE IS THE HIGHEST 6126 04:18:22,788 --> 04:18:24,357 TELEMEDICINE GROUP. 6127 04:18:24,357 --> 04:18:27,493 IN 2023 WE DON'T SEE SUBSTANTIVE 6128 04:18:27,493 --> 04:18:27,893 DIFFERENCES. 6129 04:18:27,893 --> 04:18:31,630 A SMALL DIFFERENCE IN TERMS OF 6130 04:18:31,630 --> 04:18:36,502 RURAL. 6131 04:18:36,502 --> 04:18:37,570 A MORE SUBSTANTIAL DIFFERENCE IN 6132 04:18:37,570 --> 04:18:40,673 A FRACTION OF PATIENTS COMING 6133 04:18:40,673 --> 04:18:51,017 FROM 20 MILES PLUS. 6134 04:18:52,885 --> 04:18:54,453 IS THIS CONTINUITY OF CARE OR 6135 04:18:54,453 --> 04:18:57,656 REFLECT NEW PATIENTS COMING IN? 6136 04:18:57,656 --> 04:19:01,894 WE CONTROLLED FOR THAT BY 6137 04:19:01,894 --> 04:19:06,766 KEEPING PATIENTS' LOCATION FIXED 6138 04:19:06,766 --> 04:19:10,236 AND ROUGHLY HALF THE DIFFERENCE 6139 04:19:10,236 --> 04:19:12,438 GOES AWAY AFTER WE CONTROL FOR 6140 04:19:12,438 --> 04:19:12,838 LOCATION. 6141 04:19:12,838 --> 04:19:15,174 THE WAY WE INTERPRET THAT IS 6142 04:19:15,174 --> 04:19:16,709 HALF THE INCREASE IN PATIENTS 6143 04:19:16,709 --> 04:19:18,277 COMING FROM FAR AWAY IS DRIVEN 6144 04:19:18,277 --> 04:19:22,281 BY YOUR EXISTING PATIENTS MOVING 6145 04:19:22,281 --> 04:19:23,516 VERSUS NEW PATIENTS ENTERING THE 6146 04:19:23,516 --> 04:19:26,919 PANEL. 6147 04:19:26,919 --> 04:19:28,387 AND I MENTIONED WE'LL LOOK AT 6148 04:19:28,387 --> 04:19:30,756 NEW PATIENTS ACROSS THE 6149 04:19:30,756 --> 04:19:34,226 DIFFERENT QUARTILES AT BASELINE. 6150 04:19:34,226 --> 04:19:37,496 THE HIGH TELEMEDICINE GROUP IS 6151 04:19:37,496 --> 04:19:39,465 SEEN SEEING FEWER NEW PATIENTS 6152 04:19:39,465 --> 04:19:40,332 AND ACROSS ALL GROUPS WE SEE 6153 04:19:40,332 --> 04:19:47,206 LESS NEW PATIENTS. 6154 04:19:47,206 --> 04:19:51,210 SO SUMMARY OF OUR FINDINGS, 6155 04:19:51,210 --> 04:19:51,677 TELEMEDICINE ADOPTION 6156 04:19:51,677 --> 04:19:53,245 UNFORTUNATELY ONLY LED TO A 6157 04:19:53,245 --> 04:19:59,351 SMALL OR NO GEOGRAPHIC REACH 6158 04:19:59,351 --> 04:20:02,288 AND A SMALL FRACTION IS PATIENTS 6159 04:20:02,288 --> 04:20:04,523 ENTERING THE PANEL AND AFTER THE 6160 04:20:04,523 --> 04:20:06,325 START OF THE PANDEMIC WE SEE A 6161 04:20:06,325 --> 04:20:09,161 DECREASE IN PATIENT SLOTS. 6162 04:20:09,161 --> 04:20:14,166 TO END IF YOU CAN CLICK THROUGH 6163 04:20:14,166 --> 04:20:16,135 ONCE, WHY DIDN'T MY VISION AND 6164 04:20:16,135 --> 04:20:17,870 DR. OZ'S VISION, SO MANY 6165 04:20:17,870 --> 04:20:21,173 PEOPLE'S HOPE TO TRY TO USE 6166 04:20:21,173 --> 04:20:22,942 TELEMEDICINE TO EXPAND ACCESS? 6167 04:20:22,942 --> 04:20:26,679 SOME IS DRIVEN BY WHICH 6168 04:20:26,679 --> 04:20:27,646 CLINICIANS HAVE EMBRACED 6169 04:20:27,646 --> 04:20:28,881 TELEMEDICINE, MORE URBAN 6170 04:20:28,881 --> 04:20:30,749 CLINICIANS AND CLINICIANS AND 6171 04:20:30,749 --> 04:20:32,785 MENTAL HEALTH SPECIALISTS HAVE 6172 04:20:32,785 --> 04:20:34,653 BEEN OVERWHELMED BY DEMAND OF 6173 04:20:34,653 --> 04:20:37,790 THE MENTAL HEALTH CRISIS SO IN 6174 04:20:37,790 --> 04:20:40,493 THAT CONTEXT IT'S NOT SURPRISING 6175 04:20:40,493 --> 04:20:42,595 THEY PREFERENTIALLY SOUGHT OUT 6176 04:20:42,595 --> 04:20:44,930 PATIENTS AND THOSE ARE LEAST 6177 04:20:44,930 --> 04:20:45,731 LIKELY TO USE TELEMEDICINE. 6178 04:20:45,731 --> 04:20:55,074 WHERE DO WE DO FROM HERE? 6179 04:20:55,074 --> 04:20:58,144 THE EXPECTATION IS WE OFFER 6180 04:20:58,144 --> 04:21:01,947 TELEMEDICINE AND ALL OF A SUDDEN 6181 04:21:01,947 --> 04:21:05,217 THEY'LL START OFFERING CARE WILL 6182 04:21:05,217 --> 04:21:09,555 NOT HAPPEN WE NEED TO CREATE 6183 04:21:09,555 --> 04:21:10,122 INCENTIVES AND POTENTIALLY 6184 04:21:10,122 --> 04:21:11,790 CHANGE REFERRAL NETWORKS AND 6185 04:21:11,790 --> 04:21:13,359 MAKE SURE THOSE PATIENTS IN 6186 04:21:13,359 --> 04:21:16,362 RURAL COMMUNITIES CAN GET INTO 6187 04:21:16,362 --> 04:21:18,297 THE URBAN AREAS AND WE NEED TO 6188 04:21:18,297 --> 04:21:21,200 MAKE SURE OUR RURAL PATIENTS CAN 6189 04:21:21,200 --> 04:21:21,967 ACCESS TELEMEDICINE. 6190 04:21:21,967 --> 04:21:26,772 I'LL END BY THANKING THE NIH AND 6191 04:21:26,772 --> 04:21:28,374 FOR FUNDING AND EXCITED TO TAKE 6192 04:21:28,374 --> 04:21:33,746 QUESTIONS. 6193 04:21:33,746 --> 04:21:35,714 >> GREAT, THANK YOU, 6194 04:21:35,714 --> 04:21:37,383 DR. MEHROTRA. 6195 04:21:37,383 --> 04:21:39,818 WE'LL BEGIN THE Q&A SECTION NOW. 6196 04:21:39,818 --> 04:21:41,387 WE HAVE A LITTLE BIT OF TIME. 6197 04:21:41,387 --> 04:21:44,089 THIS IS A QUESTION FOR ALL THE 6198 04:21:44,089 --> 04:21:45,758 PANELISTS, WHAT IF ANY ELEMENTS 6199 04:21:45,758 --> 04:21:47,793 HAVE BEEN IDENTIFIED TO BE 6200 04:21:47,793 --> 04:21:48,761 NECESSARY CONDITIONS TO 6201 04:21:48,761 --> 04:21:52,531 IMPLEMENT AND SUSTAIN INTEGRATED 6202 04:21:52,531 --> 04:21:54,600 TREATMENT? 6203 04:21:54,600 --> 04:22:05,010 WHO WOULD LIKE TO START? 6204 04:22:06,812 --> 04:22:13,085 WOULD ANYBODY LIKE TO START? 6205 04:22:13,085 --> 04:22:16,322 >> WHAT WE'VE SEEN WITH 6206 04:22:16,322 --> 04:22:16,855 TELEMEDICINE IS THERE'S 6207 04:22:16,855 --> 04:22:20,659 VARIATION IN HOW SUSTAIN THE 6208 04:22:20,659 --> 04:22:23,696 TELEMEDICINE USE HAS BEEN IN 6209 04:22:23,696 --> 04:22:24,897 MENTAL HEALTH CONDITIONS IT'S 6210 04:22:24,897 --> 04:22:32,705 BEEN MORE SUSTAINED THAN FOR 6211 04:22:32,705 --> 04:22:34,173 CARDIOLOGY AND HAVING A VIDEO 6212 04:22:34,173 --> 04:22:40,145 VISIT IS INEFFICIENT IN MANY 6213 04:22:40,145 --> 04:22:42,548 CIRCUMSTANCES AND WE NEED THE 6214 04:22:42,548 --> 04:22:44,984 TECHNOLOGY NECESSARY TO SUSTAIN 6215 04:22:44,984 --> 04:22:46,952 AND HOW DO YOU PROVIDE A 6216 04:22:46,952 --> 04:22:47,920 PHYSICAL EXAMPLE. 6217 04:22:47,920 --> 04:22:49,154 THAT'S AN EXAMPLE OF ONE THING 6218 04:22:49,154 --> 04:22:55,828 THAT CAN SUSTAIN THE USE. 6219 04:22:55,828 --> 04:22:58,364 >> IN TERMS OF ESSENTIAL 6220 04:22:58,364 --> 04:22:59,498 TREATMENTS OF INTEGRATED CARE IS 6221 04:22:59,498 --> 04:23:03,869 THE IDEA OF COLLABORATION AND 6222 04:23:03,869 --> 04:23:05,070 COMMUNICATION BOTH WITHIN AND 6223 04:23:05,070 --> 04:23:07,139 EXTERNAL TO A CLINIC. 6224 04:23:07,139 --> 04:23:08,574 SO IF YOU ARE IN A HEALTH CARE 6225 04:23:08,574 --> 04:23:11,810 ENVIRONMENT AND HAVE A TEAM, 6226 04:23:11,810 --> 04:23:14,847 HAVING THAT COLLABORATION 6227 04:23:14,847 --> 04:23:17,650 DEDICATED TIME POTENTIALLY FOR 6228 04:23:17,650 --> 04:23:18,917 HUDDLING IT WILL BE IMPORTANT TO 6229 04:23:18,917 --> 04:23:20,152 DRIVE THE INTEGRATIVE CARE. 6230 04:23:20,152 --> 04:23:22,955 IF YOU'RE INTEGRATING WITH LIKE 6231 04:23:22,955 --> 04:23:25,524 AN SUD SPECIALIST AND YOU'RE A 6232 04:23:25,524 --> 04:23:28,560 PRIMARY CARE PROVIDER HAVING 6233 04:23:28,560 --> 04:23:36,635 ROUTINE COMMUNICATION, EASE AND 6234 04:23:36,635 --> 04:23:40,072 HAVING THAT TEAM IS SNRNL. 6235 04:23:40,072 --> 04:23:43,876 -- ESSENTIAL. 6236 04:23:43,876 --> 04:23:48,714 >> DR. MEARA. 6237 04:23:48,714 --> 04:23:50,749 >> IN THE CONTEXT OF OUR WORK 6238 04:23:50,749 --> 04:23:52,651 FOCUSES ON THE ACO 6239 04:23:52,651 --> 04:23:53,385 ORGANIZATIONS, THE THINGS THAT 6240 04:23:53,385 --> 04:23:56,355 COME UP WHEN YOU SEE PLACES 6241 04:23:56,355 --> 04:24:00,359 ADOPTING ARE THIS TENDENCY TO 6242 04:24:00,359 --> 04:24:03,529 HAVE CONTRACTS IN MEDICAID AND 6243 04:24:03,529 --> 04:24:05,230 SEEING PATIENTS WITH HIGHER NEED 6244 04:24:05,230 --> 04:24:07,499 AND THEY HAVE HIGHER PROPORTIONS 6245 04:24:07,499 --> 04:24:10,636 ARE DUAL ELIGIBLE FOR MEDICATE, 6246 04:24:10,636 --> 04:24:14,773 HIGHER PROPORTION TO HAVE THESE 6247 04:24:14,773 --> 04:24:21,447 CONDITIONS AND THEN AS YYOU SAWA 6248 04:24:21,447 --> 04:24:24,350 LOT OF TIMES IT'S HAVING 6249 04:24:24,350 --> 04:24:27,920 SPECIALTY MENTAL HEALTH OR 6250 04:24:27,920 --> 04:24:29,254 SUBSTANCE USE PROVIDERS IN YOUR 6251 04:24:29,254 --> 04:24:29,488 NETWORK. 6252 04:24:29,488 --> 04:24:32,658 SOMETIMES YOU NEED A CHAMPION TO 6253 04:24:32,658 --> 04:24:34,159 GET THESE THINGS GOING. 6254 04:24:34,159 --> 04:24:42,301 THOSE ARE THE PATTERNS WE SEE. 6255 04:24:42,301 --> 04:24:43,135 >> THANK YOU. 6256 04:24:43,135 --> 04:24:44,570 DR. GORDON, I HAVE A QUESTION I 6257 04:24:44,570 --> 04:24:45,237 CAN START WITH YOU. 6258 04:24:45,237 --> 04:24:49,375 ARE YOU AWARE OF ANY WORK ON 6259 04:24:49,375 --> 04:24:53,011 INTEGRATING CARE FOR BEHAVIORAL 6260 04:24:53,011 --> 04:24:56,348 ADDICTIONS GAMBLING OR OTHER 6261 04:24:56,348 --> 04:24:57,983 ADDICTIVE BEHAVIORS? 6262 04:24:57,983 --> 04:24:59,818 >> IN THE HEALTH CARE SYSTEMS I 6263 04:24:59,818 --> 04:25:01,820 WORK IN IT'S BEEN LESS OF A 6264 04:25:01,820 --> 04:25:02,054 FOCUS. 6265 04:25:02,054 --> 04:25:06,725 USUALLY BEHAVIORAL ADDICTIONS IS 6266 04:25:06,725 --> 04:25:08,761 A LITTLE BIT MORE APART FROM THE 6267 04:25:08,761 --> 04:25:11,864 MEDICAL MODEL ASSOCIATED WITH 6268 04:25:11,864 --> 04:25:18,237 OPIOID USE DISORDER OR CAN BE 6269 04:25:18,237 --> 04:25:20,606 DONE WITHIN THE CONFINES OF 6270 04:25:20,606 --> 04:25:21,440 MEDICATION OR PHARMACO 6271 04:25:21,440 --> 04:25:24,610 THERAPIES, ETCETERA. 6272 04:25:24,610 --> 04:25:29,448 AGAIN, HAVING THAT GOOD LINKAGE 6273 04:25:29,448 --> 04:25:30,482 BETWEEN SPECIALTY CARE PROVIDER 6274 04:25:30,482 --> 04:25:31,717 AND PRIMARY CARE PROVIDER IS 6275 04:25:31,717 --> 04:25:33,819 GOING TO BE REALLY IMPORTANT IN 6276 04:25:33,819 --> 04:25:34,153 COMMUNICATION. 6277 04:25:34,153 --> 04:25:36,355 OFTEN TIMES IN THE REAL WORLD 6278 04:25:36,355 --> 04:25:39,725 SETTINGS WE HAVE NOTES FOR 6279 04:25:39,725 --> 04:25:41,960 SPECIALISTS OR SHARE MEDICAL 6280 04:25:41,960 --> 04:25:43,061 INFORMATION BUT SOMETIMES OFF 6281 04:25:43,061 --> 04:25:43,962 KEY CONVERSATIONS AND 6282 04:25:43,962 --> 04:25:46,265 COMMUNICATIONS CAN REALLY HELP 6283 04:25:46,265 --> 04:25:48,534 THAT INTEGRATION. 6284 04:25:48,534 --> 04:25:50,669 PARTICULARLY AREAS OF BEHAVIORAL 6285 04:25:50,669 --> 04:25:52,171 ADDICTION THAT CAN BE 6286 04:25:52,171 --> 04:25:53,572 DELETERIOUS FOR THE PATIENT AND 6287 04:25:53,572 --> 04:25:56,942 MAKING SURE THE PRIMARY CARE 6288 04:25:56,942 --> 04:25:58,610 PROVIDER OR SPECIALIST 6289 04:25:58,610 --> 04:26:02,381 UNDERSTAND THE CONTEXT OF THAT 6290 04:26:02,381 --> 04:26:02,981 ADDICT 6291 04:26:02,981 --> 04:26:03,248 ADDICTION. 6292 04:26:03,248 --> 04:26:05,918 WE'RE NOT TRAINED IN GENERAL 6293 04:26:05,918 --> 04:26:07,486 MEDICAL CARE. 6294 04:26:07,486 --> 04:26:10,689 SO SOMETIMES THAT CONSULTATION 6295 04:26:10,689 --> 04:26:14,526 AND COMMUNICATION AND AD HOC 6296 04:26:14,526 --> 04:26:16,361 COMMUNICATIONS ARE IMPORTANT TO 6297 04:26:16,361 --> 04:26:16,862 SYNERGIZE THAT CARE. 6298 04:26:16,862 --> 04:26:20,399 >> I APPRECIATE IT. 6299 04:26:20,399 --> 04:26:20,833 THANKS SO MUCH. 6300 04:26:20,833 --> 04:26:24,303 I THINK WE HAVE TIME FOR ONE 6301 04:26:24,303 --> 04:26:29,741 MORE QUESTION. 6302 04:26:29,741 --> 04:26:33,812 THERE'S AN INTERESTING APPROACH 6303 04:26:33,812 --> 04:26:36,348 TO LOOK AT THE QUARTILES AND 6304 04:26:36,348 --> 04:26:38,484 WHAT MOTIVATED THE USE OTHER 6305 04:26:38,484 --> 04:26:40,018 THAN GROUPS LIKE THREE, YEAR, 6306 04:26:40,018 --> 04:26:40,352 FIVE. 6307 04:26:40,352 --> 04:26:41,854 >> A GREAT METHODS QUESTION. 6308 04:26:41,854 --> 04:26:45,491 WHEN WE DID THIS BREAK DOWN WE 6309 04:26:45,491 --> 04:26:47,793 DID IT ARBITRARILY. 6310 04:26:47,793 --> 04:26:48,961 RESEARCHERS DO IT FIVE DIFFERENT 6311 04:26:48,961 --> 04:26:50,162 WAYS AND SENSITIVITY ANALYSES 6312 04:26:50,162 --> 04:26:52,464 AND THE RESULTS ARE ROBUST TO 6313 04:26:52,464 --> 04:26:55,467 THE DIFFERENT METHODS. 6314 04:26:55,467 --> 04:26:58,237 WE DID PRE SPECIFIED CUT OFFS 6315 04:26:58,237 --> 04:27:03,909 AND USING QUINTILES, TERTILES. 6316 04:27:03,909 --> 04:27:14,086 AND NO DIFFERENCE WE OBSERVED. 6317 04:27:14,086 --> 04:27:18,991 >> MAYBE TIME FOR ONE MORE. 6318 04:27:18,991 --> 04:27:22,394 MAYBE TO THE LARGER GROUP IF 6319 04:27:22,394 --> 04:27:24,329 ANYONE CAN SPEAK A LITTLE BIT 6320 04:27:24,329 --> 04:27:28,200 ABOUT WHETHER -- I THINK MY TIME 6321 04:27:28,200 --> 04:27:32,337 IS DONE. 6322 04:27:32,337 --> 04:27:34,339 THANK YOU ALL SO VERY MUCH. 6323 04:27:34,339 --> 04:27:37,075 >> WE HAVE A BREAK UNTIL 2:20 6324 04:27:37,075 --> 04:27:39,411 AND WE'LL RECONVENE TO TALK 6325 04:27:39,411 --> 04:27:41,079 ABOUT ENGAGING PATIENTS AND 6326 04:27:41,079 --> 04:27:41,713 FAMILIES WITH LIVED EXPERIENCE. 6327 04:27:41,713 --> 04:27:45,672 THANK YOU. 6328 04:27:45,672 --> 04:27:47,274 WELCOME BACK, EVERYONE FROM 6329 04:27:47,274 --> 04:27:47,574 THE BREAK. 6330 04:27:47,574 --> 04:27:51,945 WE'RE THRILLED TO INTRODUCE OUR 6331 04:27:51,945 --> 04:27:57,851 NEXT SESSION EXPERIENCE OF LIVED 6332 04:27:57,851 --> 04:27:59,386 EXPERIENCE AND FEEL FREE FREE TO 6333 04:27:59,386 --> 04:28:05,759 TAKE IT AWAY. 6334 04:28:05,759 --> 04:28:08,128 >> GOOD AFTERNOON, EVERYONE. 6335 04:28:08,128 --> 04:28:09,663 WELCOME TO OUR PANEL ON 6336 04:28:09,663 --> 04:28:11,598 EXPERIENCES OF PERSONS WITH 6337 04:28:11,598 --> 04:28:16,203 LIVED EXPERIENCE AND FAMILIES. 6338 04:28:16,203 --> 04:28:20,140 I'LL BE FACILITATING THIS PANEL 6339 04:28:20,140 --> 04:28:25,579 ALONG WITH KELLY DAVIS WHO WILL 6340 04:28:25,579 --> 04:28:26,747 PASS IT ON TO BEFORE INTRODUCING 6341 04:28:26,747 --> 04:28:28,448 OUR SPEAKERS. 6342 04:28:28,448 --> 04:28:29,983 >> THANKS SO MUCH. 6343 04:28:29,983 --> 04:28:32,686 HI, EVERYONE. 6344 04:28:32,686 --> 04:28:34,688 I'M VERY EXCITED TO BE HERE. 6345 04:28:34,688 --> 04:28:36,089 AS A PERSON WITH LIVED 6346 04:28:36,089 --> 04:28:37,457 EXPERIENCE I'VE PERSONALLY SEEN 6347 04:28:37,457 --> 04:28:41,161 IN OUR WORK AND IN MY 6348 04:28:41,161 --> 04:28:43,363 PARTICIPATION IN RESEARCH THE 6349 04:28:43,363 --> 04:28:44,331 DIFFERENCE LIVED EXPERIENCE CAN 6350 04:28:44,331 --> 04:28:46,066 MAKE IN FIGURING OUT WHAT THE 6351 04:28:46,066 --> 04:28:48,135 PROBLEM IS AND WHAT WE SHOULD DO 6352 04:28:48,135 --> 04:28:49,569 ABOUT IT AND WHAT'S IMPORTANT 6353 04:28:49,569 --> 04:28:51,304 OUTCOMES FOR FOLKS. 6354 04:28:51,304 --> 04:28:52,939 WE'LL HEAR SOME REALLY POWERFUL 6355 04:28:52,939 --> 04:28:56,143 EXAMPLES TODAY AND I'M EXCITED 6356 04:28:56,143 --> 04:29:01,481 TO ALSO HAVE A DISCUSSION ONCE 6357 04:29:01,481 --> 04:29:02,582 EVERYONE'S MIC'D UP. 6358 04:29:02,582 --> 04:29:05,819 >> THANK YOU, KELLY. 6359 04:29:05,819 --> 04:29:12,492 I WILL INTRODUCE OUR FIRST 6360 04:29:12,492 --> 04:29:12,726 SPEAKER. 6361 04:29:12,726 --> 04:29:23,203 SO DR. ASHLI SHEIDOW IS AT 6362 04:29:28,809 --> 04:29:31,645 CHESTNUT HEALTH SYSTEMS IN 6363 04:29:31,645 --> 04:29:35,282 SERVICES FOR TEENS AND YOUNG 6364 04:29:35,282 --> 04:29:35,549 ADULTS. 6365 04:29:35,549 --> 04:29:41,021 PARTICULARLY THOSE WITH 6366 04:29:41,021 --> 04:29:41,922 SUBSTANCE USE PROBLEMS. 6367 04:29:41,922 --> 04:29:49,563 HER TALK IS ON ENGAGING 6368 04:29:49,563 --> 04:29:50,230 INDIVIDUALS WITH LIVED 6369 04:29:50,230 --> 04:29:50,530 EXPERIENCE. 6370 04:29:50,530 --> 04:29:51,498 >> THANK YOU SO MUCH. 6371 04:29:51,498 --> 04:29:59,940 I'D LIKE TO START BY SAYING I'VE 6372 04:29:59,940 --> 04:30:04,578 HAD EXPERIENCE IN MULTIPLE 6373 04:30:04,578 --> 04:30:06,847 GENERATIONS BUT COMING FROM A 6374 04:30:06,847 --> 04:30:07,881 RESEARCHER PERSPECTIVE FOR 6375 04:30:07,881 --> 04:30:10,484 ENGAGEMENT FOR THOSE WHO USE THE 6376 04:30:10,484 --> 04:30:13,320 TERM AND I LIKE THE WAY KELLY 6377 04:30:13,320 --> 04:30:14,588 PUT IT AS WHAT CAN BE LEARNED 6378 04:30:14,588 --> 04:30:16,356 AND THE VALUE. 6379 04:30:16,356 --> 04:30:18,592 IT'S NOT ROCKET SCIENCE BUT WE 6380 04:30:18,592 --> 04:30:19,926 AS RESEARCHERS HAVEN'T DONE THIS 6381 04:30:19,926 --> 04:30:20,427 WELL. 6382 04:30:20,427 --> 04:30:23,330 IN MY CAREER, I HAVE ALWAYS DONE 6383 04:30:23,330 --> 04:30:25,398 WHAT I CALL REAL WORLD RESEARCH, 6384 04:30:25,398 --> 04:30:26,900 MEANING, IT WAS OUT IN THE 6385 04:30:26,900 --> 04:30:28,969 COMMUNITY RATHER THAN IN THE 6386 04:30:28,969 --> 04:30:37,144 IVORY TOWER OF ACADEMIA. 6387 04:30:37,144 --> 04:30:42,582 IN THE LAST YEARS I'VE BEEN IN 6388 04:30:42,582 --> 04:30:44,284 PARTICIPATORY BASED RESEARCH AND 6389 04:30:44,284 --> 04:30:46,419 CHANGED MY RESEARCH AND HOPE I 6390 04:30:46,419 --> 04:30:47,854 CAN CONVINCE YOU TO SHIFT THE 6391 04:30:47,854 --> 04:30:50,190 WAY YOU DO ECONOMICS RESEARCH. 6392 04:30:50,190 --> 04:30:52,859 I FULLY UNDERSTANDING THE WAY 6393 04:30:52,859 --> 04:30:56,196 YOU DO RESEARCH MAY NOT BE 6394 04:30:56,196 --> 04:30:57,931 FEASIBLE BUT PLEASE KNOW NO 6395 04:30:57,931 --> 04:31:00,667 MATTER TO WHAT EXTENT YOU CAN 6396 04:31:00,667 --> 04:31:03,870 SHIFT EVERY BIT CAN HELP. 6397 04:31:03,870 --> 04:31:09,476 AND SKIM OVER IN THE INTEREST OF 6398 04:31:09,476 --> 04:31:12,879 TIME BUT COME BACK TO THINGS IN 6399 04:31:12,879 --> 04:31:14,447 THE Q&A OR REACH OUT. 6400 04:31:14,447 --> 04:31:16,850 MY E-MAIL ADDRESS IS AT THE END 6401 04:31:16,850 --> 04:31:17,250 OF THE SLIDES. 6402 04:31:17,250 --> 04:31:26,593 A HEARTFELT THANK YOU TO THE TO 6403 04:31:26,593 --> 04:31:30,330 COMMUNITY MEMBERS AND STAFF AND 6404 04:31:30,330 --> 04:31:31,097 COLLEAGUES WHO I'VE WORKED WITH 6405 04:31:31,097 --> 04:31:32,666 AND PARTNERED WITH ME AND TAUGHT 6406 04:31:32,666 --> 04:31:33,500 ME A LOT OVER THE YEARS. 6407 04:31:33,500 --> 04:31:36,570 I WANT TO LET YOU KNOW MY TEAM 6408 04:31:36,570 --> 04:31:38,205 HAS COLLECTED TOOLS AND 6409 04:31:38,205 --> 04:31:39,739 RESOURCES ABOUT 6410 04:31:39,739 --> 04:31:40,540 COMMUNITY-ENGAGED RESEARCH AT 6411 04:31:40,540 --> 04:31:42,242 THE WEBSITE LISTED HERE AND YOU 6412 04:31:42,242 --> 04:31:46,079 CAN ACCESS IT THROUGH THE QR 6413 04:31:46,079 --> 04:31:46,580 CODE. 6414 04:31:46,580 --> 04:31:54,187 THIS INCLUDES A HOW-TO TOOL KIT 6415 04:31:54,187 --> 04:31:56,656 FOR PEOPLE WITH SUBSTANCE USE 6416 04:31:56,656 --> 04:31:59,960 AND SOME ITEMS I'LL COVER COME 6417 04:31:59,960 --> 04:32:02,529 FROM THAT RESOURCE AND THANK YOU 6418 04:32:02,529 --> 04:32:05,265 TO NIDA AND NIH FOR THE FUNDING 6419 04:32:05,265 --> 04:32:10,871 ON THE WORK I'LL PRESENT. 6420 04:32:10,871 --> 04:32:13,173 HERE'S A FAST OVERVIEW OF THE 6421 04:32:13,173 --> 04:32:14,608 LIVED EXPERIENCE PANEL AND THE 6422 04:32:14,608 --> 04:32:15,208 COMMUNITY BOARDS. 6423 04:32:15,208 --> 04:32:17,277 I'LL SHARE SOME EXAMPLES FROM 6424 04:32:17,277 --> 04:32:18,078 THE PROJECTS AND ALSO QUOTES 6425 04:32:18,078 --> 04:32:22,616 FROM MEMBERS WHO HAVE GIVEN ME 6426 04:32:22,616 --> 04:32:25,752 PERMISSION IN HEAL CONNECTION I 6427 04:32:25,752 --> 04:32:28,321 LED COMMUNITY-BASED 6428 04:32:28,321 --> 04:32:29,789 PARTICIPATORY RESEARCH WHERE WE 6429 04:32:29,789 --> 04:32:30,590 ENGAGED A LIVED EXPERIENCE 6430 04:32:30,590 --> 04:32:32,359 PANEL. 6431 04:32:32,359 --> 04:32:34,294 THIS WAS A NATIONWIDE PANEL 6432 04:32:34,294 --> 04:32:38,865 WHERE WE ENGAGED A 55 MEMBER 6433 04:32:38,865 --> 04:32:40,700 PANEL COMPRISED OF 11 SUB PANELS 6434 04:32:40,700 --> 04:32:42,602 FOR COMMUNITIES WITH HEALTH 6435 04:32:42,602 --> 04:32:45,171 DISPARITIES LISTED ON THE SLIDE. 6436 04:32:45,171 --> 04:32:48,375 EACH SUB PANEL FOCUSSED ON 6437 04:32:48,375 --> 04:32:50,377 CHALLENGES AND DISSEMINATION 6438 04:32:50,377 --> 04:32:52,112 CHANNELS THAT CLOSE THE SCIENCE 6439 04:32:52,112 --> 04:32:53,513 TO SERVICE GAP WITHIN THEIR 6440 04:32:53,513 --> 04:32:54,347 RESPECTIVE COMMUNITY. 6441 04:32:54,347 --> 04:32:57,250 OTHER EXAMPLES TODAY WILL COME 6442 04:32:57,250 --> 04:33:02,155 FROM THE SUPPORT OF RECOVERY 6443 04:33:02,155 --> 04:33:03,290 SERVICES FOR JUSTICE INVOLVED OR 6444 04:33:03,290 --> 04:33:12,265 EMERGING ADULT POPULATIONS. 6445 04:33:12,265 --> 04:33:15,101 JEAP HAS TWO BOARDS AND SOME ARE 6446 04:33:15,101 --> 04:33:16,937 PEOPLE WITH LIVED EXPERIENCE. 6447 04:33:16,937 --> 04:33:20,607 TODAY THE COMMUNITY BOARDS GUIDE 6448 04:33:20,607 --> 04:33:31,117 THE BROADER WORK OF THE JEAP 6449 04:33:34,087 --> 04:33:36,623 ENGAGEMENT. 6450 04:33:36,623 --> 04:33:39,826 FOR HEAL CONNECTIONS LOOKING AT 6451 04:33:39,826 --> 04:33:42,329 SPECIFIC BARRIERS TO CARE RATHER 6452 04:33:42,329 --> 04:33:46,599 THAN ACROSS ALL THE HEALTH 6453 04:33:46,599 --> 04:33:47,233 DISPARITY POPULATIONS. 6454 04:33:47,233 --> 04:33:51,371 THIS CAN ENSURE THEY REFLECT 6455 04:33:51,371 --> 04:33:53,540 REAL WORLD INEQUITIES. 6456 04:33:53,540 --> 04:33:55,141 WHAT SHOULD WE EVEN BE 6457 04:33:55,141 --> 04:33:57,043 RESEARCHING IN THE FIRST PLACE? 6458 04:33:57,043 --> 04:33:59,012 FROM EVEN THAT LEVEL TO IDENTIFY 6459 04:33:59,012 --> 04:34:01,448 THE REAL WORLD INEQUITIES. 6460 04:34:01,448 --> 04:34:03,483 THE PANELS ALSO LEAD TO 6461 04:34:03,483 --> 04:34:06,586 CENTERING PEER SUPPORT, 6462 04:34:06,586 --> 04:34:08,121 COMMUNITY CONTEXT AND 6463 04:34:08,121 --> 04:34:10,290 DISSEMINATION EQUITY AND ALSO 6464 04:34:10,290 --> 04:34:12,826 SURFACED CONTEXT SPECIFIC 6465 04:34:12,826 --> 04:34:13,126 CHALLENGES. 6466 04:34:13,126 --> 04:34:16,262 SO FOR EXAMPLE THE SUB PANEL ON 6467 04:34:16,262 --> 04:34:18,598 CO-OCCURRING OPIOID USE DISORDER 6468 04:34:18,598 --> 04:34:20,400 AND MENTAL HEALTH DISORDERS 6469 04:34:20,400 --> 04:34:22,769 EMPHASIZED TRAUMA INFORMED CARE 6470 04:34:22,769 --> 04:34:30,610 AND MENTAL HEALTH PARODY WHILE 6471 04:34:30,610 --> 04:34:34,714 THE PREGNANCY LOOKED AT LEGAL 6472 04:34:34,714 --> 04:34:38,585 CONCERNS IN THE PROVIDER 6473 04:34:38,585 --> 04:34:40,353 INTERACTIONS. 6474 04:34:40,353 --> 04:34:41,755 BROADLY I THINK OF LEARNING 6475 04:34:41,755 --> 04:34:44,958 THINGS YOU'VE NEVER LEARNED 6476 04:34:44,958 --> 04:34:49,195 BEFORE AND ALSO YOU HAVE GREATER 6477 04:34:49,195 --> 04:34:51,064 REAL WORLD IMPACT AND MAKE IT 6478 04:34:51,064 --> 04:34:53,266 LESS LIKELY YOUR RESEARCH 6479 04:34:53,266 --> 04:34:54,434 FINDINGS WILL NOT BE WANTED BY 6480 04:34:54,434 --> 04:34:55,068 THE COMMUNITY YOU'RE TRYING TO 6481 04:34:55,068 --> 04:35:05,178 HELP. 6482 04:35:05,879 --> 04:35:08,815 YOU CAN GET INSIGHT AND 6483 04:35:08,815 --> 04:35:10,617 SOLUTIONS YOU CAN'T GET ON YOUR 6484 04:35:10,617 --> 04:35:12,986 OWN OR FROM YOUR TEAM AND DIRECT 6485 04:35:12,986 --> 04:35:15,321 BENEFITS FROM THE RESEARCHERS 6486 04:35:15,321 --> 04:35:18,558 BEYOND THE MUTUAL LEARNING AND 6487 04:35:18,558 --> 04:35:22,896 IMPROVED INTELLECTUAL HUMILITY 6488 04:35:22,896 --> 04:35:24,664 IT CAN BE SEEN AS A PATH TO MORE 6489 04:35:24,664 --> 04:35:31,404 EQUITABLE RESEARCH OUTCOMES. 6490 04:35:31,404 --> 04:35:32,906 SO COMMUNITY ENGAGED RESEARCH 6491 04:35:32,906 --> 04:35:33,673 HAS BENEFITS FOR THE IMPACTED 6492 04:35:33,673 --> 04:35:41,581 COMMUNITY MEMBERS. 6493 04:35:41,581 --> 04:35:44,651 ONE MEMBER POIGNANTLY PUT IT TO 6494 04:35:44,651 --> 04:35:45,685 ME AS GIVING VOICE TO THE 6495 04:35:45,685 --> 04:35:47,954 VOICELESS BUT BE AWARE OF 6496 04:35:47,954 --> 04:35:51,157 POTENTIAL HARMS TO COMMUNITY 6497 04:35:51,157 --> 04:35:52,559 MEMBERS PARTICULARLY BECAUSE 6498 04:35:52,559 --> 04:35:55,495 SUBSTANCE USE AND MENTAL HEALTH 6499 04:35:55,495 --> 04:35:57,430 CARRIES SO MUCH STIGMA IN OUR 6500 04:35:57,430 --> 04:35:57,664 SOCIETY. 6501 04:35:57,664 --> 04:36:03,570 BE PREPARED TO AVOID THINGS 6502 04:36:03,570 --> 04:36:09,776 TOKENISM AND LOSS OF TRUST WHEN 6503 04:36:09,776 --> 04:36:12,712 PROVIDERS ENGAGE IN HURTFUL 6504 04:36:12,712 --> 04:36:14,581 BEHAVIOR SOMETIMES UNKNOWINGLY 6505 04:36:14,581 --> 04:36:17,684 BUT IT'S THE IMPACT THAT COUNTS. 6506 04:36:17,684 --> 04:36:21,321 THERE'S GUARDRAILS IN OUR TOOL 6507 04:36:21,321 --> 04:36:25,358 KIT BASED ON WHAT OUR PARTNERS 6508 04:36:25,358 --> 04:36:30,196 TAUGHT US AND SKILLS TO HONE AND 6509 04:36:30,196 --> 04:36:32,031 THE QUOTE ABOUT GIVING PARTNERS 6510 04:36:32,031 --> 04:36:34,134 CONTROL OVER WHAT AND HOW THEY 6511 04:36:34,134 --> 04:36:34,334 SHARE. 6512 04:36:34,334 --> 04:36:37,570 AND THERE ARE A COUPLE QUOTES ON 6513 04:36:37,570 --> 04:36:42,175 THE NEXT SLIDE RELATED AND YOU 6514 04:36:42,175 --> 04:36:43,643 CAN LEARN IT FROM THE BOARD AND 6515 04:36:43,643 --> 04:36:46,346 PANEL MEMBERS RATHER THAN FROM 6516 04:36:46,346 --> 04:36:46,513 ME. 6517 04:36:46,513 --> 04:36:48,848 AND EMPHASIZE THINKING HOW TO 6518 04:36:48,848 --> 04:36:50,250 ENGAGE MEMBERS FROM THE START OF 6519 04:36:50,250 --> 04:36:50,917 THE SELECTION PROCESS. 6520 04:36:50,917 --> 04:36:56,589 SHE PUT IT AS INVITING SOMEONE 6521 04:36:56,589 --> 04:36:58,591 NORM DINNER AND MUGGING THEM AT 6522 04:36:58,591 --> 04:37:00,226 THE DOOR AND ADDITIONAL WAYS 6523 04:37:00,226 --> 04:37:01,628 BEYOND EQUITABLE COMPENSATION 6524 04:37:01,628 --> 04:37:03,029 WHICH IS CRITICAL BUT WAYS 6525 04:37:03,029 --> 04:37:04,631 BEYOND THAT FOR RESEARCHERS TO 6526 04:37:04,631 --> 04:37:07,700 SHOW THEY VALUE BOARD MEMBERS 6527 04:37:07,700 --> 04:37:10,603 AND IF YOU CAN'T DIGEST ANY 6528 04:37:10,603 --> 04:37:13,873 QUOTES QUICKLY ENOUGH I'M HAPPY 6529 04:37:13,873 --> 04:37:22,348 TO SHARE MY SLIDES WITH YOU. 6530 04:37:22,348 --> 04:37:23,783 NOW, COMMUNITY IDENTIFIED 6531 04:37:23,783 --> 04:37:25,685 CHALLENGES AND THE BOARD ENGAGED 6532 04:37:25,685 --> 04:37:27,887 AT THE START OF THE JEAP 6533 04:37:27,887 --> 04:37:29,022 INITIATIVE TO DEVELOP RESEARCH 6534 04:37:29,022 --> 04:37:29,322 PRIORITIES. 6535 04:37:29,322 --> 04:37:32,892 THE PROCESS WE USED IS DETAILED 6536 04:37:32,892 --> 04:37:35,795 IN THE WEB PAGE THERE ON THE 6537 04:37:35,795 --> 04:37:35,995 SLIDE. 6538 04:37:35,995 --> 04:37:40,567 THESE RESEARCH PRIORITIES WERE 6539 04:37:40,567 --> 04:37:41,701 INTENDED TO PRIORITIZE RESEARCH 6540 04:37:41,701 --> 04:37:43,069 STUDIES AND SINCE DEVELOPED 6541 04:37:43,069 --> 04:37:45,138 THEY'VE BEEN UTILIZED IN 6542 04:37:45,138 --> 04:37:46,606 NUMEROUS GRANT APPLICATIONS AND 6543 04:37:46,606 --> 04:37:48,741 PILOT STUDIES AND REVIEW PAPERS. 6544 04:37:48,741 --> 04:37:49,676 THERE'S A BRAND NEW ONE THAT 6545 04:37:49,676 --> 04:37:58,651 JUST CAME OUT LAST NIGHT. 6546 04:37:58,651 --> 04:38:00,720 IN HEAL CONNECTION THEY 6547 04:38:00,720 --> 04:38:02,055 IDENTIFIED WHAT KEEPS THEM UP AT 6548 04:38:02,055 --> 04:38:04,290 NIGHT IN TREATMENT AND SERVICES 6549 04:38:04,290 --> 04:38:05,625 IN RESPECTIVE COMMUNITIES AND 6550 04:38:05,625 --> 04:38:10,597 THEY VARY WIDELY. 6551 04:38:10,597 --> 04:38:17,503 AGAIN, EMPHASIZING THE NEED FOR 6552 04:38:17,503 --> 04:38:23,476 TAILORED RESPONSES. 6553 04:38:23,476 --> 04:38:26,279 THESE ARE THOUGHTS ON ENGAGING 6554 04:38:26,279 --> 04:38:27,413 PEOPLE WITH LIVED EXPERIENCE AND 6555 04:38:27,413 --> 04:38:28,615 THROUGH HEALTH ECONOMICS 6556 04:38:28,615 --> 04:38:28,881 RESEARCH. 6557 04:38:28,881 --> 04:38:30,850 THESE WILL BE AVAILABLE IN MY 6558 04:38:30,850 --> 04:38:31,050 SLIDE. 6559 04:38:31,050 --> 04:38:32,919 I WON'T GO THROUGH EACH OF THEM. 6560 04:38:32,919 --> 04:38:36,789 WE CAN REVISIT THEM IN THE Q&A 6561 04:38:36,789 --> 04:38:37,390 SECTION. 6562 04:38:37,390 --> 04:38:41,194 FROM MY EXPERIENCE OF KNOWING 6563 04:38:41,194 --> 04:38:42,695 SOME ABOUT HEALTH ECONOMICS 6564 04:38:42,695 --> 04:38:44,297 RESEARCH BEING A CONSUMER AND 6565 04:38:44,297 --> 04:38:47,634 FROM THE OTHER SIDE OF WORKING 6566 04:38:47,634 --> 04:38:54,607 CLOSELY WITH PEOPLE WITH LIVED 6567 04:38:54,607 --> 04:38:56,109 EXPERIENCE. 6568 04:38:56,109 --> 04:38:58,378 BEFORE I CONCLUDE AND MAKE CLEAR 6569 04:38:58,378 --> 04:39:00,880 GENUINE COMMUNITY ENGAGE 6570 04:39:00,880 --> 04:39:04,217 RESEARCH IS DIFFICULT AND IT 6571 04:39:04,217 --> 04:39:05,451 LIKELY FOREIGN TO MORE 6572 04:39:05,451 --> 04:39:05,952 TRADITIONAL RESEARCHERS. 6573 04:39:05,952 --> 04:39:08,221 IT REQUIRES MORE WORK AND 6574 04:39:08,221 --> 04:39:09,322 INVESTMENT THAN TRADITIONAL 6575 04:39:09,322 --> 04:39:12,392 RESEARCH AND AS WELL AS A HIGH 6576 04:39:12,392 --> 04:39:14,794 DEGREE OF INTELLECTUAL HUMILITY. 6577 04:39:14,794 --> 04:39:17,330 THAT SAID, MY EXPERIENCE HAS 6578 04:39:17,330 --> 04:39:19,699 DEMONSTRATED FOR ME AT LEAST, 6579 04:39:19,699 --> 04:39:21,401 ENGAGEMENT ISN'T OPTIONAL OR 6580 04:39:21,401 --> 04:39:23,670 COMPLIMENTARY, IT'S ESSENTIAL. 6581 04:39:23,670 --> 04:39:26,139 I BELIEVE IF WE ARE TO MAKE A 6582 04:39:26,139 --> 04:39:27,740 DIFFERENCE, RESEARCH MUST BE 6583 04:39:27,740 --> 04:39:30,209 TAILORED TO REAL WORLD CONTEXT 6584 04:39:30,209 --> 04:39:31,611 AND BARRIERS. 6585 04:39:31,611 --> 04:39:33,446 SECONDLY, I BELIEVE ENGAGEMENT 6586 04:39:33,446 --> 04:39:36,482 MUST BE ONGOING AND NOT 6587 04:39:36,482 --> 04:39:36,783 EXTRACTIVE. 6588 04:39:36,783 --> 04:39:37,784 THIS MEANS THROUGHOUT THE 6589 04:39:37,784 --> 04:39:41,988 PROJECT LIFE CYCLES AND WITH A 6590 04:39:41,988 --> 04:39:44,757 MEANINGFUL, MUTUAL BENEFIT FOCUS 6591 04:39:44,757 --> 04:39:46,326 AND THIRD PARTNERSHIP MUST BE 6592 04:39:46,326 --> 04:39:48,061 ACCESS IN AND CO-OWNED. 6593 04:39:48,061 --> 04:39:49,329 SO MAKE SURE TO EVALUATE 6594 04:39:49,329 --> 04:39:52,832 YOURSELF AND THE ENGAGEMENT THAT 6595 04:39:52,832 --> 04:39:54,434 YOU'RE TRYING TO BUILD. 6596 04:39:54,434 --> 04:39:58,604 MID COURSE CORRECT IF YOU NEED 6597 04:39:58,604 --> 04:40:02,208 TO AND HAVE THAT HUMILITY IN 6598 04:40:02,208 --> 04:40:03,042 WORKING WITH PEOPLE WITH LIVED 6599 04:40:03,042 --> 04:40:04,811 EXPERIENCE TO BE THE EXPERTS AND 6600 04:40:04,811 --> 04:40:09,082 GIVE YOU GUIDANCE HOW TO 6601 04:40:09,082 --> 04:40:10,583 CONSTANTLY IMPROVE AND 6602 04:40:10,583 --> 04:40:11,517 CO-PRODUCTION AND I'LL LEAVE YOU 6603 04:40:11,517 --> 04:40:12,618 WITH A NUMBER ONE CALL TO ACTION 6604 04:40:12,618 --> 04:40:15,588 AND ONE I LIKE TO SQUEEZE IN 6605 04:40:15,588 --> 04:40:17,090 WHENEVER I CAN. 6606 04:40:17,090 --> 04:40:21,127 FIRST AS RESEARCHERS, FUND AND 6607 04:40:21,127 --> 04:40:25,965 POLICY MAKERS WE MUST MATCH 6608 04:40:25,965 --> 04:40:28,134 RECIPROCAL PARTNERSHIP TO LIFT 6609 04:40:28,134 --> 04:40:33,206 LIVED EXPERIENCE AS EXPERTISE 6610 04:40:33,206 --> 04:40:34,240 AROUND STRIVE TO OVERCOME 6611 04:40:34,240 --> 04:40:36,442 BARRIERS TO WORK WITHIN THE 6612 04:40:36,442 --> 04:40:38,211 ENTIRE RESEARCH ENTERPRISE. 6613 04:40:38,211 --> 04:40:40,813 SO NOT JUST AS INDIVIDUALS THAT 6614 04:40:40,813 --> 04:40:42,515 ARE ON COMMUNITY BOARDS AND 6615 04:40:42,515 --> 04:40:44,817 GUIDING OUR WORK, BUT ACTUALLY 6616 04:40:44,817 --> 04:40:46,719 AS PEOPLE AS STAFF AND WORKING 6617 04:40:46,719 --> 04:40:48,421 WITHIN THE RESEARCH ENTERPRISE 6618 04:40:48,421 --> 04:40:50,590 INCLUDING AS LEADERS OF FUTURE 6619 04:40:50,590 --> 04:40:54,227 RESEARCH. 6620 04:40:54,227 --> 04:41:03,770 SO THAT I HAVE MY E-MAIL ADDRESS 6621 04:41:03,770 --> 04:41:06,038 AND ALL YOU'RE DOING TO IMPROVE 6622 04:41:06,038 --> 04:41:08,574 RESEARCH AND OUTCOME AND LET ME 6623 04:41:08,574 --> 04:41:10,576 KNOW IF I CAN BE HELPFUL. 6624 04:41:10,576 --> 04:41:12,044 >> THANK YOU SO MUCH. 6625 04:41:12,044 --> 04:41:15,581 I THINK THIS WAS AN AMAZING 6626 04:41:15,581 --> 04:41:16,783 PRESENTATION, DR. SHEIDOW. 6627 04:41:16,783 --> 04:41:18,584 I APPRECIATE YOUR CALL FOR 6628 04:41:18,584 --> 04:41:19,252 ACTION. 6629 04:41:19,252 --> 04:41:23,356 SO PLEASE EVERYONE, IF YOU HAVE 6630 04:41:23,356 --> 04:41:28,094 ANY QUESTIONS, POST THEM IN THE 6631 04:41:28,094 --> 04:41:30,596 Q&A BOX AND WE'LL LEAVE THE Q&A 6632 04:41:30,596 --> 04:41:34,333 TO THE END OF THE PANEL. 6633 04:41:34,333 --> 04:41:39,939 SO LET'S ME OF ON TO OUR NEXT 6634 04:41:39,939 --> 04:41:42,742 PRESENTER, DR. KIMBERLY GEISSLER 6635 04:41:42,742 --> 04:41:44,510 WHO IS ASSOCIATE PROFESSOR AND 6636 04:41:44,510 --> 04:41:46,045 CHIEF OF THE DIVISION OF HEALTH 6637 04:41:46,045 --> 04:41:49,715 EQUITY AND HEALTH SERVICES 6638 04:41:49,715 --> 04:41:51,617 RESEARCH BASED AT BAY STATE 6639 04:41:51,617 --> 04:41:53,753 HEALTH AND HER TALK IS ON THE 6640 04:41:53,753 --> 04:41:55,354 EFFECT OF MEDICAID ACCOUNTABLE 6641 04:41:55,354 --> 04:41:58,191 CARE ORGANIZATIONS ON BEHAVIORAL 6642 04:41:58,191 --> 04:42:01,461 HEALTH CARE QUALITY AND OUTCOMES 6643 04:42:01,461 --> 04:42:02,261 FOR CHILDREN. 6644 04:42:02,261 --> 04:42:05,798 SHE IS A HEALTH ECONOMIST AND 6645 04:42:05,798 --> 04:42:09,335 HAS DONE GREAT WORK IN HEALTH 6646 04:42:09,335 --> 04:42:10,236 POLICY RESEARCH AND HEALTH CARE 6647 04:42:10,236 --> 04:42:11,904 FOR VULNERABLE POPULATIONS. 6648 04:42:11,904 --> 04:42:14,607 I'LL PASS IT TO HER. 6649 04:42:14,607 --> 04:42:24,450 THANK YOU SO MUCH. 6650 04:42:24,450 --> 04:42:26,586 >> GREAT YOU, THANK YOU SO MUCH 6651 04:42:26,586 --> 04:42:29,355 FOR INVITING ME AND HOSTING THIS 6652 04:42:29,355 --> 04:42:30,623 TODAY. 6653 04:42:30,623 --> 04:42:32,291 THIS IS RELATIVELY NEW WORK AND 6654 04:42:32,291 --> 04:42:33,326 WE'RE ONE AND A HALF YEARS INTO 6655 04:42:33,326 --> 04:42:34,427 A FIVE-YEAR PROJECT. 6656 04:42:34,427 --> 04:42:36,195 I'LL SHOW YOU SOME OF THE 6657 04:42:36,195 --> 04:42:46,606 RESULTS AS WE GO ALONG. 6658 04:42:48,441 --> 04:42:50,109 PEDIATRIC MENTAL HEALTH ARE OF 6659 04:42:50,109 --> 04:42:51,177 SERIOUS CONCERN. 6660 04:42:51,177 --> 04:42:52,478 1 IN 4 CHILDREN EXPERIENCE 6661 04:42:52,478 --> 04:42:53,379 BEHAVIORAL HEALTH DISORDERS IN 6662 04:42:53,379 --> 04:42:54,780 THE U.S. 6663 04:42:54,780 --> 04:42:58,584 THE MOST COMMON ADHD, ANXIETY 6664 04:42:58,584 --> 04:42:59,252 AND DEPRESSION. 6665 04:42:59,252 --> 04:43:01,454 MORBIDITY AND MORTALITY DUE TO 6666 04:43:01,454 --> 04:43:02,388 BEHAVIORAL HEALTH DISORDERS IS 6667 04:43:02,388 --> 04:43:06,792 HIGH WITH SUICIDE AS THE LEADING 6668 04:43:06,792 --> 04:43:11,898 CAUSE OF ADOLESCENT DEATH. 6669 04:43:11,898 --> 04:43:14,600 THERE'S SUBSTANTIAL BARRIERS 6670 04:43:14,600 --> 04:43:16,969 ARRIVING AT MULTIPLE LEVELS, 6671 04:43:16,969 --> 04:43:17,937 POLICY, COMMUNITY, HEALTH SYSTEM 6672 04:43:17,937 --> 04:43:19,305 AND PROVIDERS. 6673 04:43:19,305 --> 04:43:22,041 THE BARRIERS TO CARE 6674 04:43:22,041 --> 04:43:22,942 PARTICULARLY AFFECT LOWER INCOME 6675 04:43:22,942 --> 04:43:33,419 AND MINORITIZED POPULATIONS. 6676 04:43:34,120 --> 04:43:38,758 ONE WAY TO ADDRESS THIS IS 6677 04:43:38,758 --> 04:43:39,025 MEDICAID. 6678 04:43:39,025 --> 04:43:40,326 ALMOST 40% OF CHILDREN IN THE 6679 04:43:40,326 --> 04:43:43,729 UNITED STATES ARE ENSURED BY 6680 04:43:43,729 --> 04:43:44,931 MEDICAID OR BY THEIR CHILDREN'S 6681 04:43:44,931 --> 04:43:45,731 HEALTH INSURANCE PROGRAM. 6682 04:43:45,731 --> 04:43:48,601 MEDICAID AS YOU PROBABLY KNOW IS 6683 04:43:48,601 --> 04:43:50,870 A STATE FEDERAL PARTNERSHIP 6684 04:43:50,870 --> 04:43:52,305 PROVIDING INSURANCE TO 6685 04:43:52,305 --> 04:43:53,806 LOW-INCOME OR DISABLED 6686 04:43:53,806 --> 04:43:54,106 INDIVIDUALS. 6687 04:43:54,106 --> 04:43:57,543 THOUGH ELIGIBILITY AND BENEFITS 6688 04:43:57,543 --> 04:44:00,880 VARY BY STATE, MORE THAN HALF OF 6689 04:44:00,880 --> 04:44:03,249 CHILDREN FROM MINORITIZED ETHNIC 6690 04:44:03,249 --> 04:44:05,117 AND RACIAL GROUPS ARE COVERED BY 6691 04:44:05,117 --> 04:44:13,559 MEDICAID. 6692 04:44:13,559 --> 04:44:14,860 ONE WAY THEY'RE ADDRESSING 6693 04:44:14,860 --> 04:44:15,861 HEALTH CARE IS THROUGH 6694 04:44:15,861 --> 04:44:16,862 ACCOUNTABLE CARE ORGANIZATIONS. 6695 04:44:16,862 --> 04:44:19,131 THE ACCOUNTABLE CARE 6696 04:44:19,131 --> 04:44:20,633 ORGANIZATIONS, THERE ARE 6697 04:44:20,633 --> 04:44:22,201 VALUE-BASED PAYMENT MODEL THAT 6698 04:44:22,201 --> 04:44:24,537 CENTERED AROUND PRIMARY CARE 6699 04:44:24,537 --> 04:44:24,804 PRACTICES. 6700 04:44:24,804 --> 04:44:27,006 SO IN AN ACO, A GROUP OF 6701 04:44:27,006 --> 04:44:29,175 CLINICIANS, GENERALLY PRIMARY 6702 04:44:29,175 --> 04:44:30,710 CARE CLINICIANS PROVIDES CARE 6703 04:44:30,710 --> 04:44:33,412 FOR A SPECIFIED SET OF PATIENTS 6704 04:44:33,412 --> 04:44:35,281 AND THEN HAS RESPONSIBILITY FOR 6705 04:44:35,281 --> 04:44:36,916 THE QUALITY AND COST OF CARE FOR 6706 04:44:36,916 --> 04:44:38,751 THOSE PATIENTS. 6707 04:44:38,751 --> 04:44:42,588 MOST OF THESE ACO ARE UNDER 6708 04:44:42,588 --> 04:44:44,824 SECTION 1115 WAIVERS WHICH CAN 6709 04:44:44,824 --> 04:44:47,426 BE USED TO IMPROVE MEDICAID 6710 04:44:47,426 --> 04:44:48,027 PROGRAMS. 6711 04:44:48,027 --> 04:44:50,863 BETWEEN 2016 AND 2023, 21 STATES 6712 04:44:50,863 --> 04:44:54,367 HAD MEDICAID ACOs AT SOME POINT. 6713 04:44:54,367 --> 04:44:56,969 AND 11 STATES HAD ACTIVE 6714 04:44:56,969 --> 04:45:07,346 MEDICAID ACOs IN 2023. 6715 04:45:07,980 --> 04:45:09,682 MASSACHUSETTS IMPLEMENTED 6716 04:45:09,682 --> 04:45:13,386 MEDICAID ACOS AND LAUNCHED THEM 6717 04:45:13,386 --> 04:45:14,987 IN MARCH OF 2018. 6718 04:45:14,987 --> 04:45:17,423 AND CHILDREN WERE MOVED INTO THE 6719 04:45:17,423 --> 04:45:19,825 ACOs BASED ON THEIR PCP 6720 04:45:19,825 --> 04:45:20,126 PRACTICE. 6721 04:45:20,126 --> 04:45:23,829 THIS IS A QUASI-EXPERIMENTAL 6722 04:45:23,829 --> 04:45:25,698 DESIGN BECAUSE WE HAVE THIS 6723 04:45:25,698 --> 04:45:27,133 ASSIGNMENT THAT HAPPENS WITHOUT 6724 04:45:27,133 --> 04:45:30,469 ACTION TAKEN BY THE PERSON. 6725 04:45:30,469 --> 04:45:37,443 THERE WERE 16 ACOs AND THERE ARE 6726 04:45:37,443 --> 04:45:41,080 SUBSTANTIAL ORGANIZATIONAL 6727 04:45:41,080 --> 04:45:43,382 CHANGES AND PATIENT AND OTHER 6728 04:45:43,382 --> 04:45:43,749 CHARACTERISTICS. 6729 04:45:43,749 --> 04:45:45,918 IT WAS A HUGE TRANSFORMATION OF 6730 04:45:45,918 --> 04:45:49,021 THE CARE DELIVERY SYSTEM. 6731 04:45:49,021 --> 04:45:51,724 SO STATEWIDE MORE THAN 90% OF 6732 04:45:51,724 --> 04:45:54,627 CHILDREN MOVED TO THE ACOs 6733 04:45:54,627 --> 04:45:57,163 WITHIN A YEAR AND THIS WAS 80% 6734 04:45:57,163 --> 04:46:00,866 OF ALL MEDICAID ENROLLEES. 6735 04:46:00,866 --> 04:46:02,334 THIS WAS A HUGE CHANGE TO THE 6736 04:46:02,334 --> 04:46:02,768 DELIVERY SYSTEM IN 6737 04:46:02,768 --> 04:46:13,012 MASSACHUSETTS. 6738 04:46:15,581 --> 04:46:17,917 THINKING COULD THESE MEDICAID 6739 04:46:17,917 --> 04:46:20,486 ACOs BE A WAY TO REDUCE 6740 04:46:20,486 --> 04:46:22,021 DISPARITIES IN BEHAVIORAL HEALTH 6741 04:46:22,021 --> 04:46:23,122 CARE IN CHILDREN. 6742 04:46:23,122 --> 04:46:26,625 THEY COULD POTENTIALLY IMPROVE 6743 04:46:26,625 --> 04:46:29,895 CARE THROUGH SHARED RISK 6744 04:46:29,895 --> 04:46:34,500 CONTRACTS, INCREASEDIN 6745 04:46:34,500 --> 04:46:36,435 SENSITIVES AND INCREASED 6746 04:46:36,435 --> 04:46:38,671 MEASURES OF SOCIAL DETERMINATES 6747 04:46:38,671 --> 04:46:39,739 OF HEALTH AND CARE MANAGEMENT 6748 04:46:39,739 --> 04:46:42,041 AND INTEGRATIVE BEHAVIORAL 6749 04:46:42,041 --> 04:46:43,409 HEALTH THAT MAY BE MORE 6750 04:46:43,409 --> 04:46:45,244 DIFFICULT IN A FEE FOR SERVICE 6751 04:46:45,244 --> 04:46:45,478 SYSTEM. 6752 04:46:45,478 --> 04:46:48,180 OUR OVER ALL STUDY IS USING A 6753 04:46:48,180 --> 04:46:52,518 MIXED METHODS APPROACH TO STUDY 6754 04:46:52,518 --> 04:46:54,086 THE AFFECT OF THE IMPLEMENTATION 6755 04:46:54,086 --> 04:46:55,387 ON BEHAVIORAL HEALTH OUTCOMES 6756 04:46:55,387 --> 04:46:58,591 AND DISPARITIES IN CHILDREN WHO 6757 04:46:58,591 --> 04:47:08,467 USE MENTAL HEALTH CARE. 6758 04:47:08,467 --> 04:47:15,741 AIM 1 IS LOOKING AT THE IMPACT 6759 04:47:15,741 --> 04:47:18,377 FOR MEDICARE INSURED CHILDREN 6760 04:47:18,377 --> 04:47:22,181 AND DESPAIRS FOR MEDICAID VERSUS 6761 04:47:22,181 --> 04:47:29,822 PRIVATELY INSURED CHILDREN AND 6762 04:47:29,822 --> 04:47:40,332 CHOOSING HOW HETTER GEN AITY 6763 04:47:42,601 --> 04:47:44,103 AFFECTS OUTCOMES AND 6764 04:47:44,103 --> 04:47:46,238 ORGANIZATIONAL FEATURES MEDICAID 6765 04:47:46,238 --> 04:47:54,346 ACOs. 6766 04:47:54,346 --> 04:47:58,584 WE HAVE A HUGE AMOUNT OF DATA 6767 04:47:58,584 --> 04:48:01,320 AND PARTICIPANTS ACROSS THE 6768 04:48:01,320 --> 04:48:01,687 STUDIES. 6769 04:48:01,687 --> 04:48:02,888 WE'RE USING ALL PAIR CLAIMS DATA 6770 04:48:02,888 --> 04:48:06,225 AND NATIONAL DATA TO LOOK AT 6771 04:48:06,225 --> 04:48:07,660 CLAIMS-BASED UTILIZATION AND 6772 04:48:07,660 --> 04:48:07,927 OUTCOMES. 6773 04:48:07,927 --> 04:48:11,330 WE HAVE CONDUCTED A SURVEY OF 6774 04:48:11,330 --> 04:48:13,032 ACO LEADERSHIP. 6775 04:48:13,032 --> 04:48:16,969 THIS WILL HELP US UNDERSTAND 6776 04:48:16,969 --> 04:48:18,337 ORGANIZATIONAL CHARACTERISTICS 6777 04:48:18,337 --> 04:48:22,441 OF EACH ACO TO UNDERSTAND WHO 6778 04:48:22,441 --> 04:48:29,949 THEY'RE TREATING, WHAT KIND OF 6779 04:48:29,949 --> 04:48:32,952 EXPERIENCE THEY HAVE WITH 6780 04:48:32,952 --> 04:48:34,520 CONTRACT AND HEALTH CARE. 6781 04:48:34,520 --> 04:48:36,789 AND WE ARE INTERVIEWING THREE 6782 04:48:36,789 --> 04:48:39,959 SETS OF INFORMANTS. 6783 04:48:39,959 --> 04:48:41,427 WE'LL INCLUDE ACO LEADERSHIP TO 6784 04:48:41,427 --> 04:48:43,162 TELL US MORE ABOUT STRUCTURAL 6785 04:48:43,162 --> 04:48:44,864 CHANGES WITHIN THE ACOs, 6786 04:48:44,864 --> 04:48:47,366 PROVIDERS TO REALLY TELL US HOW 6787 04:48:47,366 --> 04:48:50,603 THESE CHANGES HAVE BEEN 6788 04:48:50,603 --> 04:48:52,071 IMPLEMENTED ON THE GROUND AND 6789 04:48:52,071 --> 04:48:53,172 PARENTS TO PROVIDE INFORMATION 6790 04:48:53,172 --> 04:48:55,241 ABOUT THEIR EXPERIENCE WITH 6791 04:48:55,241 --> 04:48:56,842 THEIR CHILD'S BEHAVIORAL HEALTH 6792 04:48:56,842 --> 04:48:57,243 CARE. 6793 04:48:57,243 --> 04:48:59,178 AND WE'RE ALSO USING THE 6794 04:48:59,178 --> 04:49:00,713 NATIONAL SURVEY OF CHILDREN'S 6795 04:49:00,713 --> 04:49:03,249 HEALTH AND THIS WILL ALLOW US TO 6796 04:49:03,249 --> 04:49:06,185 EXAMINE THINGS THAT ARE MORE 6797 04:49:06,185 --> 04:49:07,019 PATIENT REPORTED. 6798 04:49:07,019 --> 04:49:09,655 WE ALSO HAVE A COMMUNITY 6799 04:49:09,655 --> 04:49:13,025 ADVISORY BOARD AND IT HAS 6800 04:49:13,025 --> 04:49:16,996 PARTICIPANTS FROM NATIONAL 6801 04:49:16,996 --> 04:49:20,199 POLICY MAKERS AND LOCAL 6802 04:49:20,199 --> 04:49:21,634 REPRESENTATIVES FROM BEHAVIORAL 6803 04:49:21,634 --> 04:49:22,801 HEALTH CARE SYSTEMS WITHIN THE 6804 04:49:22,801 --> 04:49:24,336 STATE AND THEN REPRESENTATIVE 6805 04:49:24,336 --> 04:49:34,847 FROM A PATIENT ADVOCACY GROUP. 6806 04:49:35,414 --> 04:49:37,516 SO WE'RE LOOKING AT THE 6807 04:49:37,516 --> 04:49:38,384 RELATIONSHIP BETWEEN PATIENT 6808 04:49:38,384 --> 04:49:40,586 REPORTED EXPERIENCE AND 6809 04:49:40,586 --> 04:49:41,854 ORGANIZATIONAL FEATURES OF 6810 04:49:41,854 --> 04:49:43,422 MEDICAID ACOs. 6811 04:49:43,422 --> 04:49:45,291 ANCE WE'RE USING THE NATIONAL 6812 04:49:45,291 --> 04:49:46,892 SURVEY OF CHILDREN'S HEALTH AND 6813 04:49:46,892 --> 04:49:49,428 HERE WE'RE ABLE TO EXAMINE UNMET 6814 04:49:49,428 --> 04:49:51,096 NEED, PARENT-REPORTED EXPERIENCE 6815 04:49:51,096 --> 04:49:52,364 AND COORDINATION OF CARE. 6816 04:49:52,364 --> 04:49:55,634 AND HAD PLANNED TO USE A SURVEY 6817 04:49:55,634 --> 04:49:57,703 CONDUCTED WITH CHILDREN ONLY IN 6818 04:49:57,703 --> 04:50:01,140 MASSACHUSETTS BUT WE WEREN'T 6819 04:50:01,140 --> 04:50:02,875 ABLE TO OBTAIN THE DATA AND 6820 04:50:02,875 --> 04:50:04,443 MOVED TO A DIFFERENT DATA SOURCE 6821 04:50:04,443 --> 04:50:06,011 THAT WILL ALLOW US TO ACHIEVE 6822 04:50:06,011 --> 04:50:06,712 THE GOALS. 6823 04:50:06,712 --> 04:50:09,381 WE'RE CONDUCTING INTERVIEWS WITH 6824 04:50:09,381 --> 04:50:10,249 PARENTS ACROSS THE STATE AND 6825 04:50:10,249 --> 04:50:13,452 WITH A RANGE OF EXPERIENCES AND 6826 04:50:13,452 --> 04:50:15,587 SEVERITY OF THEIR CHILD'S MENTAL 6827 04:50:15,587 --> 04:50:17,556 ILLNESS AND THEN CONDUCTING THE 6828 04:50:17,556 --> 04:50:19,858 SURVEYS, LEADERSHIP INTERVIEWS 6829 04:50:19,858 --> 04:50:30,269 AND PROVIDER INTERVIEWS. 6830 04:50:31,971 --> 04:50:34,873 WE'RE FINDING LIMIT ED CHANGES 6831 04:50:34,873 --> 04:50:38,677 AND UNMET NEED AND OTHER 6832 04:50:38,677 --> 04:50:40,946 PARENT-REPORTED SURVEY OUTCOMES 6833 04:50:40,946 --> 04:50:43,449 RELATED TO MEDICAID ACO 6834 04:50:43,449 --> 04:50:43,816 IMPLEMENTATION. 6835 04:50:43,816 --> 04:50:47,953 WE FIND WELL AWARENESS OF 6836 04:50:47,953 --> 04:50:51,657 PARENTS WITH CHILDREN WITH 6837 04:50:51,657 --> 04:50:53,425 BEHAVIORAL HEALTH SYSTEM AND 6838 04:50:53,425 --> 04:50:55,361 ONGOING LOCAL AND STATE 6839 04:50:55,361 --> 04:50:57,963 INITIATIVES MAKES IDENTIFYING 6840 04:50:57,963 --> 04:51:00,766 CHANGES RELATED TO ACO'S 6841 04:51:00,766 --> 04:51:02,201 CHALLENGING FROM A POLICY 6842 04:51:02,201 --> 04:51:12,411 PERSPECTIVE. 6843 04:51:13,112 --> 04:51:14,380 A RECENT EXAMPLE OF 6844 04:51:14,380 --> 04:51:15,047 INCORPORATING LIVED EXPERIENCE 6845 04:51:15,047 --> 04:51:18,217 IS THAT WE CONDUCTED ALL THESE 6846 04:51:18,217 --> 04:51:19,852 CLAIMS BASED ANALYSES AND NEED 6847 04:51:19,852 --> 04:51:21,854 TO INTERPRET THE FINDINGS. 6848 04:51:21,854 --> 04:51:25,657 SO WE NEED TO DETERMINE IS THE 6849 04:51:25,657 --> 04:51:28,427 FINDING OF DECREASED VISITS FOR 6850 04:51:28,427 --> 04:51:29,795 CHILDREN WITH BEHAVIORAL HEALTH 6851 04:51:29,795 --> 04:51:32,197 CONDITIONS DUE TO ACCESS TO CARE 6852 04:51:32,197 --> 04:51:33,899 OR DUE TO IMPROVED COMMUNICATION 6853 04:51:33,899 --> 04:51:34,900 AND OTHER SETTINGS? 6854 04:51:34,900 --> 04:51:39,505 THIS IS SOMETHING YOU CANNOT 6855 04:51:39,505 --> 04:51:41,073 TELL FROM CLAIMS DATA AND 6856 04:51:41,073 --> 04:51:42,608 COMBINING IT WITH SURVEY DATA 6857 04:51:42,608 --> 04:51:44,243 AND EXAMINING UNMET NEED AND 6858 04:51:44,243 --> 04:51:47,112 PARENT INTERVIEWS FOR A MORE 6859 04:51:47,112 --> 04:51:49,014 HOLISTIC INTERPRETATION OF 6860 04:51:49,014 --> 04:51:50,215 CHANGES AND OVER USE AND 6861 04:51:50,215 --> 04:51:52,518 APPROPRIATE USE OF SERVICES IS 6862 04:51:52,518 --> 04:51:52,951 COMMONLY MENTIONED. 6863 04:51:52,951 --> 04:51:54,586 WE'LL DO ADDITIONAL ANALYSES TO 6864 04:51:54,586 --> 04:51:56,255 FIND DIFFERENT SETS OF SERVICES 6865 04:51:56,255 --> 04:51:58,157 THAN ORIGINALLY PLANNED. 6866 04:51:58,157 --> 04:52:01,226 AND THINKING ABOUT THE LIVED 6867 04:52:01,226 --> 04:52:04,430 EXPERIENCE, PARENTS OFTEN DON'T 6868 04:52:04,430 --> 04:52:11,937 OBSERVE THE BEHIND THE SCENES 6869 04:52:11,937 --> 04:52:16,442 CHANGES AND NEED TO IN CORP RATE 6870 04:52:16,442 --> 04:52:19,311 MULTIPLE LEVELS AND DEDICATING 6871 04:52:19,311 --> 04:52:20,846 EXPERTISE, TIME AND RESOURCE TO 6872 04:52:20,846 --> 04:52:22,414 INCORPORATING THE LIVED 6873 04:52:22,414 --> 04:52:26,585 EXPERIENCE IS CRITICAL TO 6874 04:52:26,585 --> 04:52:28,287 ADVANCE THE SCIENCE. 6875 04:52:28,287 --> 04:52:30,022 THIS IS MY CONTACT INFORMATION 6876 04:52:30,022 --> 04:52:32,891 AND THANK YOU AGAIN TO NIH FOR 6877 04:52:32,891 --> 04:52:41,900 FUNDING THIS STUDY. 6878 04:52:41,900 --> 04:52:43,135 >> THANKS SO MUCH. 6879 04:52:43,135 --> 04:52:47,473 I'M GOING TO TURN IT TO OUR NEXT 6880 04:52:47,473 --> 04:52:48,173 PANELIST. 6881 04:52:48,173 --> 04:52:54,546 EXCITED TO HEAR FROM DR. LAURA 6882 04:52:54,546 --> 04:52:56,014 CHAVEZ FROM NATIONWIDE 6883 04:52:56,014 --> 04:52:56,448 CHILDREN'S. 6884 04:52:56,448 --> 04:52:58,584 >> THANK YOU FOR ALLOWING ME TO 6885 04:52:58,584 --> 04:53:01,453 SHARE OUR WORK. 6886 04:53:01,453 --> 04:53:03,122 I WANT TO BEGIN WITH 6887 04:53:03,122 --> 04:53:06,325 ACKNOWLEDGING FUNDING FOR THIS 6888 04:53:06,325 --> 04:53:09,128 WORK FROM NIMHD AND ALSO WILL BE 6889 04:53:09,128 --> 04:53:14,600 PRESENTING PART OF A PROJECT 6890 04:53:14,600 --> 04:53:21,206 USING A PEDIATRIC ACCOUNTABLE 6891 04:53:21,206 --> 04:53:24,042 DATA FROM CHILDREN'S NATIONWIDE 6892 04:53:24,042 --> 04:53:26,578 AND I HAVE SOME DISCLOSURES 6893 04:53:26,578 --> 04:53:30,215 ABOUT THE DATA AND OF COURSE I 6894 04:53:30,215 --> 04:53:33,385 WANT TO ACKNOWLEDGE 6895 04:53:33,385 --> 04:53:38,590 CO-INVESTIGATORS ON THE PROJECT 6896 04:53:38,590 --> 04:53:41,560 AS WELL AS ANALYSTS. 6897 04:53:41,560 --> 04:53:44,029 FIRST, A BIT OF BACKGROUND. 6898 04:53:44,029 --> 04:53:47,099 I WANTED TO SHOW TRENDS IN 6899 04:53:47,099 --> 04:53:48,667 POVERTY SINCE 2009 IN THE UNITED 6900 04:53:48,667 --> 04:53:49,935 STATES FOR CHILDREN. 6901 04:53:49,935 --> 04:53:52,704 WHICH IS MEASURED WITH TWO 6902 04:53:52,704 --> 04:53:53,138 DIFFERENT MEASURES. 6903 04:53:53,138 --> 04:53:56,408 THE OFFICIAL MEASURE IN RED AND 6904 04:53:56,408 --> 04:53:58,677 SUPPLEMENTAL POVERTY MEASURE IN 6905 04:53:58,677 --> 04:53:58,877 BLUE. 6906 04:53:58,877 --> 04:54:02,114 THE OFFICIAL MEASURE IS BASED ON 6907 04:54:02,114 --> 04:54:03,182 TAXABLE INCOME USED TO DETERMINE 6908 04:54:03,182 --> 04:54:05,717 ELIGIBILITY FOR BENEFITS AND THE 6909 04:54:05,717 --> 04:54:07,052 SUPPLEMENTAL POVERTY MEASURE WAS 6910 04:54:07,052 --> 04:54:09,054 CREATED WITH THE INTENTION OF 6911 04:54:09,054 --> 04:54:12,658 OFFERING A CLEARER PICTURE OF 6912 04:54:12,658 --> 04:54:13,959 THE CONDITIONS OF POVERTY THAT 6913 04:54:13,959 --> 04:54:15,260 TAKE INTO ACCOUNT SOCIAL 6914 04:54:15,260 --> 04:54:15,894 PROGRAMS THAT OFFSET FINANCIAL 6915 04:54:15,894 --> 04:54:18,530 HARDSHIPS. 6916 04:54:18,530 --> 04:54:21,733 AND THEY'RE GENERALLY MOVING IN 6917 04:54:21,733 --> 04:54:23,769 PARALLEL. 6918 04:54:23,769 --> 04:54:27,706 YOU'LL SEE IN 2021 A 6919 04:54:27,706 --> 04:54:29,374 SUPPLEMENTAL POVERTY MEASURE DID 6920 04:54:29,374 --> 04:54:31,276 DIFFER FROM THE ORIGINAL MEASURE 6921 04:54:31,276 --> 04:54:33,512 AND REACHED A HISTORIC LOW OF 6922 04:54:33,512 --> 04:54:33,779 5.2%. 6923 04:54:33,779 --> 04:54:37,382 THIS WITH US LARGELY DUE TO 6924 04:54:37,382 --> 04:54:38,817 POLICY IT CHANGES THAT HAPPENED 6925 04:54:38,817 --> 04:54:41,553 IN 2021. 6926 04:54:41,553 --> 04:54:43,589 THE CHILD TAX CREDIT AND TO GIF 6927 04:54:43,589 --> 04:54:46,858 A BRIEF REFRESHER ON WHAT WAS 6928 04:54:46,858 --> 04:54:47,659 MEANINGFUL ABOUT THAT POLICY 6929 04:54:47,659 --> 04:54:47,926 CHANGE. 6930 04:54:47,926 --> 04:54:51,630 SO IT EXPANDED THE SIZE OF THE 6931 04:54:51,630 --> 04:54:51,863 CREDIT. 6932 04:54:51,863 --> 04:54:53,832 IT WAS NEARLY DOUBLE AND MADE 6933 04:54:53,832 --> 04:54:57,002 FULLY REFUNDABLE AND HALF THE 6934 04:54:57,002 --> 04:54:59,338 CREDIT WAS OFFERED TO FAMILIES 6935 04:54:59,338 --> 04:55:03,809 IN ADVANCE OF TAX FILING 6936 04:55:03,809 --> 04:55:05,177 DEPENDENT ON THE AGE OF THE 6937 04:55:05,177 --> 04:55:08,614 CHILD, $300 PER MONTH FOR EACH 6938 04:55:08,614 --> 04:55:10,582 CHILD UNDER 6 AND $250 A MONTH 6939 04:55:10,582 --> 04:55:11,783 FOR OLDER CHILDREN. 6940 04:55:11,783 --> 04:55:14,186 IT ALSO INCLUDED HOUSEHOLDS WITH 6941 04:55:14,186 --> 04:55:15,787 NO OR VERY LOW ECONOMIC THAT HAD 6942 04:55:15,787 --> 04:55:17,689 BEEN PREVIOUSLY INCLUDED FROM 6943 04:55:17,689 --> 04:55:20,659 THE CHILD TAX CREDIT. 6944 04:55:20,659 --> 04:55:23,128 AND IT'S REDUCING CHILD POVERTY 6945 04:55:23,128 --> 04:55:23,929 ON THE SUPPLEMENTAL POVERTY 6946 04:55:23,929 --> 04:55:25,297 MEASURE BY MORE THAN 30%. 6947 04:55:25,297 --> 04:55:28,600 WE ALSO SAW IN THIS TIME 6948 04:55:28,600 --> 04:55:30,602 RESEARCH HAS DEMONSTRATED 6949 04:55:30,602 --> 04:55:31,803 REDUCED FOOD INSECURITY AND 6950 04:55:31,803 --> 04:55:33,872 MATERIAL HARDSHIP AND ALSO IN 6951 04:55:33,872 --> 04:55:36,208 SOME STUDIES EVIDENCE OF MENTAL 6952 04:55:36,208 --> 04:55:37,943 HEALTH BENEFIT FOR ADULTS WITH 6953 04:55:37,943 --> 04:55:38,710 CHILDREN LIKE REDUCED DEPRESSION 6954 04:55:38,710 --> 04:55:46,385 AND ANXIETY. 6955 04:55:46,385 --> 04:55:48,754 WE'RE INTERESTED IN 6956 04:55:48,754 --> 04:55:51,857 UNDERSTANDING THE IMPACT ON 6957 04:55:51,857 --> 04:55:58,697 DLNLT TELEHEALTH AS WELL. 6958 04:55:58,697 --> 04:56:02,501 -- ADOLESCENT TELEHEALTH AS 6959 04:56:02,501 --> 04:56:04,636 WELL AND WE HYPOTHESIZED A 6960 04:56:04,636 --> 04:56:07,673 CHANGE IN INCOME REDUCTION IN 6961 04:56:07,673 --> 04:56:08,740 POVERTY COULD BENEFIT -- COULD 6962 04:56:08,740 --> 04:56:11,276 HAVE POSITIVE IMPACTS ON CHILD 6963 04:56:11,276 --> 04:56:11,977 MENTAL HEALTH. 6964 04:56:11,977 --> 04:56:15,414 ONE IS THROUGH THE INVESTMENT 6965 04:56:15,414 --> 04:56:16,281 PATHWAY. 6966 04:56:16,281 --> 04:56:17,883 THIS ADDITIONAL MONTHLY INCOME 6967 04:56:17,883 --> 04:56:21,253 COULD OFFER FAMILIES ADDITIONAL 6968 04:56:21,253 --> 04:56:22,854 RESOURCES THAT THEY CAN USE TO 6969 04:56:22,854 --> 04:56:25,724 INVEST IN PROMOTING RESOURCES 6970 04:56:25,724 --> 04:56:28,093 LIKE FOOD, HOUSING OR EVEN 6971 04:56:28,093 --> 04:56:28,727 OPPORTUNITIES TO SPEND MORE TIME 6972 04:56:28,727 --> 04:56:30,595 WITH CHILDREN. 6973 04:56:30,595 --> 04:56:33,231 AND THROUGH THE STRESS PATHWAY 6974 04:56:33,231 --> 04:56:35,667 THROUGH REDUCED FINANCIAL 6975 04:56:35,667 --> 04:56:37,169 DISTRESS FOR CAREGIVERS WE ALSO 6976 04:56:37,169 --> 04:56:38,303 ANTICIPATED POSITIVE MENTAL 6977 04:56:38,303 --> 04:56:42,941 HEALTH BENEFITS THERE. 6978 04:56:42,941 --> 04:56:45,310 THIS IS WHAT MOTIVATED OUR 6979 04:56:45,310 --> 04:56:48,613 PROJECT FUNDED BY NIMHD FOCUSSED 6980 04:56:48,613 --> 04:56:51,149 ON UNDERSTANDING THE CHANGES THE 6981 04:56:51,149 --> 04:56:54,219 POLICY HAD AND THE EFFECTS ON 6982 04:56:54,219 --> 04:56:58,590 BEHAVIORAL HEALTH FOR MEDICAID 6983 04:56:58,590 --> 04:56:59,257 AND ENROLLED ADOLESCENTS. 6984 04:56:59,257 --> 04:57:03,061 AND THIS IS PART THE LARGER 6985 04:57:03,061 --> 04:57:04,396 PROJECT THE MIXED METHODS 6986 04:57:04,396 --> 04:57:06,064 PROJECT AND SHOW SOME 6987 04:57:06,064 --> 04:57:09,201 QUANTITATIVE UNLESS WE DID 6988 04:57:09,201 --> 04:57:11,536 WITHIN OHIO THAT HAVE ADDITIONAL 6989 04:57:11,536 --> 04:57:13,839 QUALITATIVE FOCUSES WHILE WE 6990 04:57:13,839 --> 04:57:14,573 INTERVIEWED ADOLESCENTS ABOUT 6991 04:57:14,573 --> 04:57:19,378 THEIR EXPERIENCES. 6992 04:57:19,378 --> 04:57:22,581 I DON'T HAVE TIME TO SHARE BOTH 6993 04:57:22,581 --> 04:57:25,650 OF THOSE TODAY. 6994 04:57:25,650 --> 04:57:27,419 FOR OUR QUANTITATIVE ANALYSIS 6995 04:57:27,419 --> 04:57:31,056 I'LL SHOW YOU TODAY, I'LL FOCUS 6996 04:57:31,056 --> 04:57:32,157 ON OHIO. 6997 04:57:32,157 --> 04:57:34,593 IN OHIO PARTNERS FOR KIDS, 6998 04:57:34,593 --> 04:57:40,332 MEDICAID ACL, A SAMPLE OF 9,974 6999 04:57:40,332 --> 04:57:44,002 OLDER ADOLESCENTS AND TO TRY TO 7000 04:57:44,002 --> 04:57:45,837 UNDERSTAND WHAT WAS THE EFFECT 7001 04:57:45,837 --> 04:57:48,840 TO THE BEST EXTENT WE CAN ON 7002 04:57:48,840 --> 04:57:50,342 THIS FEDERAL POLICY ON OUTCOMES 7003 04:57:50,342 --> 04:57:52,444 WE COMPARED CHANGES IN TWO 7004 04:57:52,444 --> 04:57:53,812 DIFFERENT AGE GROUPS. 7005 04:57:53,812 --> 04:57:58,650 WE COMPARE AN AGE GROUP OF OLDER 7006 04:57:58,650 --> 04:58:01,853 ADOLESCENTS WHO HAVE NOD NOT 7007 04:58:01,853 --> 04:58:03,522 TURNED 18 WE THE END OF 2021 AND 7008 04:58:03,522 --> 04:58:06,258 THE FAMILY WOULD HAVE BEEN 7009 04:58:06,258 --> 04:58:07,526 ELIGIBLE TO RECEIVE THE PAYMENTS 7010 04:58:07,526 --> 04:58:09,895 COMPARED TO A SLIGHTLY OLDER AGE 7011 04:58:09,895 --> 04:58:11,963 GROUP THAT JUST AGED OUT AND 7012 04:58:11,963 --> 04:58:14,599 TURNED 18 BEFORE THE END OF 7013 04:58:14,599 --> 04:58:18,036 2021. 7014 04:58:18,036 --> 04:58:21,072 AND THE MEAN OUTCOME IS 7015 04:58:21,072 --> 04:58:24,543 PROBABILITY OF AN ACUTE HEALTH 7016 04:58:24,543 --> 04:58:26,578 CARE VISIT OR PATIENT SETTING 7017 04:58:26,578 --> 04:58:28,580 AND BASED ON THE MEDICAID CLAIMS 7018 04:58:28,580 --> 04:58:33,251 DATA AND HAVING A PRIMARY MENTAL 7019 04:58:33,251 --> 04:58:35,954 HEALTH DIAGNOSIS FOR THIS 7020 04:58:35,954 --> 04:58:38,223 ENCOUNTER OR ANY DIAGNOSIS OF 7021 04:58:38,223 --> 04:58:38,824 DELIBERATE SELF-HARM ON THE 7022 04:58:38,824 --> 04:58:40,792 ENCOUNTER. 7023 04:58:40,792 --> 04:58:42,527 AND TO GIVE YOU A BIT OF CONTEXT 7024 04:58:42,527 --> 04:58:44,930 ABOUT WHERE IN OHIO THIS IS 7025 04:58:44,930 --> 04:58:46,565 TAKING PLACE, WE'RE FOCUSSED ON 7026 04:58:46,565 --> 04:58:50,368 PARTNERS FOR KIDS WHICH IS A 7027 04:58:50,368 --> 04:58:52,504 MEDICAID ACL THAT COVERS OVER 7028 04:58:52,504 --> 04:58:54,473 3,000 MEDICAID INVOLVED 7029 04:58:54,473 --> 04:58:58,577 PEDIATRIC PATIENTS IN CENTRAL 7030 04:58:58,577 --> 04:58:59,911 AND SOUTHEASTERN OHIO. 7031 04:58:59,911 --> 04:59:02,380 THIS IS A GEOGRAPHICALLY DIVERSE 7032 04:59:02,380 --> 04:59:05,584 AREA OF THE STATE INCLUDING 7033 04:59:05,584 --> 04:59:09,688 RURAL AND URBAN AND LARGE NUMBER 7034 04:59:09,688 --> 04:59:12,157 OF COUNTIES WITH A PROPORTION OF 7035 04:59:12,157 --> 04:59:13,325 CHILDREN LIVING BELOW THE 7036 04:59:13,325 --> 04:59:13,758 POVERTY LINE. 7037 04:59:13,758 --> 04:59:15,861 IN THE DARKER SHADED COUNTIES 7038 04:59:15,861 --> 04:59:17,262 MORE THAN A QUARTER OF CHILDREN 7039 04:59:17,262 --> 04:59:23,168 LIVING BELOW THE POVERTY LINE. 7040 04:59:23,168 --> 04:59:26,037 SO IN OUR ANALYTIC APPROACH 7041 04:59:26,037 --> 04:59:27,672 WE'RE USING A DIFFERENCE 7042 04:59:27,672 --> 04:59:28,673 APPROACH. 7043 04:59:28,673 --> 04:59:31,910 WE'RE ASSUMING THAT BUT FOR THIS 7044 04:59:31,910 --> 04:59:34,579 ADDITIONAL CHILD BENEFIT FOR TWO 7045 04:59:34,579 --> 04:59:37,015 GROUPS OF SIMILARLY AGED 7046 04:59:37,015 --> 04:59:39,251 ADOLESCENTS, WE WOULD EXPECT TO 7047 04:59:39,251 --> 04:59:43,355 SEE THE SIMILAR OUTCOME 7048 04:59:43,355 --> 04:59:44,990 TRAJECTORIES. 7049 04:59:44,990 --> 04:59:46,892 WE'RE USING AN INTENT TO TREAT 7050 04:59:46,892 --> 04:59:49,461 APPROACH AND WE DON'T HAVE 7051 04:59:49,461 --> 04:59:51,796 INFORMATION ON WHETHER OR NOT 7052 04:59:51,796 --> 04:59:53,532 FAMILIES DID INDEED IN FACT 7053 04:59:53,532 --> 04:59:55,567 RECEIVE THE CHILD TAX CREDIT BUT 7054 04:59:55,567 --> 04:59:58,203 WE KNOW IN OUR STATE AND IN 7055 04:59:58,203 --> 04:59:59,871 OTHER STATES THE HIGH PROPORTION 7056 04:59:59,871 --> 05:00:01,973 OF FAMILIES DID RECEIVE THE 7057 05:00:01,973 --> 05:00:04,576 CHILD TAX CUT AND MONTHLY 7058 05:00:04,576 --> 05:00:04,843 PAYMENTS. 7059 05:00:04,843 --> 05:00:06,611 AND WE'RE ALSO USING HISTORICAL 7060 05:00:06,611 --> 05:00:10,582 DATA IN OUR MODELLING STRATEGY 7061 05:00:10,582 --> 05:00:12,817 TO ACCOUNT FOR SEASONALITY. 7062 05:00:12,817 --> 05:00:14,119 WHETHER THERE WERE DIFFERENCES 7063 05:00:14,119 --> 05:00:15,820 IN THE FIRST HALF TO THE SECOND 7064 05:00:15,820 --> 05:00:18,023 HALF OF THE YEAR IN ACUTE MENTAL 7065 05:00:18,023 --> 05:00:22,627 HEALTH CARE VIFLTS. 7066 05:00:22,627 --> 05:00:24,629 -- HEALTH CARE VISITS. 7067 05:00:24,629 --> 05:00:29,267 THIS IS OUR LOGISTIC REGRESSION 7068 05:00:29,267 --> 05:00:29,868 MODEL FOR BEHAVIORAL HEALTH 7069 05:00:29,868 --> 05:00:30,068 EVENT. 7070 05:00:30,068 --> 05:00:34,573 AND COMPLICATED BUT WE'RE 7071 05:00:34,573 --> 05:00:41,846 FOCUSSED ON THIS RED HIGHLIGHTED 7072 05:00:41,846 --> 05:00:43,181 INTERACTION TERM WHICH IS 7073 05:00:43,181 --> 05:00:44,616 ESSENTIALLY WE'RE LOOKING TO SEE 7074 05:00:44,616 --> 05:00:46,351 IF WE CAN DETECT A GREATER 7075 05:00:46,351 --> 05:00:49,087 DIFFERENCE BETWEEN THE TWO AGE 7076 05:00:49,087 --> 05:00:52,190 GROUPS IN 2021 WHEN THE CTC 7077 05:00:52,190 --> 05:00:55,126 POLICY WAS IN EFFECT AND WE 7078 05:00:55,126 --> 05:00:58,396 CONTROL FOR INDIVIDUAL 7079 05:00:58,396 --> 05:00:59,030 DEMOGRAPHIC CHARACTERISTICS AS 7080 05:00:59,030 --> 05:01:03,301 WELL AS FIXED EFFECTS. 7081 05:01:03,301 --> 05:01:05,370 HERE ARE SOME OF THE DESCRIPTIVE 7082 05:01:05,370 --> 05:01:07,806 DATA INCLUDING THE HISTORICAL 7083 05:01:07,806 --> 05:01:11,576 DATA PRIOR TO THE CTC POLICY 7084 05:01:11,576 --> 05:01:13,478 BEING INTRODUCED AS WELL AS 2021 7085 05:01:13,478 --> 05:01:17,349 WHEN THE POLICY INTO EFFECT AND 7086 05:01:17,349 --> 05:01:20,118 OUR TWO AGE GROUPS AND THE LAST 7087 05:01:20,118 --> 05:01:24,389 OF THE CTC INELIGIBLE GROUP THAT 7088 05:01:24,389 --> 05:01:26,124 TURNED 18 BEFORE THE END OF THE 7089 05:01:26,124 --> 05:01:27,659 CALENDAR YEAR AND THOSE WHO 7090 05:01:27,659 --> 05:01:30,362 TURNED 18 AFTER THE CALENDAR 7091 05:01:30,362 --> 05:01:33,264 YEAR. 7092 05:01:33,264 --> 05:01:37,569 IN THE HISTORICAL DATA WE SEE A 7093 05:01:37,569 --> 05:01:39,838 CONSISTENT OUTCOME OF AN ACUTE 7094 05:01:39,838 --> 05:01:42,440 EVENT AND ABOUT 2% OF OUR 7095 05:01:42,440 --> 05:01:45,377 SAMPLE. 7096 05:01:45,377 --> 05:01:48,146 THEN WE LOOK AT THE CHILD TAX 7097 05:01:48,146 --> 05:01:50,215 CREDIT YEAR THERE'S A SMALLER 7098 05:01:50,215 --> 05:01:51,049 SAMPLE BECAUSE WARE ONLY USING 7099 05:01:51,049 --> 05:01:54,019 ONE YEAR OF DATA IN THIS GROUP. 7100 05:01:54,019 --> 05:01:55,987 THE YEAR WHEN THE POLICY WENT 7101 05:01:55,987 --> 05:01:59,357 INTO AFFECT BUT WE SEE A SIMILAR 7102 05:01:59,357 --> 05:02:02,527 PERCENT OF THE SAMPLE WITH THE 7103 05:02:02,527 --> 05:02:02,761 EVENTS. 7104 05:02:02,761 --> 05:02:06,197 IN THE FAR RIGHT COLUMN YOU SEE 7105 05:02:06,197 --> 05:02:09,200 A HINT OF A POSSIBLE GREATER 7106 05:02:09,200 --> 05:02:12,003 DECREASE FOR THE ELIGIBLE 7107 05:02:12,003 --> 05:02:12,337 ADOLESCENTS. 7108 05:02:12,337 --> 05:02:13,772 SO DECREASE FROM BEFORE THE 7109 05:02:13,772 --> 05:02:18,576 POLICY WENT INTO AFFECT OF 2.5% 7110 05:02:18,576 --> 05:02:24,149 TO 1.8%. 7111 05:02:24,149 --> 05:02:28,219 AND HERE ARE OUR COEFFICIENT FOR 7112 05:02:28,219 --> 05:02:30,588 INTERACTION TERM AND WE SEE IN 7113 05:02:30,588 --> 05:02:34,592 THE OVER ALL TOTAL SAMPLE 7114 05:02:34,592 --> 05:02:38,229 SIGNIFICANT ODDS RATIO BELOW 1 7115 05:02:38,229 --> 05:02:40,532 AND SEE A SIGNIFICANT 7116 05:02:40,532 --> 05:02:46,571 INTERACTION IN OUR SUB GROUP OF 7117 05:02:46,571 --> 05:02:48,840 MALES BUT NOT FOR FEMALES. 7118 05:02:48,840 --> 05:02:57,582 WE HAD ALSO LOOKED AT THE BEFORE 7119 05:02:57,582 --> 05:03:00,318 THE POLICY WENT INTO AFFECT AND 7120 05:03:00,318 --> 05:03:01,486 TRENDS WERE PARALLEL OR 7121 05:03:01,486 --> 05:03:03,254 DIFFERENCE OR LEADING UP TO WHEN 7122 05:03:03,254 --> 05:03:04,355 THE POLICY WENT INTO AFFECT 7123 05:03:04,355 --> 05:03:06,324 ALREADY FOR THE TWO GROUPS. 7124 05:03:06,324 --> 05:03:09,294 SO WE WEREN'T SEEING ODDS RATIOS 7125 05:03:09,294 --> 05:03:10,595 THAT WE WE'RE SEEING THEY 7126 05:03:10,595 --> 05:03:13,865 INCLUDED ONE LEADING UP TO THE 7127 05:03:13,865 --> 05:03:14,099 POLICY. 7128 05:03:14,099 --> 05:03:18,103 SO NOT SEEING STRONG EVIDENCE 7129 05:03:18,103 --> 05:03:27,312 THIS WAS ALREADY A TREND. 7130 05:03:27,312 --> 05:03:37,856 IN SUMMARY WE SAW A DECREASE BUT 7131 05:03:39,390 --> 05:03:40,892 NOT SIGNIFICANT FOR FEMALE 7132 05:03:40,892 --> 05:03:42,093 ADOLESCENTS. 7133 05:03:42,093 --> 05:03:45,096 SO OUR RESULTS WE REPEATED OUR 7134 05:03:45,096 --> 05:03:46,431 RESULTS TO EXAMINE THE 7135 05:03:46,431 --> 05:03:48,500 ROBUSTNESS OF OUR FINDINGS USING 7136 05:03:48,500 --> 05:03:54,606 DIFFERENT MODELLING APPROACHES 7137 05:03:54,606 --> 05:03:58,576 AS WELL AS USING ADOLESCENTS 7138 05:03:58,576 --> 05:04:02,046 BORN IN THE MONTHS OF DECEMBER 7139 05:04:02,046 --> 05:04:04,716 OR JANUARY AS WELL AS EXPLORE 7140 05:04:04,716 --> 05:04:06,451 USING DISCRETION DISCONTINUITY 7141 05:04:06,451 --> 05:04:07,218 AS AN ADDITIONAL ANALYTIC 7142 05:04:07,218 --> 05:04:13,224 APPROACH. 7143 05:04:13,224 --> 05:04:15,660 SO IN CONCLUSION, WE HAVE A 7144 05:04:15,660 --> 05:04:18,263 MEDICAID AND ACO SAMPLE, WE DID 7145 05:04:18,263 --> 05:04:22,133 SEE AN ASSOCIATION WITH THE CTC 7146 05:04:22,133 --> 05:04:24,135 IN REDUCED RISK FOR MENTAL 7147 05:04:24,135 --> 05:04:26,237 HEALTH CARE UTILIZATION. 7148 05:04:26,237 --> 05:04:28,106 WE FOUND DIFFERENT FINDINGS FOR 7149 05:04:28,106 --> 05:04:31,943 MALE AND FEMALE AND WE'RE STILL 7150 05:04:31,943 --> 05:04:34,579 EXPLORING AND HAVE BEEN 7151 05:04:34,579 --> 05:04:35,580 DEMONSTRATED IN OTHER LITERATURE 7152 05:04:35,580 --> 05:04:38,983 THAT HAD EXAMINED THE AFFECT OF 7153 05:04:38,983 --> 05:04:40,285 THE CANADIAN CHILD BENEFIT BUT 7154 05:04:40,285 --> 05:04:44,122 WE HAVE PLANS IN OUR STUDY TO 7155 05:04:44,122 --> 05:04:46,191 ALSO EXPAND THIS BEYOND OHIO 7156 05:04:46,191 --> 05:04:48,059 USING THE DATA TO LOOK AT 7157 05:04:48,059 --> 05:04:49,093 DIFFERENT STATES AND ALSO TO 7158 05:04:49,093 --> 05:04:54,098 LOOK AT OTHER OUTCOMES SUCH AS 7159 05:04:54,098 --> 05:04:55,266 CONTINUATION OF MENTAL HEALTH 7160 05:04:55,266 --> 05:04:58,102 CARE AND THE ROLE CTC MAY HAVE 7161 05:04:58,102 --> 05:05:01,706 PLAYED AND ADOLESCENTS WHO HAVE 7162 05:05:01,706 --> 05:05:02,574 MENTAL HEALTH NEEDS TO CONTINUE 7163 05:05:02,574 --> 05:05:06,578 TO RECEIVE PHARMACO THERAPY 7164 05:05:06,578 --> 05:05:16,955 AROUND PATIENT VISITS. 7165 05:05:17,422 --> 05:05:19,190 >> THANKS SO MUCH, DR. CHAVEZ. 7166 05:05:19,190 --> 05:05:23,194 NOW WE'LL MOVE TO OUR Q&A 7167 05:05:23,194 --> 05:05:23,428 SESSION. 7168 05:05:23,428 --> 05:05:25,396 WE'RE ANSWER AS MANY QUESTIONS 7169 05:05:25,396 --> 05:05:27,398 AS POSSIBLE AND MAY COMBINE 7170 05:05:27,398 --> 05:05:30,602 SIMILAR QUESTIONS TO GET THROUGH 7171 05:05:30,602 --> 05:05:31,569 THEM. 7172 05:05:31,569 --> 05:05:33,037 I'LL START US OFF. 7173 05:05:33,037 --> 05:05:36,407 THE FIRST QUESTION WE HAVE IS -- 7174 05:05:36,407 --> 05:05:38,076 DO YOU HAVE A CAPACITY 7175 05:05:38,076 --> 05:05:40,044 ASSESSMENT OR TOOL AVAILABLE TO 7176 05:05:40,044 --> 05:05:41,980 ASSESS ORGANIZATIONAL TO ENGAGE 7177 05:05:41,980 --> 05:05:43,648 IN RESEARCH IN A MEANINGFUL WAY 7178 05:05:43,648 --> 05:05:46,050 AND IDENTIFY STEPS THAT CAN BE 7179 05:05:46,050 --> 05:05:47,685 TAKEN COLLABORATIVELY BETWEEN 7180 05:05:47,685 --> 05:05:49,721 RESEARCHERS AND THE ORGANIZATION 7181 05:05:49,721 --> 05:05:51,589 TO ENHANCE CAPACITY AND INTEREST 7182 05:05:51,589 --> 05:05:58,730 IN ENGAGING IN RESEARCH. 7183 05:05:58,730 --> 05:06:02,267 >> THAT'S A HEFTY QUESTION BUT 7184 05:06:02,267 --> 05:06:03,768 THOUGH WE DON'T CALL IT 7185 05:06:03,768 --> 05:06:08,773 ASSESSMENT BUT I LIKE THE 7186 05:06:08,773 --> 05:06:10,275 TERMINOLOGY IT'S MORE 7187 05:06:10,275 --> 05:06:11,342 COMPLICATED THAN A CAPACITY 7188 05:06:11,342 --> 05:06:11,676 INVESTMENT. 7189 05:06:11,676 --> 05:06:13,878 WHILE WE DON'T CALL IT AN 7190 05:06:13,878 --> 05:06:19,284 INVESTMENT PER SE THE TOOL KIT 7191 05:06:19,284 --> 05:06:20,318 COVERS VARIOUS TOPICS THAT WOULD 7192 05:06:20,318 --> 05:06:23,655 BUILD TO A FULLER CAPACITY 7193 05:06:23,655 --> 05:06:23,955 ASSESSMENT. 7194 05:06:23,955 --> 05:06:26,357 SO WE HAVE -- WE START WITH 7195 05:06:26,357 --> 05:06:27,859 CHAPTERS ON DECIDING OVERARCHING 7196 05:06:27,859 --> 05:06:29,260 GOALS AND OBJECTIVES OF WHY 7197 05:06:29,260 --> 05:06:31,896 YOU'D WANT TO PARTNER AND TO 7198 05:06:31,896 --> 05:06:32,830 CENTER YOURSELF ON WHY YOU'D 7199 05:06:32,830 --> 05:06:34,599 WANT TO PARTNER AND WHAT THAT 7200 05:06:34,599 --> 05:06:35,300 MIGHT LOOK LIKE. 7201 05:06:35,300 --> 05:06:37,802 WE COVERED THE SPECTRUM OF 7202 05:06:37,802 --> 05:06:40,305 COMMUNITY ENGAGEMENT SO YOU CAN 7203 05:06:40,305 --> 05:06:41,673 DETERMINE WHERE IT'S FEASIBLE 7204 05:06:41,673 --> 05:06:43,474 FOUR AND THEN YOU SORT OF HOLD 7205 05:06:43,474 --> 05:06:44,575 YOURSELF TRUE AND PRESENT THAT 7206 05:06:44,575 --> 05:06:48,579 LEVEL OF ENGAGEMENT TO THE 7207 05:06:48,579 --> 05:06:49,814 COMMUNITY PARTNERS SO THERE'S 7208 05:06:49,814 --> 05:06:51,416 CLEAR EXPECTATIONS WHERE YOU'RE 7209 05:06:51,416 --> 05:06:53,117 AT ON THE SPECTRUM AND IN EACH 7210 05:06:53,117 --> 05:06:55,219 LEVEL OF THAT SPECTRUM HAS 7211 05:06:55,219 --> 05:06:58,589 DIFFERENT CONSIDERATIONS AND WE 7212 05:06:58,589 --> 05:07:00,725 ALSO INCLUDE A SECTIONAL 7213 05:07:00,725 --> 05:07:01,960 TRAINING WAS MENTIONED SO 7214 05:07:01,960 --> 05:07:05,229 TRAINING FOR YOUR RESEARCH TEAM 7215 05:07:05,229 --> 05:07:06,164 MEMBERS THAT YOU MIGHT CONSIDER 7216 05:07:06,164 --> 05:07:08,800 AND DO SPEND A FAIR AMOUNT OF 7217 05:07:08,800 --> 05:07:12,537 TIME WALKING THROUGH THE ROLE OF 7218 05:07:12,537 --> 05:07:13,738 THE EXPECTATIONS AND 7219 05:07:13,738 --> 05:07:14,872 INVESTIGATOR FOR THE RESEARCH 7220 05:07:14,872 --> 05:07:17,675 STAFF SO YOU THINK THROUGH THAT. 7221 05:07:17,675 --> 05:07:19,277 THERE ARE ALSO NUMEROUS 7222 05:07:19,277 --> 05:07:20,912 ADMINISTRATIVE CONSIDERATIONS WE 7223 05:07:20,912 --> 05:07:21,946 HAVE ENCOUNTERED. 7224 05:07:21,946 --> 05:07:23,481 AND SO THOSE REALLY NEED TO BE 7225 05:07:23,481 --> 05:07:27,552 THOUGHT THREE -- THROUGH AND 7226 05:07:27,552 --> 05:07:29,687 ADDRESSED SO WE HAVE A CHAPTER 7227 05:07:29,687 --> 05:07:30,021 ON THAT. 7228 05:07:30,021 --> 05:07:31,189 THE QUESTION MENTIONED THE 7229 05:07:31,189 --> 05:07:31,856 PRIVACY. 7230 05:07:31,856 --> 05:07:37,862 WE HAVE AN ENTIRE CHAPTER ON 7231 05:07:37,862 --> 05:07:41,566 ENSURING PRIVACY AND 7232 05:07:41,566 --> 05:07:44,769 CONFIDENTIALITY IT WAS BASED ON 7233 05:07:44,769 --> 05:07:47,171 PEOPLE WITH LIVED EXPERIENCE OF 7234 05:07:47,171 --> 05:07:48,272 SUBSTANCE USE AND HAS DIFFERENT 7235 05:07:48,272 --> 05:07:49,107 RAMIFICATIONS FOR DIFFERENT 7236 05:07:49,107 --> 05:07:50,108 POPULATIONS. 7237 05:07:50,108 --> 05:07:52,143 WE TRIED TO CAPTURE ALL WE 7238 05:07:52,143 --> 05:07:54,012 LEARNED THE PARTNERS WE WORK 7239 05:07:54,012 --> 05:07:56,514 WITH AND THERE WAS ENGAGEMENT AS 7240 05:07:56,514 --> 05:07:56,714 WELL. 7241 05:07:56,714 --> 05:07:59,517 WE HAVE SOME OF THAT INITIAL 7242 05:07:59,517 --> 05:08:01,319 ENGAGEMENT BUT THERE'S A FEW 7243 05:08:01,319 --> 05:08:01,919 CHAPTERS COMING IN JUNE. 7244 05:08:01,919 --> 05:08:05,023 WE HAVE A CHAPTER OF SUSTAINING 7245 05:08:05,023 --> 05:08:07,191 ENGAGEMENT COMING IN JUNE. 7246 05:08:07,191 --> 05:08:10,194 AND THEN TRAINING. 7247 05:08:10,194 --> 05:08:11,929 WE COVER ON BOARDING AND 7248 05:08:11,929 --> 05:08:14,232 TRAINING FOR THE COMMUNITY BOARD 7249 05:08:14,232 --> 05:08:15,433 MEMBERS FOCUSSED ON DIGESTING 7250 05:08:15,433 --> 05:08:18,102 RESEARCH AND A LOT OF THAT WE 7251 05:08:18,102 --> 05:08:18,836 PULLED TOGETHER OTHER PEOPLE'S 7252 05:08:18,836 --> 05:08:19,037 TOOLS. 7253 05:08:19,037 --> 05:08:20,004 SO THAT'S ANOTHER THING WE TRIED 7254 05:08:20,004 --> 05:08:24,075 TO DO WAS TO PULL TOGETHER TOOLS 7255 05:08:24,075 --> 05:08:26,978 THAT WE DID TO TRY TO BE HELPFUL 7256 05:08:26,978 --> 05:08:29,313 FROM FOLKS AND NOT RECREATE THE 7257 05:08:29,313 --> 05:08:29,647 WHEEL. 7258 05:08:29,647 --> 05:08:31,249 SOME OF THE FINAL CHAPTERS ARE 7259 05:08:31,249 --> 05:08:32,183 COMING OUT SO IT'S NOT QUITE 7260 05:08:32,183 --> 05:08:37,488 READY BUT CHECK BACK. 7261 05:08:37,488 --> 05:08:38,589 >> GREAT. 7262 05:08:38,589 --> 05:08:41,259 THANK YOU. 7263 05:08:41,259 --> 05:08:43,261 THE NEXT QUESTION IS FOR 7264 05:08:43,261 --> 05:08:45,229 DR. CHAVEZ. 7265 05:08:45,229 --> 05:08:47,498 LAURA, CAN YOU PLEASE DESCRIBE A 7266 05:08:47,498 --> 05:08:48,299 LITTLE BIT MORE ABOUT THE 7267 05:08:48,299 --> 05:08:51,736 QUALITY OF DATA YOU HAD 7268 05:08:51,736 --> 05:08:54,972 COLLECTED AND HOW IT HELPED WITH 7269 05:08:54,972 --> 05:08:56,140 YOUR INTERPRETATION OF THE 7270 05:08:56,140 --> 05:08:56,374 RESULTS. 7271 05:08:56,374 --> 05:09:00,645 >> THANKS FOR THAT QUESTION. 7272 05:09:00,645 --> 05:09:02,380 THE QUALITATIVE DATA WARE STILL 7273 05:09:02,380 --> 05:09:04,315 DOING THE CODING FOR SO THAT'S 7274 05:09:04,315 --> 05:09:06,184 MORE LABOR INTENSIVE TO HAVE 7275 05:09:06,184 --> 05:09:08,586 RESULTS READY FOR PRESENTATION 7276 05:09:08,586 --> 05:09:11,989 BUT WE INTERVIEWED WITHIN THE 7277 05:09:11,989 --> 05:09:15,259 MEDICAID ACL PARENTS OF 7278 05:09:15,259 --> 05:09:17,228 ADOLESCENTS WHO HAD A BEHAVIORAL 7279 05:09:17,228 --> 05:09:19,564 HEALTH NEED. 7280 05:09:19,564 --> 05:09:20,565 INTERVIEWED THEM ABOUT THE 7281 05:09:20,565 --> 05:09:21,866 EXPERIENCE RECEIVING THE CHILD 7282 05:09:21,866 --> 05:09:28,005 TAX CREDIT AS WELL AS THE OLDER 7283 05:09:28,005 --> 05:09:33,911 ADOLESCENT TAX CREDIT IMPACTED 7284 05:09:33,911 --> 05:09:34,345 FAMILY DYNAMICS. 7285 05:09:34,345 --> 05:09:36,247 WE HAD INTERESTING PRELIMINARY 7286 05:09:36,247 --> 05:09:37,348 FINDING LIKE I SAID WE'RE STILL 7287 05:09:37,348 --> 05:09:38,216 WORKING THROUGH THE CODING. 7288 05:09:38,216 --> 05:09:40,017 THAT'S THE KEY IN TRYING TO 7289 05:09:40,017 --> 05:09:41,719 UNDERSTAND THE COMPLICATED 7290 05:09:41,719 --> 05:09:41,986 POLICIES. 7291 05:09:41,986 --> 05:09:46,090 TO HEAR THE VOICES FROM 7292 05:09:46,090 --> 05:09:48,526 CAREGIVERS TO UNDERSTAND WHAT 7293 05:09:48,526 --> 05:09:50,561 THE EXPERIENCE WAS LIKE AND 7294 05:09:50,561 --> 05:10:01,038 UNDERSTAND FINDINGS AS WELL. 7295 05:10:02,173 --> 05:10:08,346 >> NEXT QUESTION I HAVE ISES 7296 05:10:08,346 --> 05:10:10,114 WHAT INNOVATIVE METHODS CAN BE 7297 05:10:10,114 --> 05:10:13,551 EMPLOYED TO INTEGRATE PARTNER 7298 05:10:13,551 --> 05:10:14,719 FEEDBACK INTO RESEARCH. 7299 05:10:14,719 --> 05:10:15,486 KIMBERLY MIGHT INVITE TO YOU 7300 05:10:15,486 --> 05:10:23,261 ANSWER FIRST. 7301 05:10:23,261 --> 05:10:25,129 >> MIXED METHODS IS RELATIVELY 7302 05:10:25,129 --> 05:10:27,532 STANDARD BUT THE WAYS YOU CAN 7303 05:10:27,532 --> 05:10:28,399 IMPLEMENT CAN DIFFER. 7304 05:10:28,399 --> 05:10:33,704 IN OUR CURRENT STUDY WE HAVE 7305 05:10:33,704 --> 05:10:35,339 ACCIDENTALLY FALLEN INTO THE 7306 05:10:35,339 --> 05:10:36,941 QUANTITATIVE AND QUALITATIVE AT 7307 05:10:36,941 --> 05:10:38,576 THE SAME TIME DUE TO LOGISTICAL 7308 05:10:38,576 --> 05:10:43,548 CONSTRAINTS BASICALLY. 7309 05:10:43,548 --> 05:10:45,616 ONE THING THAT'S BEEN USEFUL FOR 7310 05:10:45,616 --> 05:10:51,355 US IS LISTENING AND READING 7311 05:10:51,355 --> 05:10:52,023 PARTICIPANT INTERVIEWS TO FIGURE 7312 05:10:52,023 --> 05:10:53,090 OUT WHETHER THEY'RE SAYING 7313 05:10:53,090 --> 05:10:55,393 THINGS THAT WE COULD LOOK AT IN 7314 05:10:55,393 --> 05:10:56,627 QUANTITATIVE DATA THAT WE MIGHT 7315 05:10:56,627 --> 05:11:00,698 NOT HAVE THOUGHT OF OTHERWISE. 7316 05:11:00,698 --> 05:11:03,467 THESE MIGHT NOT BE THINGS THAT 7317 05:11:03,467 --> 05:11:05,970 RISE TO THE LEVEL OF A FULL 7318 05:11:05,970 --> 05:11:09,006 THEME IN QUALITATIVE ANALYSIS 7319 05:11:09,006 --> 05:11:12,843 BUT IF A PARENT IS MENTIONING I 7320 05:11:12,843 --> 05:11:16,047 NEED TO GO PART-TIME TO ATTEND 7321 05:11:16,047 --> 05:11:18,583 THE APPOINTMENTS WE MAY BE ABLE 7322 05:11:18,583 --> 05:11:19,951 TO SURVEY DATA IF WE SEE 7323 05:11:19,951 --> 05:11:20,585 DIFFERENCES IN PARENT EMPLOYMENT 7324 05:11:20,585 --> 05:11:25,523 OR ANYTHING LIKE THAT. 7325 05:11:25,523 --> 05:11:27,325 I THINK THIS CAN REALLY MOVE THE 7326 05:11:27,325 --> 05:11:28,693 RESEARCH FORWARD IS FIGURING OUT 7327 05:11:28,693 --> 05:11:30,695 WHAT CAN WE DO IN THIS STUDY AND 7328 05:11:30,695 --> 05:11:34,632 WHAT CAN WE DO IN FUTURE STUDIES 7329 05:11:34,632 --> 05:11:36,567 TO UNDERSTAND WHAT PARENTS ARE 7330 05:11:36,567 --> 05:11:38,569 REPORTING AS IMPORTANT AND 7331 05:11:38,569 --> 05:11:39,070 UNDERSTAND THAT IN THE 7332 05:11:39,070 --> 05:11:44,508 QUANTITATIVE DATA. 7333 05:11:44,508 --> 05:11:45,343 >> THANK YOU SO MUCH. 7334 05:11:45,343 --> 05:11:47,044 MAYBE ANOTHER QUESTION FOR THE 7335 05:11:47,044 --> 05:11:47,345 PANEL. 7336 05:11:47,345 --> 05:11:50,548 I KNOW SOME OF YOU ALREADY SPOKE 7337 05:11:50,548 --> 05:11:55,987 TO THIS BUT OTHER INNOVATIVE 7338 05:11:55,987 --> 05:11:58,089 METHODS TO BE EMPLOYED TO 7339 05:11:58,089 --> 05:11:59,457 INCORPORATE PARTNER FEEDBACK. 7340 05:11:59,457 --> 05:12:00,758 ANY SUGGESTIONS? 7341 05:12:00,758 --> 05:12:03,794 >> I'LL JUMP IN. 7342 05:12:03,794 --> 05:12:06,430 I'LL ADD THE PLUG AGAIN FOR 7343 05:12:06,430 --> 05:12:08,499 MAKING YOUR RESEARCH TEAM A 7344 05:12:08,499 --> 05:12:11,035 PLACE PREPARED FOR AND WELCOMING 7345 05:12:11,035 --> 05:12:12,837 FOR PEOPLE WITH LIVED EXPERIENCE 7346 05:12:12,837 --> 05:12:16,407 TO WORK ON YOUR RESEARCH TEAM AS 7347 05:12:16,407 --> 05:12:17,508 RESEARCHERS ON YOUR RESEARCH 7348 05:12:17,508 --> 05:12:18,209 TEAM. 7349 05:12:18,209 --> 05:12:20,811 SOMETIMES I'VE BEEN FORTUNATE 7350 05:12:20,811 --> 05:12:28,919 BECAUSE OF THE JEAP NIRNT -- 7351 05:12:28,919 --> 05:12:29,654 INITIATIVE HAVING SUPPORTS BUILT 7352 05:12:29,654 --> 05:12:35,526 OUT AND LEARN PROCESSES FOR 7353 05:12:35,526 --> 05:12:38,429 IMPROVING THE ABILITY TO DO 7354 05:12:38,429 --> 05:12:38,629 THAT. 7355 05:12:38,629 --> 05:12:40,531 ASIDE FROM WORKING DIRECTLY ON 7356 05:12:40,531 --> 05:12:42,600 THE RESEARCH, WE'VE DONE A TON 7357 05:12:42,600 --> 05:12:45,736 OF WORK ON COMMUNITY BOARDS ALSO 7358 05:12:45,736 --> 05:12:47,071 KNOWN AS COMMUNITY ADVISORY 7359 05:12:47,071 --> 05:12:48,572 BOARDS OR CABS, I PREFER TO MAKE 7360 05:12:48,572 --> 05:12:52,009 IT A PARTNERSHIP THAN AN 7361 05:12:52,009 --> 05:12:53,744 ADVISORISHIP. 7362 05:12:53,744 --> 05:12:55,846 WE FOCUS ON COMMUNITY BOARDS, 7363 05:12:55,846 --> 05:12:56,480 OUR PANELS. 7364 05:12:56,480 --> 05:12:59,283 WE ALSO PARTNER WITHIN THAT WORK 7365 05:12:59,283 --> 05:13:06,791 WE PARTNER WITH THEM IDENTIFYING 7366 05:13:06,791 --> 05:13:07,925 DIFFERENT PROJECTS AND 7367 05:13:07,925 --> 05:13:09,126 IDENTIFYING WHAT SHOULD BE 7368 05:13:09,126 --> 05:13:10,795 RESEARCHED IN THE FIRST PLACE. 7369 05:13:10,795 --> 05:13:14,131 CONCEPTUALIZING PROJECTS AND 7370 05:13:14,131 --> 05:13:14,832 PROCEDU 7371 05:13:14,832 --> 05:13:15,666 PROCED 7372 05:13:15,666 --> 05:13:16,901 PROCEDURES PROBLEM SOLVING AND 7373 05:13:16,901 --> 05:13:20,037 INTERPRETING THE FINDINGS AND IN 7374 05:13:20,037 --> 05:13:22,306 PARTICULAR MAKING SURE THAT OUR 7375 05:13:22,306 --> 05:13:23,474 INTERPRETATION AND THE WAY WE'RE 7376 05:13:23,474 --> 05:13:25,609 GOING TO DISSEMINATE THINGS 7377 05:13:25,609 --> 05:13:29,714 ISN'T GOING TO CAUSE HARM TO 7378 05:13:29,714 --> 05:13:31,048 THEIR COMMUNITY. 7379 05:13:31,048 --> 05:13:32,016 ALSO DISSEMINATION PLANS. 7380 05:13:32,016 --> 05:13:35,219 HOW TO GET THE WORK OUT THERE. 7381 05:13:35,219 --> 05:13:36,620 AND WHAT ARE THE NEXT STEPS. 7382 05:13:36,620 --> 05:13:38,689 WE'VE DONE THE RESEARCH AND 7383 05:13:38,689 --> 05:13:41,959 CONCLUDED WHAT ARE THE NEXT 7384 05:13:41,959 --> 05:13:42,193 STEPS. 7385 05:13:42,193 --> 05:13:44,095 WE'VE ALSO DONE LIKE PUBLIC 7386 05:13:44,095 --> 05:13:46,430 FORUMS WHERE IT'S REALLY 7387 05:13:46,430 --> 05:13:47,765 INTENDED TO BE A DISCUSSION 7388 05:13:47,765 --> 05:13:50,534 BETWEEN RESEARCHERS AND PEOPLE 7389 05:13:50,534 --> 05:13:54,038 WITH LIVED EXPERIENCE. 7390 05:13:54,038 --> 05:13:56,173 WE DO LISTENING SESSIONS SORT OF 7391 05:13:56,173 --> 05:13:57,975 ONE TIME KIND OF THINGS AND THEN 7392 05:13:57,975 --> 05:13:59,944 OF COURSE THE QUALITATIVE 7393 05:13:59,944 --> 05:14:00,945 RESEARCH AND MIXED METHODS 7394 05:14:00,945 --> 05:14:03,214 KIMBERLY WAS TALKING ABOUT. 7395 05:14:03,214 --> 05:14:04,448 AGAIN THOUGH WITH ANY OF THOSE 7396 05:14:04,448 --> 05:14:05,916 IT'S CRITICAL TO PAUSE AND MAKE 7397 05:14:05,916 --> 05:14:09,186 SURE THAT YOU HAVE PREPARED 7398 05:14:09,186 --> 05:14:12,390 YOURSELF AND YOUR TEAM REALLY 7399 05:14:12,390 --> 05:14:14,492 WELL SO YOU DON'T PERPETUATE 7400 05:14:14,492 --> 05:14:16,494 MORE HARM TO COMMUNITIES THAT 7401 05:14:16,494 --> 05:14:18,362 MAY HAVE BEEN HARMED BY 7402 05:14:18,362 --> 05:14:28,572 RESEARCHERS. 7403 05:14:29,740 --> 05:14:33,310 >> I WAS WONDERING IF OTHER 7404 05:14:33,310 --> 05:14:34,612 PANELISTS ALSO HAD COMMENTS ON 7405 05:14:34,612 --> 05:14:36,247 THAT. 7406 05:14:36,247 --> 05:14:39,884 SORRY, KELLY. 7407 05:14:39,884 --> 05:14:41,986 IF NOT MAYBE ANOTHER QUESTION, 7408 05:14:41,986 --> 05:14:43,888 KELLY, YOU WANTED TO RAISE? 7409 05:14:43,888 --> 05:14:45,356 >> YEAH. 7410 05:14:45,356 --> 05:14:49,260 OUR NEXT QUESTION IS HOW CAN 7411 05:14:49,260 --> 05:14:52,630 ENGAGING MENTAL HEALTH AND 7412 05:14:52,630 --> 05:14:53,864 SUBSTANCE USE D 7413 05:14:53,864 --> 05:14:54,365 SUBSTANCE USE DISORDER 7414 05:14:54,365 --> 05:14:55,099 STAKEHOLDERS CHANGE THE APPROACH 7415 05:14:55,099 --> 05:14:57,168 OR METHOD? 7416 05:14:57,168 --> 05:14:58,235 IF YOU HAVE ANY ADDITIONAL 7417 05:14:58,235 --> 05:15:00,471 EXAMPLES IT WOULD BE REALLY 7418 05:15:00,471 --> 05:15:09,847 HELPFUL. 7419 05:15:09,847 --> 05:15:12,817 >> READ THAT ONE MORE TIME. 7420 05:15:12,817 --> 05:15:16,787 >> HOW CAN ENGAGING MENTAL 7421 05:15:16,787 --> 05:15:17,655 HEALTH AND SUBSTANCE USE 7422 05:15:17,655 --> 05:15:19,256 DISORDER STAKEHOLDERS IN 7423 05:15:19,256 --> 05:15:20,024 RESEARCH CHANGE THE RESEARCH 7424 05:15:20,024 --> 05:15:22,393 APPROACH QUESTIONS OR METHODS 7425 05:15:22,393 --> 05:15:26,363 AND I THINK IF THERE'S EXAMPLES 7426 05:15:26,363 --> 05:15:28,732 YOU ALL HAVEN'T DISCUSSED OR 7427 05:15:28,732 --> 05:15:30,601 PART OF YOUR PREPARATION IT 7428 05:15:30,601 --> 05:15:40,678 WOULD BE HELPFUL. 7429 05:15:40,678 --> 05:15:42,580 >> I DIDN'T GET TO MENTION WE 7430 05:15:42,580 --> 05:15:43,781 HAVE A COMMUNITY ADVISORY GROUP 7431 05:15:43,781 --> 05:15:46,550 FOR THE STUDY THAT HELPED US A 7432 05:15:46,550 --> 05:15:48,752 LOT IN DEVELOPING OUR INTERVIEW 7433 05:15:48,752 --> 05:15:51,388 GUIDES AND PILOT INTERVIEW 7434 05:15:51,388 --> 05:15:52,223 GUIDES. 7435 05:15:52,223 --> 05:15:55,993 THE VALUE OF THE QUALITATIVE 7436 05:15:55,993 --> 05:15:58,596 DATA IS CONTINGENT ON ASKING THE 7437 05:15:58,596 --> 05:16:00,698 RIGHT QUESTIONS AND YOU DON'T 7438 05:16:00,698 --> 05:16:02,566 KNOW UNLESS YOU DO THE WORK 7439 05:16:02,566 --> 05:16:05,436 AHEAD OF TIME AND STAKEHOLDERS 7440 05:16:05,436 --> 05:16:06,036 AND PARTNERS IN RESEARCH ARE 7441 05:16:06,036 --> 05:16:14,945 CRITICAL TO THAT. 7442 05:16:14,945 --> 05:16:16,680 >> I TOTALLY AGREE WITH THAT AND 7443 05:16:16,680 --> 05:16:20,017 ONE THING WE'RE THINKING ABOUT 7444 05:16:20,017 --> 05:16:24,522 IS SORT OF HOW TO ASK ADDITIONAL 7445 05:16:24,522 --> 05:16:26,490 QUESTIONS IN THE FUTURE THAT 7446 05:16:26,490 --> 05:16:26,824 HAVE COME UP. 7447 05:16:26,824 --> 05:16:30,060 WE'RE HEARING ABOUT THE USE OF 7448 05:16:30,060 --> 05:16:34,298 CRISIS SERVICES IN LIEU OF E.D. 7449 05:16:34,298 --> 05:16:35,733 SERVICES AND THINKING WHAT ARE 7450 05:16:35,733 --> 05:16:37,768 THE NEXT STEPS IN THAT AREA OF 7451 05:16:37,768 --> 05:16:38,802 RESEARCH FOR PEDIATRIC 7452 05:16:38,802 --> 05:16:42,640 POPULATIONS THAT HAVE BEEN LESS 7453 05:16:42,640 --> 05:16:43,908 STUDIED. 7454 05:16:43,908 --> 05:16:46,310 >> MY ANSWER COVERED IN THE LAST 7455 05:16:46,310 --> 05:16:49,213 ANSWER I GAVE ABOUT EVERYTHING 7456 05:16:49,213 --> 05:16:52,516 FROM OUR BOARDS HAS BEEN A PART 7457 05:16:52,516 --> 05:16:53,918 FROM CONCEPTUALIZING THE 7458 05:16:53,918 --> 05:16:55,319 RESEARCH QUESTIONS THEMSELVES TO 7459 05:16:55,319 --> 05:16:58,622 HELPING US DETERMINE HOW TO GO 7460 05:16:58,622 --> 05:17:00,024 AFTER AND EXAMINE THE RESEARCH 7461 05:17:00,024 --> 05:17:03,227 QUESTIONS, CHANGE SOME OF THE 7462 05:17:03,227 --> 05:17:04,562 WAY WE MEASURE THINGS SOME OF 7463 05:17:04,562 --> 05:17:06,463 THE PROCEDURES IN THE RESEARCH 7464 05:17:06,463 --> 05:17:09,133 STUDIES AND THE WAY WE DO 7465 05:17:09,133 --> 05:17:11,368 RECRUITMENT TO INTERPRETING AND 7466 05:17:11,368 --> 05:17:11,702 DISSEMINATION. 7467 05:17:11,702 --> 05:17:13,203 THE FULL RANGE THAT HAD IMPACT 7468 05:17:13,203 --> 05:17:23,747 IN DIFFERENT WAYS ALONG THE WAY. 7469 05:17:24,281 --> 05:17:30,621 >> GREAT, WELL THANK YOU, ALL, 7470 05:17:30,621 --> 05:17:31,622 LAU 7471 05:17:31,622 --> 05:17:42,166 LAURA, KIMBERLY AND THANK YOU. 7472 05:17:44,768 --> 05:17:47,171 >> WE HAVE A FINAL REFLECTIONS 7473 05:17:47,171 --> 05:17:51,942 AND NEW DIRECTIONS IN CLOSING 7474 05:17:51,942 --> 05:17:55,846 REMARKS FROM DR. SCHACKMAN AND 7475 05:17:55,846 --> 05:18:00,317 DR. CASTEDO DE MARTELL. 7476 05:18:00,317 --> 05:18:01,652 TAKE IT AWAY. 7477 05:18:01,652 --> 05:18:05,756 >> THANKS SO MUCH FOR THE 7478 05:18:05,756 --> 05:18:09,460 INTRODUCTION, JENNIFER. 7479 05:18:09,460 --> 05:18:11,328 I'M SIERRA NEW HERE AND HAD BEEN 7480 05:18:11,328 --> 05:18:13,764 OUT ON MATERNITY LEAVE. 7481 05:18:13,764 --> 05:18:16,100 I WANTED TO SAY IT WAS EXCITING 7482 05:18:16,100 --> 05:18:17,635 TO SEE SOME FAMILIAR FACES BUT 7483 05:18:17,635 --> 05:18:19,103 ALSO TO HAVE THE OPPORTUNITY TO 7484 05:18:19,103 --> 05:18:21,005 SEE A LOT OF NEW FACES OR NEW TO 7485 05:18:21,005 --> 05:18:21,639 ME, ANYWAY. 7486 05:18:21,639 --> 05:18:24,341 I'M LOOKING FORWARD TO 7487 05:18:24,341 --> 05:18:26,076 CONTINUING TO SUPPORT THOSE 7488 05:18:26,076 --> 05:18:28,345 DOING NIDA FUNDED HEALTH 7489 05:18:28,345 --> 05:18:30,781 ECONOMIC RESEARCHES WHEN I FULLY 7490 05:18:30,781 --> 05:18:34,218 RETURN FROM MATERNITY LEAVE IN A 7491 05:18:34,218 --> 05:18:36,053 COUPLE WEEKS AND DR. SCHACKMAN 7492 05:18:36,053 --> 05:18:38,789 AND I WILL WRAP THINGS OFF WITH 7493 05:18:38,789 --> 05:18:42,393 SOME CLOSING REMARKS AND WANTED 7494 05:18:42,393 --> 05:18:44,962 TO DOES A QUESTION TO 7495 05:18:44,962 --> 05:18:45,896 DRDR 7496 05:18:45,896 --> 05:18:48,532 DR. SCHACKMAN WHAT YOU SAW ABOUT 7497 05:18:48,532 --> 05:18:55,372 THE KEY TAKEAWAYS FROM TODAY'S 7498 05:18:55,372 --> 05:18:55,973 PRESENTATIONS? 7499 05:18:55,973 --> 05:18:56,140 >> 7500 05:18:56,140 --> 05:19:05,449 >> I'M BRUCE SCHACKMAN FROM 7501 05:19:05,449 --> 05:19:08,085 WEILL CORNELL MEDICAL COLLEGE 7502 05:19:08,085 --> 05:19:11,855 AND JUST AN ADD, DR. MURPHY 7503 05:19:11,855 --> 05:19:15,793 SPOKE EARLIER AS HEAD OF OUR 7504 05:19:15,793 --> 05:19:16,827 CONSULTATION SERVICE FOR 7505 05:19:16,827 --> 05:19:18,629 RESEARCHERS WHO WANT HELP 7506 05:19:18,629 --> 05:19:24,568 GETTING STARTED IN THIS AREA. 7507 05:19:24,568 --> 05:19:25,302 IT'S FREE ALSO. 7508 05:19:25,302 --> 05:19:27,805 SO ALSO, THANK YOU TO THE ALMOST 7509 05:19:27,805 --> 05:19:30,641 180 PEOPLE STILL STICKING WITH 7510 05:19:30,641 --> 05:19:31,675 US. 7511 05:19:31,675 --> 05:19:37,481 IT'S BEEN A VERY RICH BUT ALSO 7512 05:19:37,481 --> 05:19:41,318 EXHAUSTING SET OF PANELS. 7513 05:19:41,318 --> 05:19:47,691 I THINK THEME OVER ALL IS 7514 05:19:47,691 --> 05:19:49,626 EVERYONE IS FOCUSSED ON REAL 7515 05:19:49,626 --> 05:19:50,260 WORLD APPLICATIONS. 7516 05:19:50,260 --> 05:19:51,929 WE REALLY APPRECIATE AND 7517 05:19:51,929 --> 05:19:54,798 SPEAKING FOR SIERRA AND MYSELF, 7518 05:19:54,798 --> 05:19:56,066 HOW MANY OF THE PRESENTATIONS 7519 05:19:56,066 --> 05:19:56,700 FOCUSSED ON INTEGRATED 7520 05:19:56,700 --> 05:20:01,071 INTERVENTIONS. 7521 05:20:01,071 --> 05:20:03,273 INTEGRATING BETWEEN MENTAL 7522 05:20:03,273 --> 05:20:06,343 HEALTH AND BEHAVIORAL AND 7523 05:20:06,343 --> 05:20:07,678 PRIMARY CARE. 7524 05:20:07,678 --> 05:20:10,481 THOSE ARE THE CONTEXT, IF YOU 7525 05:20:10,481 --> 05:20:10,681 WILL. 7526 05:20:10,681 --> 05:20:13,784 WHAT I CAME AWAY FROM ONE OF THE 7527 05:20:13,784 --> 05:20:15,619 BIGGEST THEMES IS TOOLS, TOOLS, 7528 05:20:15,619 --> 05:20:18,088 TOOLS, TOOLS. 7529 05:20:18,088 --> 05:20:22,626 TOOLS ARE REALLY HELPFUL WE HOPE 7530 05:20:22,626 --> 05:20:27,097 FOR REAL WORLD APPLICATION. 7531 05:20:27,097 --> 05:20:30,634 THE IMPLEMENTATION COSTING TOOLS 7532 05:20:30,634 --> 05:20:32,803 LIKE COINS CAN HELP SUPPORT 7533 05:20:32,803 --> 05:20:38,108 DECISIONS WHETHER TO ENGAGE IN 7534 05:20:38,108 --> 05:20:39,042 IMPLEMENTATION OF PROCESS NORT 7535 05:20:39,042 --> 05:20:41,411 AND HAVE A REAL UNDERSTANDING 7536 05:20:41,411 --> 05:20:44,248 WHAT THAT INVOLVES. 7537 05:20:44,248 --> 05:20:50,754 AND THEY ALSO POOLS ALSO PROVIDE 7538 05:20:50,754 --> 05:20:52,823 OPPORTUNITIES FOR COMMON 7539 05:20:52,823 --> 05:20:54,224 MEASURES SUCH AS THOSE THAT 7540 05:20:54,224 --> 05:20:57,661 DR. MURPHY REFERRED TO IN THE 7541 05:20:57,661 --> 05:20:58,095 JCOIN PRESENTATION. 7542 05:20:58,095 --> 05:21:00,531 THE OTHER SIDE OF THE TOOLS THAT 7543 05:21:00,531 --> 05:21:02,232 WAS STIMULATING IS THINKING 7544 05:21:02,232 --> 05:21:05,235 ABOUT PAYMENT AND PAYMENT 7545 05:21:05,235 --> 05:21:05,469 DESIGN. 7546 05:21:05,469 --> 05:21:08,505 THAT REFLECT REFLECTS THE APPR 7547 05:21:08,505 --> 05:21:12,142 WE ALL GOT OF THE GREAT 7548 05:21:12,142 --> 05:21:20,184 COMPLEXITY OF HAVING MULTIPLE 7549 05:21:20,184 --> 05:21:21,485 PAIRS AND CONSTRAINTS AND 7550 05:21:21,485 --> 05:21:24,121 APPROACHES AND INCENTIVES AND 7551 05:21:24,121 --> 05:21:25,689 HOW TO BRING IT TOGETHER TO 7552 05:21:25,689 --> 05:21:27,691 PROVIDE THE SERVICE OR MAKE A 7553 05:21:27,691 --> 05:21:30,627 DECISION ABOUT HOW TO PROVIDE 7554 05:21:30,627 --> 05:21:35,232 THE SERVICE. 7555 05:21:35,232 --> 05:21:37,267 ANOTHER THING WE BOTH TOOK AWAY 7556 05:21:37,267 --> 05:21:40,404 WE TALKED ABOUT BEFORE IS 7557 05:21:40,404 --> 05:21:41,672 EFFECTIVE RESEARCH REQUIRES 7558 05:21:41,672 --> 05:21:42,973 MULTIPLE PERSPECTIVES AS IT WAS 7559 05:21:42,973 --> 05:21:44,141 TALKED ABOUT IN THE LAST PANEL. 7560 05:21:44,141 --> 05:21:45,809 IN PARTICULAR I LIKE THE 7561 05:21:45,809 --> 05:21:48,512 OBSERVATION THAT NO ONE HAS THE 7562 05:21:48,512 --> 05:21:49,279 FULL PICTURE. 7563 05:21:49,279 --> 05:21:52,649 EVERYONE HAS AN ANGLE ON THE 7564 05:21:52,649 --> 05:21:54,852 PICTURE AND WE NEED DIFFERENT 7565 05:21:54,852 --> 05:21:56,286 PIECES OF THE PUZZLE. 7566 05:21:56,286 --> 05:21:57,221 PEOPLE WITH LIVED AND LIVING 7567 05:21:57,221 --> 05:22:02,326 EXPERIENCE AND FAMILY MEMBERS 7568 05:22:02,326 --> 05:22:04,895 PARTICULARLY WHAT VALUES THEY 7569 05:22:04,895 --> 05:22:06,363 VALUE AND SEE AS IMPORTANT TO 7570 05:22:06,363 --> 05:22:08,198 STUDY AND THE IMPLEMENTERS IN 7571 05:22:08,198 --> 05:22:09,867 THE WORK FLOWS AND PAYERS TO 7572 05:22:09,867 --> 05:22:14,538 UNDERSTAND HOW THEY BALANCE 7573 05:22:14,538 --> 05:22:17,608 BEHAVIORAL AND NON-BEHAVIORAL 7574 05:22:17,608 --> 05:22:20,510 COSTS AND THOSE ARE SOME 7575 05:22:20,510 --> 05:22:20,777 EXAMPLES. 7576 05:22:20,777 --> 05:22:22,312 THERE'S MANY PIECES OF THE 7577 05:22:22,312 --> 05:22:24,948 PUZZLE AND NEED INPUT FROM MANY 7578 05:22:24,948 --> 05:22:25,949 STAKEHOLDERS AND NEEDS DIVERSE 7579 05:22:25,949 --> 05:22:29,920 TEAMS TO DO ECONOMIC RESEARCH. 7580 05:22:29,920 --> 05:22:33,624 FINALLY, I WOULD SAY THE POLICY 7581 05:22:33,624 --> 05:22:33,857 IMPACT. 7582 05:22:33,857 --> 05:22:37,928 VERY CHALLENGING TO IDENTIFY 7583 05:22:37,928 --> 05:22:47,404 IMPACTS OF POLICYIES IT'S ALSO 7584 05:22:47,404 --> 05:22:51,208 COMPLEX WHEN THERE'S MULTIPLE 7585 05:22:51,208 --> 05:22:53,677 POLICIES GOING ON AT THE SAME 7586 05:22:53,677 --> 05:22:55,679 TIME OR MAY INTERACT WITH ONE 7587 05:22:55,679 --> 05:22:57,514 ANOTHER AND TO THINK ABOUT 7588 05:22:57,514 --> 05:23:01,218 IMPACTS ON BOTH DEMAND AND 7589 05:23:01,218 --> 05:23:03,987 SUPPLY. 7590 05:23:03,987 --> 05:23:07,424 A LARGER DISCUSSION ABOUT THE 7591 05:23:07,424 --> 05:23:10,260 SUPPLY OF PROVIDERS AND HOW THAT 7592 05:23:10,260 --> 05:23:13,797 MAY BE TOUGH TO APPROACH WITH 7593 05:23:13,797 --> 05:23:14,064 POLICIES. 7594 05:23:14,064 --> 05:23:17,200 ONE POSITIVE THING AND 7595 05:23:17,200 --> 05:23:18,602 INTERESTING THING I TOOK AWAY IS 7596 05:23:18,602 --> 05:23:21,772 THERE ARE POLICIES NOT FOCUSSED 7597 05:23:21,772 --> 05:23:23,573 ON BEHAVIORAL HEALTH THAT HAVE 7598 05:23:23,573 --> 05:23:25,742 SOME POTENTIALLY PROMISING 7599 05:23:25,742 --> 05:23:25,976 IMPACT. 7600 05:23:25,976 --> 05:23:27,711 THINGS LIKE SICK LEAVE OR THE 7601 05:23:27,711 --> 05:23:28,946 CHILD TAX CREDIT. 7602 05:23:28,946 --> 05:23:31,181 THOSE HAVE THINGS NOT DESIGN FOR 7603 05:23:31,181 --> 05:23:33,817 BEHAVIORAL HEALTH IMPACT BUT 7604 05:23:33,817 --> 05:23:36,820 SEEM TO HAVE A POTENTIAL FOR 7605 05:23:36,820 --> 05:23:38,188 IMPACT IN CERTAIN COMMUNITIES. 7606 05:23:38,188 --> 05:23:39,089 I THINK DOING MORE RESEARCH IN 7607 05:23:39,089 --> 05:23:48,398 THAT AREA WOULD BE GREAT. 7608 05:23:48,398 --> 05:23:50,500 THAT'S ALL I WANT TO SAY RIGHT 7609 05:23:50,500 --> 05:23:52,336 NOW, SIERRA. 7610 05:23:52,336 --> 05:23:54,571 I WANT TO TURN IT BACK TO YOU 7611 05:23:54,571 --> 05:23:57,441 AND ASK YOU WHAT YOU TAKEAWAY IN 7612 05:23:57,441 --> 05:23:59,576 TERMS OF FUTURE DIRECTIONS FOR 7613 05:23:59,576 --> 05:24:00,577 THE FIELD. 7614 05:24:00,577 --> 05:24:03,880 >> YEAH, THANKS SO MUCH FOR 7615 05:24:03,880 --> 05:24:06,883 THOSE THOUGHTS. 7616 05:24:06,883 --> 05:24:09,619 I WANTED TO START BY POINTING TO 7617 05:24:09,619 --> 05:24:15,559 A COUPLE YEARS AGO A COMMENTARY 7618 05:24:15,559 --> 05:24:18,328 THAT EXPANDED UPON THE 7619 05:24:18,328 --> 05:24:19,997 CONSOLIDATED HEALTH ECONOMIC 7620 05:24:19,997 --> 05:24:21,098 REPORTING STANDARD FOR THOSE WHO 7621 05:24:21,098 --> 05:24:23,367 AREN'T FAMILIAR WITH THOSE. 7622 05:24:23,367 --> 05:24:27,838 AND THAT COMMENTARY CALLED FOR 7623 05:24:27,838 --> 05:24:29,573 GREATER INVOLVEMENT OF THE 7624 05:24:29,573 --> 05:24:34,311 PUBLIC AND PATIENT POPULATIONS 7625 05:24:34,311 --> 05:24:36,213 IN ECONOMIC EVALUATION RESEARCH. 7626 05:24:36,213 --> 05:24:36,980 BECAUSE THEY'LL BE BEARING A LOT 7627 05:24:36,980 --> 05:24:39,416 OF THE IMPACT OF DECISIONS MADE 7628 05:24:39,416 --> 05:24:43,020 BASED ON THE ECONOMIC 7629 05:24:43,020 --> 05:24:43,320 EVALUATIONS. 7630 05:24:43,320 --> 05:24:49,760 AND SO AS IT WAS POINTED OUT, 7631 05:24:49,760 --> 05:24:52,963 THAT'S A COST CUTTING THEME. 7632 05:24:52,963 --> 05:24:56,233 SINCE IT'S PART OF THE EMERGING 7633 05:24:56,233 --> 05:24:57,534 GUIDELINES ACROSS ECONOMIC 7634 05:24:57,534 --> 05:24:59,503 EVALUATION WRIT LARGE, WE 7635 05:24:59,503 --> 05:25:02,105 DEFINITELY SEE THAT AS A 7636 05:25:02,105 --> 05:25:02,873 POTENTIAL FUTURE DIRECTION AND 7637 05:25:02,873 --> 05:25:04,474 SOMETHING THAT COULD CONTINUE TO 7638 05:25:04,474 --> 05:25:08,412 GROW AND CONTINUE TO DEVELOP. 7639 05:25:08,412 --> 05:25:11,548 SIMILARLY, AS WE'RE INVOLVING 7640 05:25:11,548 --> 05:25:13,583 THOSE PERSPECTIVES, THERE'S A 7641 05:25:13,583 --> 05:25:16,586 REAL OPPORTUNITY FOR CONDUCTING 7642 05:25:16,586 --> 05:25:18,055 DISSEMINATION SCIENCE RESEARCH 7643 05:25:18,055 --> 05:25:21,391 TO DEVELOP AND TEST THOSE TOOLS 7644 05:25:21,391 --> 05:25:28,732 FOR THOSE DIFFERENT AUDIENCES 7645 05:25:28,732 --> 05:25:30,400 DR. SCHACKMAN ALLUDED THIS WHEN 7646 05:25:30,400 --> 05:25:33,837 HE REFERRED TO TOOLS, TOOLS, 7647 05:25:33,837 --> 05:25:34,037 TOOLS. 7648 05:25:34,037 --> 05:25:36,206 THEY WORK, WE THINK. 7649 05:25:36,206 --> 05:25:37,507 WE WANT TO SEE IF THEY'RE HAVING 7650 05:25:37,507 --> 05:25:41,311 THE KINDS OF IMPACTS WE WANT TO 7651 05:25:41,311 --> 05:25:43,947 SEE AND MAYBE IF WE HAVE MORE 7652 05:25:43,947 --> 05:25:45,215 INFORMATION, DOES IT LEAD TO 7653 05:25:45,215 --> 05:25:47,551 BETTER DECISIONS? 7654 05:25:47,551 --> 05:25:49,252 WE HAVE THE WORLD OF INFORMATION 7655 05:25:49,252 --> 05:25:54,024 AT OUR FINGER TIPS WITH THINGS 7656 05:25:54,024 --> 05:25:56,059 LIKE THE INTERNET BUT HAVEN'T 7657 05:25:56,059 --> 05:25:58,728 SOLVED THE WORLD'S PROBLEMS JUST 7658 05:25:58,728 --> 05:26:00,230 YET SO IT'S IMPORTANT TO SEE IF 7659 05:26:00,230 --> 05:26:02,632 THEY HAVE THE KIND OF IMPACT WE 7660 05:26:02,632 --> 05:26:11,475 HOPE. 7661 05:26:11,475 --> 05:26:13,743 I KNOW WE HAVE A FEW WRAP UP 7662 05:26:13,743 --> 05:26:14,778 STATEMENTS FROM SOME OF OUR 7663 05:26:14,778 --> 05:26:15,078 ORGANIZERS. 7664 05:26:15,078 --> 05:26:16,847 I WANT TO GO AHEAD AND TURN IT 7665 05:26:16,847 --> 05:26:22,018 BACK TO THEM WITH ONE MORE THANK 7666 05:26:22,018 --> 05:26:24,754 YOU TO ALL OUR EXCELLENT 7667 05:26:24,754 --> 05:26:25,489 SPEAKERS AND ORGANIZATION TEAM 7668 05:26:25,489 --> 05:26:29,426 AND HAND IT BACK TO DR. HUMENSKY 7669 05:26:29,426 --> 05:26:30,994 TO CLOSE US OUT. 7670 05:26:30,994 --> 05:26:33,396 >> THANK YOU TO BRUCE AND SIERRA 7671 05:26:33,396 --> 05:26:38,168 FOR TAKING THE TIME TO SUMMARIZE 7672 05:26:38,168 --> 05:26:40,370 THE MEETING AND PULLED TOGETHER 7673 05:26:40,370 --> 05:26:41,805 THE THEMES THAT IS HELPFUL TO 43 7674 05:26:41,805 --> 05:26:43,340 WITH THE BREADTH OF DISCUSSIONS 7675 05:26:43,340 --> 05:26:44,174 WE HAD TODAY. 7676 05:26:44,174 --> 05:26:46,743 I APPRECIATE YOU TAKING THE TIME 7677 05:26:46,743 --> 05:26:47,878 TO TIE IT ALL TOGETHER. 7678 05:26:47,878 --> 05:26:49,379 WE WANTED TO JUST TAKE THE 7679 05:26:49,379 --> 05:26:51,481 OPPORTUNITY TO THANK A FEW 7680 05:26:51,481 --> 05:26:53,717 PEOPLE WITHOUT WHOM TODAY'S 7681 05:26:53,717 --> 05:26:54,818 MEETING COULDN'T HAVE HAPPENED. 7682 05:26:54,818 --> 05:26:57,554 FIRST, THANK YOU TO ALL OF 7683 05:26:57,554 --> 05:26:59,055 TODAY'S SPEAKERS AND THEIR 7684 05:26:59,055 --> 05:27:01,391 RESEARCH TEAMS FOR DOING THIS 7685 05:27:01,391 --> 05:27:01,791 IMPORTANT WORK. 7686 05:27:01,791 --> 05:27:03,460 WE'RE LEARNING MORE ABOUT HOW 7687 05:27:03,460 --> 05:27:05,128 OUR MARKETS FUNCTION AND HEALTH 7688 05:27:05,128 --> 05:27:07,464 CARE SYSTEMS FUNCTION AND HOW WE 7689 05:27:07,464 --> 05:27:12,969 CAN BEST SERVE PATIENTS AND 7690 05:27:12,969 --> 05:27:13,236 FAMILIES. 7691 05:27:13,236 --> 05:27:14,871 WE'LL ALSO THANK THE 7692 05:27:14,871 --> 05:27:16,806 FACILITATORS WHO PROVIDE THEIR 7693 05:27:16,806 --> 05:27:17,474 PERSPECTIVES ON THESE ISSUES AND 7694 05:27:17,474 --> 05:27:18,642 WE APPRECIATE YOU TAKING THE 7695 05:27:18,642 --> 05:27:22,078 TIME TO DO SO. 7696 05:27:22,078 --> 05:27:30,487 WE WANT TO THANK THE FOLKS 7697 05:27:30,487 --> 05:27:32,889 LISTED AND COULDN'T HAVE DONE IT 7698 05:27:32,889 --> 05:27:36,726 WITHOUT YOU AND THE NIH 7699 05:27:36,726 --> 05:27:41,298 VIDEOCAST TEAM AND BOB HAMNER 7700 05:27:41,298 --> 05:27:45,468 AND KEVIN AND FOLKS AT THE 7701 05:27:45,468 --> 05:27:47,537 MEETING AND TWO RETIRED SARAH 7702 05:27:47,537 --> 05:27:50,507 DUFFY AND TAMARA WHO WERE 7703 05:27:50,507 --> 05:27:53,577 INSTRUMENTAL IN DEVELOPING THIS 7704 05:27:53,577 --> 05:27:56,746 MEETING PRIOR TO THEIR 7705 05:27:56,746 --> 05:27:57,781 RETIREMENTS AND THANK THEM FOR 7706 05:27:57,781 --> 05:28:00,083 THEIR SUPPORT AND CONTRIBUTIONS. 7707 05:28:00,083 --> 05:28:03,186 WE THANK LINDSEY MARTIN FOR 7708 05:28:03,186 --> 05:28:06,289 PICKING UP THE TORCH AFTER THE 7709 05:28:06,289 --> 05:28:09,125 RETIREME 7710 05:28:09,125 --> 05:28:12,829 RETIREMENTS AND SUPPORTIVE 7711 05:28:12,829 --> 05:28:13,830 OPENING REMARKS EARLIER TODAY. 7712 05:28:13,830 --> 05:28:20,937 I WANT TO THANK THE NIMHD FOLKS 7713 05:28:20,937 --> 05:28:27,210 WHO SUPPORTED THE MEETING. 7714 05:28:27,210 --> 05:28:29,479 A RECORDING OF THE MEETING WILL 7715 05:28:29,479 --> 05:28:34,050 BE AVAILABLE AT NIH VIDEOCAST 7716 05:28:34,050 --> 05:28:35,051 AND VIEWED AT YOUR CONVENIENCE 7717 05:28:35,051 --> 05:28:45,051 AND ENJOY THE REST OF YOUR DAY.