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Addiction Treatment Access Increases Under Medicaid Expansion, Study Shows

A new study suggests that Medicaid expansion can give low-income individuals better access to buprenorphine for opioid addiction. One concern about expanding Medicaid under the Affordable Care Act (ACA) is that it will give patients increased access to addicting opioid medications. The new study results, published in Health Affairs, could help alleviate these concerns.

Addiction Treatment and Medicaid Study Findings

West Virginia is at the epicenter of a national opioid crisis, with a 2016 fatal opioid overdose rate of 43.4 per 100,000 population—more than triple the US average.

Researchers looked at claims data from 2014 to 2016 among people enrolled in the West Virginia Medicaid expansion program under the Affordable Care Act. The researchers wanted to examine trends in treatment for opioid use disorder (OUD) in this population. Such patients may have had limited access to OUD treatment before the expansion.

About 5.5 percent of all enrollees included in the study were diagnosed with OUD each year. From 2014 to 2016, the monthly prevalence of OUD diagnoses nearly tripled. About one-third of those patients diagnosed with OUD filled buprenorphine orders in early 2014. This rate increased to more than 75 percent by late 2016.

The mean annual duration of filled buprenorphine increased from 161 days to 185 days in 2014 to 2016. Researchers found that most patients who received buprenorphine also received counseling and drug testing. This aligns with FDA recommendations for medication-assisted treatment for OUD.

State Medicaid Expansion and Addiction Treatment

The new study focused solely on data from West Virginia, since it has experienced some of the most serious consequences of the national opioid crisis. In 2016, the fatal opioid overdose rate in West Virginia was more than three times the national average, at 43.4 per 100,000 people.
As OUD and other addictions persist throughout the nation, other states and researchers are also considering the potential impact of Medicaid expansion.

Researchers writing in the Journal of General Internal Medicine looked at trends in fatal drug overdoses deaths in Arizona, Maine, and New York. These three states had all expanded Medicaid program eligibility before implementation of the ACA. Results show that rates of drug overdose deaths rose less sharply in these states compared with all states that did not expand Medicaid.

A study published in the Journal of Health Economics in 2018 found that “aggregate opioid admissions to specialty treatment facilities increased 18 percent in expansion states, most of which involved outpatient medication-assisted treatment (MAT).” The results also showed that opioid admissions from Medicaid beneficiaries rose 113 percent. These effects were greatest in expansion states with comprehensive MAT coverage.

This year, Virginia became the 33rd state to expand Medicaid, which included expanded access to addiction treatment options. Virginia Commonwealth University examined the prevalence of SUD among uninsured Virginia residents and newly eligible Medicaid members. The university reports that opioid prescriptions have declined among members, but a growing number are receiving co-prescriptions for the opioid antagonist naloxone. This is also part of a statewide effort to curb the opioid crisis.

Addiction Treatment and Behavioral Health EHR Solutions

If you’re a behavioral health provider in a state that has enacted Medicaid expansion, you may be seeing increased demand. BestNotes EHR, created for behavioral health and addiction treatment organizations, can help you streamline your services so you can improve care, track patient outcomes, and increase practice revenue. Contact us today to learn more, and even schedule a free demo.

date:  May 21, 2019
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Three Important Steps to Get Started With Behavioral Health and Addiction Treatment Telehealth

A growing number of companies in various industries now employ remote workers, reducing workplace expenses, expanding opportunities, and even increasing productivity. Behavioral health is no exception to this movement, with the rise of telehealth allowing therapists and other clinicians to see patients remotely.

The growing popularity of telehealth among both patients and providers makes it worthwhile, and even essential, for behavioral health and addiction treatment organizations to adopt.

Making Remote Behavioral Health and Addiction Treatment Telehealth Work

Telehealth is more than just setting up a Skype account. Billing requirements, HIPAA rules, and other aspects of healthcare can make telehealth more complicated than other remote industries.
Here are some steps to help you get started with telehealth in behavioral health and addiction treatment organizations.

1. Hire the right people.

Whether your remote workers are clinicians or administrative staff, it’s important to find individuals best suited for telehealth. “We like to see a history of working autonomously or indications that the applicant is a self-starter,” says Jon Winther, Chief Marketing Officer at BestNotes.

The right qualities may not be immediately obvious, so behavioral health organizations might want to spend more time on candidates when hiring remote workers. Even after hiring, consider a probation period of 3-9 months to “test drive” the relationship. This will not only help you get familiar with each other, but can encourage trust between management, staff, and patients, which is vital element for remote work, including telehealth.

2. Use collaborative tools.

Communication is a major concern among organizations new to telehealth and remote work. Fortunately, numerous free or low-cost solutions can help clinicians, managers, and support staff stay in touch and on-task.

Besides email, other communication solutions include Google Chat and Zoom. Google’s suite of applications, such as Docs and Sheets, allow multiple users to edit or contribute to documents. Trello, Asana, and Slack can help with task management. There are also many different telehealth software and practice management solutions available for behavioral health and addiction treatment organizations.

3. Provide thorough training.

Even providers who support telehealth recognize that it requires different skills than in-person patient interactions. Not only do clinicians need to be trained in the telehealth software, but should also develop appropriate skills. These include:

Understanding when virtual care is appropriate and when in-person care is required
Communicating effectively with virtual patients
Accurately evaluating signs and symptoms for virtual patients
Applying best practices to virtual care.

In 2014, the American Telemedicine Association (ATA) announced an accreditation program for eligible telemedicine providers. Starting in 2017, this telehealth accreditation program has been managed through a partnership with ClearHealth Quality Institute.

Telehealth and other health software providers usually offer training with the purchase of their solutions. For example, the entire implementation process at BestNotes is done with videoconferencing. Staff training is also performed over videoconference, even for in-office employees. When considering and purchasing telehealth solutions, make sure to ask vendors about any training they offer.

Support Your Telehealth Practice With Specialized EHR

BestNotes EHR was developed specifically to serve behavioral health and addiction treatment practices. Whether you’ve already launched your telehealth program or you’re exploring the possibility, BestNotes can help operations stay streamlined and cost-effective.

Contact us today to learn more about how BestNotes EHR can help you improve care, track patient outcomes, and increase practice revenue.

date:  May 17, 2019
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What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

One main goal of the Affordable Care Act (ACA) is increased insurance coverage for low-income Americans. The ACA aimed to achieve this goal partly through the expansion of Medicaid to most U.S. adults at 138 percent of the federal poverty level.

Although there are financial incentives for adopting the Medicaid expansion, the decision is still up to individual states. As of April 2019, 36 states and the District of Columbia have adopted the Medicaid expansion. This leaves 14 states that have not expanded their Medicaid program coverage.

What Are Section 1115 Waivers?

Federal law gives individual states some flexibility in how they implement and operate their Medicaid programs. States may also apply for a Section 1115 waiver, granted by the Centers for Medicare & Medicaid Services.

Section 1115 waivers give states additional leeway to deviate from federal Medicaid guidelines and laws. States also can use the waivers to test different ways to deliver or fund Medicaid services.

Behavioral Health and Section 1115 Waivers

Many people who are currently uninsured and living at or below the federal poverty level also struggle with mental illness, addiction, or other behavioral health issues. Federal law requires all state Medicaid programs to provide some mental health services. Some state Medicaid programs provide beneficiaries with addiction treatment services.
By expanding Medicare coverage, more individuals may gain access to services to help address their behavioral health needs.
Even states that have not formally expanded Medicaid can use Section 1115 waivers to expand coverage to additional low-income residents. The mental-health organization NAMI has officially called on every state to expand Medicaid and apply for Section 1115 waivers to ensure that Medicaid programs provide “adequate mental health services and supports.”

One use for Section 1115 waivers is to improve service systems for behavioral health and addiction treatment. As of September 2017, 12 states had approved Section 1115 Medicaid waivers related to behavioral health.

How Are States Using Section 1115 Waivers?

Under new legislation, the Idaho Department of Health and Welfare has been directed to seek a Section 1115 waiver for multiple changes to the state Medicaid program. If the waivers are not approved by January 1, 2020, then all individuals at or below the federal poverty line will be enrolled in Medicaid.

One change involves adding questions about substance use disorder to the initial Health Assessment to direct beneficiaries to services early. Another change is the use of Medicaid funds directly for inpatient behavioral health and addiction treatment services.

Arizona used a waiver approved in 2016 to better integrate physical and behavioral health, including payment incentives to providers. In Delaware, a waiver allowed the state in 2015 to implement a voluntary program that provides enhanced behavioral health services for certain Medicaid beneficiaries.

Prepare for Expanded Behavioral Health Services

Behavioral health and addiction treatment providers could see an increase in demand in states that have expanded Medicaid coverage or received Section 1115 waivers. Adopting a comprehensive EHR solution can help you keep up with demand while streamlining services.

Created specifically for behavioral health professionals, BestNotes EHR offers the features you need to improve patient care, increase practice revenue, and reduce staff frustration. Contact us today to learn more about our solutions, or to schedule a free demonstration.

date:  May 02, 2019
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Curious About Telemedicine for Behavioral Health? Here Are Some Things to Know:

The early adoption of telemedicine, a term often used interchangeably with telehealth, has surpassed the early adoption of electronic health records (EHRs), survey results show. Telehealth is even finding favor with specialists who experience significant burnout.

Telehealth platform company American Well reported at the ATA19 telehealth conference that physician adoption of telehealth increased 340 percent between 2015 and 2018. Even among providers who have not used telehealth, more of them are willing to try it.

Why is Telemedicine Becoming More Appealing?

Telemedicine has already been found to have numerous benefits to behavioral health and addiction treatment providers and their patients.

Closing care gaps: Specialists, including behavioral health clinicians, tend to practice in higher-population areas, creating fewer options for small towns and rural areas. Telemedicine could help bridge some of the care gaps found in behavioral health and addiction treatment.

Reducing care shortages: Although mental health needs are growing across the United States, there is also an increasing shortage of care providers. As addiction, suicide, and other behavioral health concerns increase, telemedicine may mean a difference between life and death.

Improving patient results: Experts note that telemedicine can make counseling and other types of substance abuse treatment more accessible to clients. This expanded accessibility can help individuals get support and make better decisions when faced with the option to use addictive substances.

Improving practice revenue: Telemedicine can be more convenient for patients than in-office visits. It reduces the risk of canceled appointments and no-shows. Faster check-ins can streamline the practice and improve billable hours.

What Are Some Concerns in Implementing Telemedicine?

Telemedicine is a growing technology, and the healthcare field overall is always changing. Researchers, clinicians, and administrators are working to resolve several issues associated with telemedicine. Some of these include:
Fragmented Care: Telemedicine offers a convenient source of care for many patients. At the same time, it could also lead to increased healthcare fragmentation if telemedicine providers do not coordinate with other members of a patient’s healthcare team.

Interoperability: Much like with EHRs, providers have many options for telehealth solutions. Unfortunately, the wide variety of solutions and software may limit interoperability. Behavioral health providers should be aware of this when entering the telemedicine space.

Measuring Value and Effectiveness: As U.S. healthcare moves to a value-based model, efforts to measure value and effectiveness should not exclude telemedicine. Experts at the American Telemedicine Association’s 2019 conference in New Orleans suggest that providers focus on building relationships with patients and asking telehealth users if they feel their needs were met.

Staff Effectiveness: All clinicians and support staff must be thoroughly prepared and trained for the adoption. Take time to address any questions and concerns. Be sure that remote workers have all the information, training, and equipment they need, and are aware of expectations.

Support Your Telemedicine Practice With Specialized EHR

BestNotes EHR was developed specifically to serve behavioral health and addiction treatment practices. Whether you’ve already invested in a telehealth program, you are just starting the process, or simply considering adding it to your practice, BestNotes can help you stay streamlined and cost-effective.

Contact us today to learn more about how BestNotes EHR can help you improve care, track patient outcomes, and increase practice revenue.

date:  Apr 25, 2019
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California Addiction Treatment News

While it has not seen the devastating levels of opioid addiction as other states, California still faces the challenges of opioids and other addictions. Here are the behavioral health issues and solutions making headlines in the state.

California Expands Addiction Treatment Program

The “Hub and Spoke” system of addiction treatment involves regional treatment centers connected to supporting facilities, creating a network that resembles the hub and spokes of a wheel. This helps patients get appropriate help close to home, with individualized treatment plans.
This system was first launched in Vermont in 2012, and since 2017 has been implemented on a larger scale in California. Funded by $90 million in federal grants, California began with 18 hubs and 57 spokes. It has expanded to more than 200 spokes across the state.

San Francisco-Based Insurer Reduces Members’ Opioid Use

Blue Shield of California reports that members with chronic, non-cancer pain have reduced their overall opioid use by 56 percent compared to 2014 levels. The organization in 2015 launched the Narcotic Safety Initiative to reduce members’ opioid use by 50 percent.

The initiative focused on both preventing patients from being prescribed high levels opioids and reducing the number of patients currently using long-term, high levels of opioids. This includes targeting extended-release opioids, which can contribute to opioid tolerance, and reducing opioid misuse and promoting alternative pain management.

University of California Grad Students Offer Solutions to Persistent Issues

Kate Linker, a grad student in anatomy and neurobiology at UC Irvine, has uncovered data on why adolescents are at such high risk of addiction. Teenage addiction may be connected to the brain’s immune system, Linker suggests. She is currently working with the California-based company Plexxikon to develop a new treatment that suppresses drug motivation without affecting other behaviors.

Many Providers Limited in Treating Opioid Abuse

Research from UC San Francisco has found that at least six states with high rates of opioid abuse also have tighter restrictions on the ability of nurse practitioners (NPs) to prescribe medication that could can help treat addiction. The study, published in JAMA, recommends reforms to relax restrictions and help health providers better address the opioid crisis.

California is one state that more severely restricts NP scopes of practice. However, lawmakers have introduced a bill to eliminate the physician collaboration requirement, a recommendation from the California Future Health Workforce Commission. Study corresponding author Joanne Spetz, Ph.D., suggests that, even without changes in current regulations, states might develop programs that connect NPs with physicians who are willing to supervise them in offering buprenorphine.

Medication May Reduce Arrests in People With Opioid Use Disorder

Research indicates that people with opioid use disorder who are prescribed buprenorphine or methadone may be less likely likely to be arrested and incarcerated compared to those not taking the medication. The study, published in the journal Addiction, included 303 individuals who had entered three opioid treatment programs in California over a period of five years.

Addiction Treatment and Behavioral Health Solutions

BestNotes EHR, created for behavioral health and addiction treatment organizations, can help you improve care, track patient outcomes, and increase practice revenue. Contact us today to learn more.

date:  Apr 18, 2019
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