Working Together for Health & Wellness

September 21st, 2011 by admin No comments »

We’ve had to make lots of difficult decisions in response to the ongoing funding shortfalls in our behavioral health system (as well as everywhere in state government).  Many decisions (while painful in the short term) have been necessary to maintain long term system stability as Arizona continues to emerge from this unprecedented fiscal crisis.  While Arizona is gaining ground economically, the progress is slow and requires ongoing, innovative approaches and strong collaboration by all behavioral health system partners.  Because of our partnerships- our system remains strong. 

State government has been working hard to protect coverage and services for individuals with behavioral health needs.  A recent public letter from Dr. Nelson outlined some of our innovations to creatively reinforce our behavioral health system.  We’ve needed to reduce behavioral health provider reimbursement rates, but we’ve taken other actions to help out behavioral health providers and folks that receive services.  For example, we increased the percentage that must be spent on services and decreased the amount of profit behavioral health authorities are allowed to earn- pressing a larger percentage of the total money into services.  

We’re also making real efforts to bring members, families, advocates and stakeholders together as a community to work with a common purpose to preserve and strengthen the behavioral health system.  Members and families routinely sit on our committees and offer valuable input in the redesign of programs that have to operate with less funds. Member-operated organizations such as the Phoenix Visions of Hope have created programs such as warm line crisis response to help members who have lost benefits and need help.  The Family Involvement Center, which offers support to family members in the behavioral health system, has a number of programs to help family members cope with the loss of benefits. 

We’ve also been encouraging the integration of physical and behavioral healthcare among behavioral health providers with acute care health plans and community health centers around the state.  Our new reform initiative will offer whole heath services to persons with Serious Mental Illness in Maricopa County beginning in October 2013.  Tragically, folks with serious mental illness typically die 25 to 30 years younger than the general population, primarily because of physical health issues, many of which are preventable.  This initiative, through the development of Health Homes, will offer these individuals both physical and behavioral health care through one health plan by a team of dedicated health care professionals.  Not only will this new health care delivery system improve health outcomes and reduce costs, there will be an emphasis on prevention, wellness and self-directed disease management programs that have typically not been offered as a routine part of health care.  While these partnerships should also reduce overall healthcare costs, they will also improve quality of care and health outcomes. 

There’s no question that these are tough times and our hearts go out to those who are suffering.  However, we’ll continue to do everything in our power to minimize any harm brought on by budget cuts and continue to make the adjustments in a way that maintains stability and keeps our system strong.  You have my commitment that every decision will be made with our members’ best interest as the number one priority.  Our primary goal—even during these challenging budgetary times—is to provide the best possible behavioral health care to our members and we’re committed to achieving that goal along with our partners in the behavioral health system- and to seek out new ways (like integrating behavioral primary health care) to improve health and wellness.

Is Marijuana Medicine? Information for Doctors

September 20th, 2011 by admin 7 comments »

Next month, the U of A College of Medicine Phoenix is going to host a lecture about marijuana and whether it is medicine.  Dr. Sue Sisley, St. Joseph’s Hospital, will be giving the presentation at the Phoenix Theatre on October 11th at 5:30.

In an earlier blog, Dr. Laura Nelson, ADHS’s Chief Medical Officer, and I shared what we had compiled about the medical research concerning marijuana.  We talked about how patients will likely ask their primary care doctor or go to their medical home to discuss whether marijuana is an option for them.  And we emphasized how important it is to keep Arizona’s Medical Marijuana Program – Medical.

Hopefully, physicians will be able to take advantage of Dr. Sisley’s information in October as she examines “Marijuana – Is It Medicine?”  The presentation is free, but you have to RSVP to Brigitte Jordan at bjordan1@email.arizona.edu or (602) 827-2018.

Own Your Own Health Data

September 20th, 2011 by admin No comments »

For years, you’ve heard that you should take your health care into your own hands.  It may soon be easier because HHS wants you to be able to access your electronic health care records.  One key argument to give people access is if they know what is there, they’ll ask better questions or even make notes about problems in your file before meeting a health care professional.  If this happens, it could be really good for folks with chronic diseases like diabetes, heart disease or cancer.  Stay tuned – it takes awhile to get changes like this through the system.  In the meantime, you can follow the progress on Health IT.

Raising Arizona Babies

September 19th, 2011 by admin No comments »

Do you know someone who’s pregnant and needs help finding low-cost prenatal care? Someone looking for post-partum depression resources; help with breastfeeding; low-cost dental care; or the nearest WIC clinic?  One great resource that can help is our Pregnancy & Breastfeeding Hotline.  The Hotline (1-800-833-4642) is a statewide service funded by our Title V Maternal and Child Health Block Grant and it helps thousands of callers every year with a variety of maternal and child health issues- like the importance of folic acid- and providing lots of referrals for a variety of community resources. 

The Pregnancy & Breastfeeding Hotline also supports AHCCCS’s Baby Arizona program.  Baby Arizona is a faster, simpler way of getting prenatal care before a pregnant woman’s AHCCCS application process is complete. Prenatal care providers across the state agree to see pregnant women while their eligibility is being determined. Once a women goes to the Baby Arizona provider she chooses, the provider helps her apply and pre-enroll her in a health plan. That way, women begin prenatal care at no cost while their eligibility is still being processed.  It’s a great way to facilitate early entry into prenatal care- increasing the likelihood of a healthy birth outcome.  By the way, when a pregnant woman applies for AHCCCS she’s considered a family of 2 (or more if there are multiples)- meaning that she’s not in the “childless adult” category- and wouldn’t be subject to the enrollment freeze for childless adults.

AZ’s New Pandemic Readiness Plan

September 16th, 2011 by admin No comments »

Remember our responses to the 2009-2010 H1N1 Pandemic?  One of the reasons why Arizona’s public health responses were so effective was that we had a well researched and tested pandemic readiness plan.  But… public health readiness isn’t a static process, and once the pandemic was finished we set out to revise our plan with lessons learned.  Over the last few months our public health preparedness team has put together a new and improved 2011 Pandemic Influenza Response Plan.  Hopefully we won’t need it in the near future- but as you might recall from the last influenza pandemic- novel viruses come at unexpected times and without warning… so it makes sense to stay on your toes.

A Look in the Mirror

September 15th, 2011 by admin No comments »

Many folks don’t know that our Licensing division undergoes a periodic audit (survey) to look at compliance to our Federal contract with the Centers for Medicare Medicaid Services (CMS). This past week, 3 surveyors from the regional office of CMS came to review our Long Term Care and Medical Facilities areas. This survey centered on complaint surveys and their prioritization, initiation and investigation. This audit is much like the surveys the Division of Licensing performs on our licensees. There’s an “entrance” whereby the Surveyors explain why they’re here, what they’re going to look at and items that they’ll need in order to help them with their survey. Then there are a few days of what can be intensive record review, interviews with staff and other associated investigatory activity. 

Then the Surveyors compile their information and hold an “exit” with the staff to review what they did, found and suggestions from the survey. During this, exit the staff finds out areas the Surveyor reviewed and if there are any areas they will need to improve upon (findings).  CMS asks for a plan of correction where we would provide a description of how the issue(s) will be resolved, when they’ll be resolved and how we’ll maintain and monitor things.  

Lots of hard work goes into preparing for these CMS visits. Thank you’s go to everyone who work in the Bureaus of Long Term Care Licensing and Bureau of Medical Facilities Licensing. It is truly a team effort as CMS looks at the field work/documentation of the Surveyors, the reviews of the Team Leaders and Bureau Chiefs and the documentation files etc. the Program Project Specialists and the Support Staff maintain.  We don’t have our report back yet- but all indications are that we did well on our assessment.

Healthy Homes

September 14th, 2011 by admin 1 comment »

For decades, removing lead (Pb) from the environment has been a public health priority because residual contamination from decades of using products containing harmful lead continued to cause health problems.  Fortunately, the public health interventions (removing Pb from gas, paint, and cans) worked and today 99.9% of Arizona kids have blood lead levels below the standard.  As a result, the CDC has been phasing out childhood lead poisoning prevention programs and replacing them with a new initiative called Healthy Homes.    

We found out last week that our Office of Environmental Health will begin developing a Healthy Homes Program for of Arizona. This fall, our new Arizona Healthy Homes Program will build and enhance relationships with housing and environmental health programs throughout the state to reduce housing related health concerns, such as childhood lead poisoning, asthma, allergies and unintended injuries, by increasing the number of healthy homes for our most vulnerable and underserved communities.  The first year will be spent working with partners to perform a needs assessment to determine which housing related health hazards pose the greatest risk to Arizonans.  Stay Tuned.

Behavioral Health Kicking the Habit

September 13th, 2011 by admin No comments »

For the past 16 months, our folks in the Division of Behavioral health and our Bureau of Tobacco and Chronic Disease and ASHline have been working to train clinical behavioral health staff in Maricopa and Pima Counties on how to get folks into smoking cessation (quit) services.  The overall goal of this collaboration was to establish a systemic change within the behavioral health system for cessation services and to move Arizona toward being tobacco free!   This involves assessing every single patient at every single visit for tobacco use and providing them the opportunity to be referred for tobacco cessation counseling.

The trend is good.  Our latest data suggests that nearly 10% of all referrals came from our Regional Behavioral Health Authorities.  Here’s the kicker- of those referred, nearly 50% are enrolling for ongoing cessation counseling, which exceeds the enrollment rate of the overall population!  This is truly wonderful.  Most recently, Magellan has officially implemented referral linkages to ASHLine in their electronic health record system and will begin to roll out communication/training to the clinics immediately- allowing case managers and medical staff to easily access the referral form for each client they see while going completely electronic.  Our joint success in this venture, which is far ahead of the curve for integrating behavioral health and tobacco control, will continue to capture the attention of our partners on the national level.

Own your Own Health Data

September 12th, 2011 by admin No comments »

For years, you’ve heard that you should take your health care into your own hands  It may soon be easier – the federal Health and Human Services Secretary wants you to be able to access your electronic health care records. One key argument to give people access is if they know what is there, they will ask better questions or even make notes about problems in your file before meeting a health care professional.  If this happens, it could be really good for folks with chronic diseases like diabetes, heart disease or cancer.  Stay tuned – it takes awhile to get changes like this through the system.  In the meantime, you can follow the progress on Health IT

Hospital Pass Reboot

September 12th, 2011 by admin No comments »

Back in June a resident of our Arizona Community Protection and Treatment Center (ACPTC) (one of our civilly committed sex offenders) escaped while he was on an approved pass to go to church.  He was found by Tempe police later that day.  Because of the security issues that the event raised, I asked the staff at the ACPTC and the Forensic Hospital to suspend the pass programs until we can assess what happened and to give us the time we need to review and revise our protocols for approving passes and setting the operational conditions under which they’re approved.  We’ve looked into a number of safety elements over the last couple of months and have landed on the new policies for issuing community passes for the ACPTC and the Forensic Hospital folks.

The new policies are unique to each program but contain many of the same principles.  For example, any forensic patient or ACPTC resident leaving the grounds of the hospital will be required to wear a GPS monitor.  The monitors are about the size of an average cell phone and are attached to the person’s ankle with a strap that completes an electrical circuit when connected.  Using GPS, our staff can locate folks on a pass to within a few feet.  If a person attempts to remove the unit an immediate alarm is sent notifying staff of the tamper attempt.

Forensic patients and ACPTC residents will also be required to complete a level system prior to gaining different off campus privileges.  The lower levels of the system require 1:1 monitoring by staff (who must remain within five feet of the person on all outings).  Intermediate levels allow graduated privileges including lower staff to patient/resident ratios, followed by outings with approved family members or sponsors and finally ending with individual outings prior to release from the program.  At each level patients or residents need to accomplish positive treatment outcomes and spend a predetermined minimum amount of days on each level.  Advancement or reduction of levels requires a review to make sure each person is suited for advancement or reduction.  The policy also includes protocols to inform local law enforcement about the pass so they’re better informed.

We think these new processes will help balance the treatment needs of individuals while balancing the public safety needs for our forensic patients and the civilly committed sex offenders in the ACPTC.