Posts Tagged ‘substance abuse’

Major Regulatory Reform Milestone

May 5th, 2014

clipboard-iconLast week we passed a major milestone in our Strategic Plan when we filed our final new set of rules for the Arizona’s 5,500 licensed healthcare facilities.  With this week’s filing – we’ve now completed our overhaul of the State’s regulations for hospitals, behavioral health inpatient facilities, nursing care institutions, recovery care centers, hospices, behavioral health residential facilities, assisted living facilities, outpatient surgical centers, outpatient treatment centers, adult day health care facilities, home health agencies, behavioral health specialized transitional facilities, substance abuse transitional facilities, behavioral health respite homes, adult behavioral health therapeutic homes, child care facilities and the regulatory standards for licensed professional midwives.

During our 4 year regulatory reform effort, we worked hard with our partners to develop a better set of rules.  The new model sets some prescriptive minimum standards – and then requires facility operators to develop an additional set of policies and procedures to ensure patient and resident health & safety.  Facilities are also required to measure patient and resident outcomes.  If they have bad (preventable) outcomes – our survey teams will determine whether the facility wasn’t following its policies and procedures, had inadequate policies and procedures, or both.

While the rules are done, we still need to educate and train our survey teams and healthcare facilities on the new regulations.  Because the final rules depend largely on outcomes and solid policies and procedures rather than just static standards – this effort won’t happen overnight.  It’ll probably take about 18 months to get everybody up to speed on the new expectations.

5 Years of Behavioral Health Innovation Paying Dividends (Part III)

April 30th, 2014

Over the past couple of weeks, I’ve reflected about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness.  So far, I’ve covered integrated health homes and improvements to the crisis system.

On the kids front, more than 1,500 Maricopa County youth who experience behavioral health challenges have benefitted from participating in “MY LIFE” (Magellan Youth Leaders Inspiring Future Empowerment).  Through this group- members get support from their peers and develop critical skills in leadership and mental health resiliency.  Their activities have been invaluable in the fight against stigma associated with behavioral health issues.

Minors in the juvenile justice system in Maricopa County have had access to culturally relevant substance use and disorder treatment programs.  Sixty-four percent of the participants in the 21-month program decreased or eliminated their substance use- and more than 70% report completing treatment without returning to the juvenile justice setting.  Magellan earned the SAMSHA Science and Service Award for implementing this program.

“Health Windows” Provide Important Health Information to Hard-to-Reach Populations

April 28th, 2014

flagsVentanilla de Salud (Health Windows) is a program that improves access to preventive health care, health education, and public health screening at Mexican consular offices throughout the US. There are 5 Ventanillas in AZ (Douglas, Nogales, Phoenix, Tucson, and Yuma).  The Ventanillas are operated jointly by the Department of Health of Mexico (Secretaria de Salud de México) and the Department of Foreign Affairs of Mexico (Secretaria de Relaciones Exteriores de México).

Their health education mission includes providing information about diabetes, obesity, hypertension, mental health, substance abuse, women’s health, domestic violence, birth control and health insurance.  Nationwide 1,182,760 people accessed services in 2013 and another  2,718,617 received educational information and referral to community health centers or received early detection results.

The Program has had an important influence on the relationship between Arizona and Sonora by strengthening ties between the two states through the delivery of health information.  You can find out more about the Ventanillas, including Locations and Health Information on the Ventanilla de Salud website– and make sure you add this to your list of community public health prevention partners.


5 Years of Behavioral Health Innovation Paying Dividends (Part I)

April 15th, 2014

MPeople with a serious mental illness die more than 30 years earlier than people without those challenges.  Over the next few weeks, I’ll be reflecting about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness.

I’ll start with a project that began with modest funding from SAMHSA, through a grant meant for small pilots to test concepts in our community.  In 2009, we and AHCCCS jointly applied for and got a Transformation Transfer Initiative grant which was used to initiate a peer-based whole health program Maricopa and Pima Counties.  The goal of the program was to help transform the behavioral health system into one that applies a holistic approach to consumer health.

Magellan Health Services of Arizona launched the first phase of Integrated Health Homes as part of this initiative- bringing together mental health and physical health care.  The model was a partnership between Magellan, Maricopa Integrated Health System, and CHOICES Network, Partners in Recovery, People of Color Network and Southwest Network.  By 2013, there were 10 Integrated Health Homes in Maricopa County that have been providing coordinated care for members.  Thousands of people have received coordinated care and achieved better outcomes through these health homes.  Here are some additional typical health home participant vignettes that profile service recipients who can benefit from the initiative.

In the coming weeks, I’ll cover improvements in the Crisis Response System, the kids system of care, children’s substance abuse, coordination with the correctional system, and performance dashboards.

Arizona’s First Ever State Health Assessment

February 13th, 2014

Today we published Arizona’s first ever comprehensive State Health Assessment. The objective of the State Health Assessment is to give Arizona’s public health and health care systems a clear tool to help drive future decision-making and resource allocation as we collectively design and implement evidence-based interventions to improve health and wellness outcomes across Arizona.  

The Assessment uses Arizona-specific data to assess the state of the public’s health in Arizona and has been a collaborative effort among all of the health departments in each AZ county as well as the ADHS.  The 15 priority health issues in the Report are obesity, tobacco use, substance abuse, healthcare associated infections, suicides, teen pregnancy, creating healthy communities, behavioral health services, diabetes, heart disease, other chronic diseases (cancer, respiratory disease, asthma), accidents and injuries, oral health, access to well care, and access to health insurance. 

Each public health indicator is summarized for its significance and scope, trending, and comparative analysis against national data.  The report also provides in-depth analysis for a number of indicators in each of Arizona’s 126 Community Health Analysis Areas. 

Please take time to look at the State Health Assessment and the county level community health assessments.  After you’re done, we’d appreciate hearing from you through the survey monkey as we take the next giant step to create Arizona’s first State Health Improvement Plan.

Behavioral Health Outreach Along the Border

October 11th, 2013

We have two Regional Behavioral Health Authorities working to improve and protect mental health along the border. Cenpatico and Community Partnership of Southern Arizona (CPSA) offer specialized programs to help combat substance abuse and prevent suicide as well as to help those with behavioral health issues.  

One of the CPSA-sponsored prevention activities near the border includes substance abuse and suicide prevention. Providers work with youth and families, behavioral health providers and first responders in the communities of Sahuarita, Amado, and on the Tohono O’odham Nation.  In addition, prevention work with populations similar to border populations has been conducted with the south side communities of Tucson. 

Another prevention program involves life skills training with 18 at-risk youth through the Southern Arizona Aids Foundation.  The drug-free community effort serves 300 residents in the town of Amado in partnership with the Pima County Community Prevention Coalition and 25 participants in the Youth Empowered for Success program at Tohono O’odham High School with Child and Family Resources and Arizona Youth Partnership. 

In collaboration with Campesinos sin Fronteras in Yuma County, Cenpatico has recruited and trained 4 promotores (Health Outreach Workers) to facilitate “placticas” in public places like community centers, libraries and in community members’ homes.  These “placticas” range in subject matters like diabetes and depression, the importance of managing your blood pressure.


Coming Attraction: AZ’s 1st State Health Assessment

August 23rd, 2013

Publication of Arizona’s very first State Health Assessment is just around the corner  The 2013 Arizona State Health Assessment will use AZ quantitative and qualitative data to assess the public health status of the state.  The end product will be a comprehensive summary of the 15 leading health issues that have the greatest impact in Arizona. 

Over 10,000 community members participated across the state in helping provide valuable input.  Our county health departments did the heavy lifting and engaged the public and their local partners to develop county level community health assessments. Primary data was collected through local community participation in surveys, focus groups and strategy meetings to establish local priorities and really capture the community’s concerns.  Secondary data from public data banks such as hospital discharge data, Behavioral Risk Factor Surveillance System, and the disease registries was also part of the analysis. 

The State Health Assessment uses a combination of the Community Health Status Indicator Project and the Healthy People 2020 Mobilize, Assess, Plan, Implement, Track Models. The 15 leading health issues identified in the Assessment were compiled from county and state priority rankings. Each indicator is summarized for its significance and scope, trending over the past few years, and comparative analysis against national data.  

The 15 priority health issues that’ll be identified in the Report are (in no particular order): obesity, tobacco use, substance abuse, healthcare associated infections, suicides, teen pregnancy, creating healthy communities, behavioral health services, diabetes, heart disease, other chronic diseases (cancer, respiratory disease, asthma), accidents and injuries, oral health, access to well care, and access to health insurance. 

The State Health Assessment will provide the starting point for our first ever State Health Improvement Plan in 2014… which will outline actionable and specific strategies, tactics and interventions for improving population health.  The Improvement Plan will provide a roadmap for Arizona policy makers at the state, county and local level as well as our partners in the private sector to take serious concrete steps to improve population health outcomes while reducing health care costs in AZ.

Integrated Care Responses On Deck

January 8th, 2013

We all need to take care of both our physical and behavioral health needs in order to be healthy. The mind and body aren’t separated- and neither should the health-care delivery system- especially for folks with a serious mental illness. Folks with a serious mental illness die more than 25 years earlier than the general population… an unacceptable health disparity in anybody’s book. The increased mortality is largely from treatable medical conditions caused by modifiable risk factors like smoking, obesity, substance abuse, and not accessing primary and acute medical care. Population health issues. 

We recognized the need to address this unacceptable health disparity when we put together our Strategic Map and Plan that includes integrating behavioral and acute healthcare. It’s been a long haul and a lot of work- and we passed a major milestone today when folks submitted their bids on our Request For Proposal (otherwise known as RFP) for the delivery of behavioral health services in Maricopa County.  We received bids from: 1) Magellan Complete Care of Arizona, Inc.; 2) Cenpatico of Arizona LLC; 3) Arizona Physicians IPA, Inc. (APIPA), d/b/a UnitedHealthcare Community Plan, operating as UnitedHealthcare Whole Health; 4) Mercy Maricopa Integrated Care; and 5) Partners in Integrated Health, LLC. 

Our evaluation team will begin their analysis shortly…  and we expect the evaluation process to take 8 weeks or so.  The entity that ends up getting the contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa County beginning on 10/1/13.  

It’s difficult to put into words how much work has gone into this solicitation. I know that many of you put this work on top of all your normal work, had put off other projects, and sacrificed some of your home-life for this product- and I just really want you to know that I appreciate it. It’s going to save lives. Stay tuned.

New Electronic Birth Certificate ‘Round the Corner

December 26th, 2012

Our Vital Records shop does a lot more than manage the State’s birth and death certificate system (which we’ve been doing since 1885).  We’re also an integral part of the Nation’s Vital Statistics System, which serves as the backbone of national data sharing in public health. The data collected under the National Vital Statistics System works in partnership with the National Center for Health Statistics to produce critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy.  All these data are retrieved from the nation’s network of Vital Records shops like ours. 

There have been two birth certificate standards that the states are currently following – the 1989 and the 2003 standard. We’ve been one of the states that had been following the 1989 standard- but not anymore.  Beginning the first week in January, we’ll be turning the key on the new 2003 Standard.  The new Electronic Birth Registration System that we’ll be using will collect a lot more public health surveillance data.  It’s also an electronic system- which will make things much faster and efficient.  The new system will have impacts all throughout our Strategic Plan.  Here are a couple examples: 

  • A1 – Reduce Obesity – The former 1989 standard had zero data on the mother’s height and weight- meaning we couldn’t calculate the mom’s BMI.  Starting next week, we’ll be able to collect this data- which will give us better surveillance- and in turn, help us identify more targeted public health interventions- helping us to make progress in reducing critical risk factors for poor maternal and child health outcomes.
  • A2 – Reduce Tobacco Use and Substance Abuse –  The old system only captured generic measures about maternal smoking during pregnancy.  The new system will have specific cigarette smoking data before and during pregnancy- providing rich data for prevention activities- helping us to improve birth outcomes. 

Other important data elements include information on breastfeeding, whether mother received food during pregnancy from the WIC program (helping us to better evaluate our WIC program), critical medical data elements like congenital anomalies, and fertility treatments (Assisted Reproductive Technology)…  all of which provide newer opportunities for prevention.  The public health applications that the new system will provide are too long to list in a short blog like this… but they’re substantial- believe me.  We’re even going to be able to incorporate the data we’ll be collecting in the new system into our new Midwife rules. 

From a customer service perspective, the new system has improved security for fraud prevention and will provide speedier transactions for printing birth certificates at the county level.  Thanks to all the IT and vital records team that put in the endless hours to make this new application possible.

Outcomes: Public Health’s Lighthouse

October 16th, 2012

One of our primary objectives over the last couple of years has been to shift the focus of our performance measures away from process and procedures toward actual outcomes.  In other words, we don’t want to measure our success on whether someone’s paperwork is right, but on whether the services we provide actually help folks achieve their recovery goals.  That’s why it’s so exciting to see the system continue to develop easy-to-use behavioral health outcomes dashboards as a new performance tool and to inform consumer choice. 

Outcome Dashboards are like a scorecard- allowing folks to easily review performance and outcomes information (employment, housing, staying out of crisis centers, abstaining from substance abuse, avoiding arrests, etc.) at the at the tip of a finger by region of the state.  Links are also included so the user can then visit dashboards developed by each Regional Behavioral Health Authority, where provider-level performance can be reviewed. 

Our updated Behavioral Health System Performance Framework and Dashboard provides an easy to read outcomes summary including dials for Quality of Life, Access to Services, Service Delivery, and Coordination/Collaboration metrics.  Each category includes demographic data provided by clients, audits of client records, analysis of claims and survey data reported by the Regional Behavioral Health Authorities.