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Looking Forward to Value-Based Care in 2020

Value-based payment (VBP) models and value-based care have been difficult to implement, and behavioral health in particular has been slow to adopt VBP models. However, this year saw significant changes toward the implementation of VBP that providers should know about.

Key payers and providers, including the Centers for Medicare and Medicaid Services (CMS), announced in late 2018 that 48 percent of their business was finally tied to VBP models, according to Forbes. The Health Care Transformation Task Force is aiming for 75 percent of their respective businesses operating under VBP models by the end of 2020.

With that in mind, behavioral health and addiction treatment providers should be aware of significant developments in value-based care, and prepare for additional changes.

Value-Based Care Affects Healthcare Business and Financial Practices

The move to VBP has driven providers and healthcare organizations to rethink how they do business, operate efficiently, and control costs. As a result, the last few years have seen a rapid increase in healthcare mergers and acquisitions. Additionally, providers and health systems have been partnering with behavioral health organizations to expand their behavioral health or addiction treatment offerings in a cost-effective way.

In transitioning to VBP, providers are also rethinking how they work with payers. VBP models require payers and providers to agree on how much reimbursement is needed. Payers are encouraged to help providers choose the best care approach, while providers are encouraged to stay within their financial limits, while both sides work to reduce risk.

New Technology Will Influence Move to Value Based Care

As VBP encourages increased accuracy and healthcare savings, developers are demonstrating new technologies to help track health data. This includes digital therapeutics, a subset of digital health that leverages sophisticated software programs to help manage health conditions based on evidence-based interventions. Digital therapeutics could help patients with chronic conditions, including behavioral health concerns, follow treatment plans while supplying providers with more helpful data to guide those treatment plans.

Value Based Care Could Accelerate Under New Leadership

New leadership may also be key in encouraging the move to VBP models. This month, the Trump Administration chose Brad Smith to direct the Center for Medicare and Medicaid Innovation (CMMI). This agency was created by the Affordable Care Act and is tasked with testing and implementing healthcare payment and service models, especially those with a VBP focus.

Smith is former COO of insurance giant Anthem’s Diversified Business Group, and the co-founder and CEO of palliative care services company Aspire Health. In his new role, Smith will also be a senior advisor for value-based transformation to Department of Health and Human Services Secretary Alex Azar. Colleagues have noted that his experience in healthcare and entrepreneurship could help further the implementation of VBP models.

Prepare Your Practice for Value Based Care

The right EHR system is vital for behavioral health and addiction treatment providers looking to record and track patient data. Enter and track patient information accurately with BestNotes, a behavioral health EHR solution built specifically for your practice’s needs. Contact us today to learn more, or schedule a live demo.

date:  Jan 16, 2020
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National Behavioral Health and Addiction Treatment News of 2019

This year has seen a lot of significant developments in behavioral health and addiction treatment. Let’s take a look at some of the biggest stories that made headlines across the nation in 2019.

Multiple Opioid Lawsuit Results

In August 2019, an Oklahoma judge ruled that consumer healthcare company Johnson & Johnson helped encourage the state’s opioid crisis. Although the company was originally ordered to pay $572 million, a state district judge reduced that to a one-time payment of $465 million. However, an appeal filed in December 2019 argues that this amount is not enough to cover the state’s opioid abatement plan.

In October, pharmaceutical firm Teva and drug distributors AmerisourceBergen, Cardinal Health, and McKesson all settled with Ohio’s Cuyahoga and Summit counties in a lawsuit that alleged the companies recklessly prescribed and distributed opioid medications. Before the $260 million settlement, the lawsuit was widely expected to influence the results of more than 2,000 other opioid-related suits.

Concerns About Vaping and Tobacco Increase

Vaping and tobacco use received a lot of news coverage this year. Part of that coverage involved lawsuits against e-cigarette company JUUL Labs Inc., accusing the firm of deliberately targeting minors. In the fall, several cases of lung injuries associated with the use of vaping products were reported to the CDC.

Finally, on December 20, President Donald Trump signed a $1.4 trillion spending package that raised the federal legal age for purchasing tobacco from 18 to 21. The law, which includes the purchase of e-cigarettes and vaping cartridge, will take effect summer 2020.

FDA Approved Controversial New Depression Treatment

The U.S. Food and Drug Administration in March 2019 approved Spravato (esketamine) nasal spray, in conjunction with oral antidepressant, for treating depression in adults for whom other antidepressant medicines have been ineffective. Critics of esketamine have argued that, due to its similarities to ketamine, the medication has a high potential for abuse. Currently the treatment is highly restricted under a Risk Evaluation and Mitigation Strategy.

Mental Health Coverage Remains Limited Nationally

Research shows that more Americans are having difficulty finding affordable behavioral health treatment, although under a 2008 law, insurers are required to provide equal access for mental and physical health care. The limited affordability of behavioral healthcare accompanies rising rates of addiction, suicide, depression, and anxiety. This year, consulting company Milliman reported that patients are more likely to use out-of-network providers for behavioral health or substance abuse treatment than for other conditions.

NAATP Releases New Guidebook for Addiction Treatment Providers

This year, the National Association of Addiction Treatment Providers (NAATP) released The Addiction Treatment Provider Quality Assurance Guidebook: A Guide to the Core Competencies for the Delivery of Addiction Treatment Services. This Guidebook is part of the association’s efforts to protect addiction treatment consumers and improve addiction treatment quality. In case you missed it, we covered the new guidebook in more detail earlier in the BestNotes blog.

Happy new year from BestNotes!

Is your behavioral health and addiction treatment practice prepared for 2020? Whether you’re looking to switch EHR systems or implement EHR software for the first time, BestNotes is prepared to help you every step of the way. Contact us today to learn more about how to make 2020 your practice’s best year yet!

date:  Jan 06, 2020
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Functional Family Therapy: What it Is, and How to Use it

Children and teens have unique and often complex behavioral health needs. Functional family therapy (FFT) is often used to address behavioral concerns in juveniles aged 11-18 years. Here is an overview of FFT and how it works.

What does Functional Family Therapy involve?

Developed by Drs. James Alexander and Bruce Parsons, FTT is a short-term intervention that involves the whole family in addressing adolescent behavior problems.

FFT involves a series of five progressive phases:

Engagement: The therapist(s) work to demonstrate responsiveness and establish credibility with family members. Therapists are highly involved and available to the family, helping prevent youth and families from dropping out of the program.
Motivation: This phase encourages motivation and lasting change by working to reduce family hostility and blame, increase hope, and build healthier family relationships.
Assessment: The therapist helps identify patterns within a family through observation and questioning. This phase transitions from focusing on an individual problem to a more relational point of view. This helps prepare participants for the next phases of FTT.
Behavior Change: The therapist guides family members through communication training, parenting skills, and youth compliance and skill building. This helps improve family and individual functioning. This phase may include other therapeutic approaches, including cognitive-behavioral strategies.
Generalization: This final phase applies the improvements made in the Behavior Change phase to other areas. Therapists help participants plan for future challenges to prevent relapse. This phase often incorporates other community systems and members, such as probation officers or teachers, into the treatment process.

FTT usually lasts about 30 hours, in about 12-14 sessions over 3-5 months.

Proponents recommend that a team of master’s level therapists, under the oversight of a licensed clinical therapist, participate in this type of therapy.

All youths who participate in and complete FTT must also have at least one adult caregiver who is willing to be engaged in treatment and provide support during the process.

Who is Functional Family Therapy for?

Research indicates that FFT can help low- to high-risk youths with behavior problems and substance abuse. Individuals who participate in FFT also may have additional behavioral health concerns, including anxiety and depression.

FFT can benefit youth with multiple serious offenses, including felonies. FFT participants have been referred from multiple sources, such as juvenile justice, child welfare, mental health providers, and schools.

How effective is Functional Family Therapy?

Several studies have found that FTT is effective in reducing behavioral risk factors, substance use, and recidivism.

One Utah study found that families who participate in FFT significantly improved rates of reoffense and recidivism among serious delinquent youth. The same study found improvements in the juvenile court records of siblings of targeted youth, indicating that the family overall, beyond the targeted individuals, can benefit from FTT.

FFT has been endorsed by the Center for Disease Control and Prevention and the U.S. Department of Justice, according to Pennsylvania State University’s EPISCenter.

Does Your EHR Support Your Treatment Approach?

Behavioral health and addiction treatment providers usually offer different treatment approaches for different clients and conditions. Shouldn’t your EHR solution be just as flexible? BestNotes EHR solutions offer many customization options to help you work more effectively and improve profitability. Contact us today to learn more or schedule a demo.

date:  Dec 27, 2019
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Amid Opioid Epidemic, Rising Meth Use Gets Less Attention

As community leaders, health providers, and lawmakers work to address the nation’s ongoing opioid crisis, many parts of the United States are seeing a rise in other illicit substances. In many regions, this includes methamphetamine use and addiction.

Methamphetamine, or meth, is chemically similar to amphetamine, used in the treatment of narcolepsy or attention-deficit hyperactivity disorder. The illicit version of the drug is highly addictive, causing a strong high when meth is injected, smoked, or snorted.

Is meth use increasing in the United States?

Data from a variety of sources indicate a rise in meth use across the nation. For example, San Diego County officials reported that there were 483 unintentional methamphetamine-related deaths in the county in 2018. This is an increase from 368 in 2017, and a record high.

In Erie County, Pa., opioid overdose deaths have been declining after a peak in 2017. However, area law enforcement officials also report a regional rise in the use of crystal meth.

Although widely considered a rural problem, meth use is also reaching U.S. cities. The Wisconsin Department of Justice reported that about 300 cases of meth use were reported across the state in 2008. That rose to more than 1,200 in 2019, including a rise of meth use in the more populated Madison area.

Who is at risk of meth use?

Because meth is a stimulant that is believed to increase libido, its use has been associated with risky sexual behavior. This has led to a possible connection between meth use and increased risk of HIV.

Among youths who have used meth, researchers have found several potential risk factors:
History of other risky behaviors
History of a psychiatric disorder
Family environment and family history of drug use

Other risk factors that may contribute to the use of meth and other illicit substances, include:

History of trauma
Lack of healthy coping techniques
Multiple childhood psychiatric disorders

What are some challenges to treating meth use and addiction?

The greatest challenge in addressing meth addiction is the lack of a well-established treatment specifically for this condition. The effectiveness of current treatments are also highly variable.

Meth addiction is usually treated with a combination of medical detox, inpatient or outpatient treatment, and relapse prevention. One study suggests that the opioid antagonist naltrexone could help treat meth addiction.

Concurrent conditions are also common with meth use, creating additional challenges. Researchers at the University of Washington recently found that patients who receive treatment for opioid use disorder are more than twice as likely to drop out of treatment if they also use meth. In San Diego County, adult arrestees who have used meth are more likely to demonstrate some form of mental illness than those who do not have a history of the drug.

EHR for Behavioral Health and Addiction Treatment Providers

Substance abuse, including methamphetamine use, is complicated to treat. The right EHR solution can help you track patient progress and coordinate care with other specialists to help you and your clients achieve optimal results. BestNotes EHR software was designed with you in mind. Contact us today to learn more about how we can help strengthen your practice.

date:  Dec 19, 2019
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California Behavioral Health and Addiction Treatment News for December 2019

Across the nation, many states and communities are working to address a variety of behavioral health challenges. Here is some of the behavioral health and addiction treatment news making headlines in California.

Controversial California Law Could Force Conservatorship for Severe Behavioral Health and Substance Abuse

Under a law passed last year, the counties of San Francisco, Los Angeles, and San Diego can create conservatorships for a person with serious behavioral health or substance use disorders who cannot care for themselves. Los Angeles County is currently considering a plan to take guardianship over some homeless individuals and place them in mandatory treatment.

Earlier this year, San Francisco passed an ordinance to implement a similar program, although no individuals have yet been sent to treatment. The ACLU of Southern California has argued that this plan will not resolve the state’s homelessness problems. However, some community members support mandatory rehab for individuals with severe needs amid California’s increasing homelessness crisis.

Statewide “Warmline” May Help Prevent Mental Health Crises

The San Francisco Peer-Run Warm Line, first launched in 2014, has expanded throughout California. This expansion comes with a state budget allocation of $10.8 million for 3 years.

Compared to a crisis hotline, a warmline is intended to help individuals who need mental-health support but who are not in immediate crisis. By providing earlier intervention and emotional support, such as connecting individuals to behavioral health services, a warmline could help reduce the risk of an emergency hospital visit or ER call. However, they are a recent invention and their impact has not been thoroughly studied.

Southern California Opioid Fatalities Highest in Orange County

While the total number of opioid-related deaths has declined since 2016, Orange County still has the highest rate of opioid-related deaths in California. The county is also seeing an increase in heroin and fentanyl overdoses.

A county report, “Addressing the Opioid Crisis in Orange County,” found that overdose deaths are more common in areas with some of the highest concentrations of treatment centers. Additionally, many county addiction treatment centers do not offer medication-assisted treatment (MAT). While there is evidence for its effectiveness, MAT continues to face stigma and uncertainty among community members.

Despite Parity Laws, Mental Health Coverage Remains Limited

Consulting company Milliman recently issued a report that patients are much more likely to use out-of-network providers for behavioral health and addiction or substance abuse treatment than for other conditions. This disparity has increased since a previous study that Milliman published in 2017. For example, inpatient behavioral health care in California was 7.8 times more likely to be out-of-network.

Many Americans find it more difficult to find affordable behavioral health treatment, despite a 2008 law requiring insurers to provide equal access for mental and physical health care. The lack of affordability has become a nationwide concern amid rising rates of addiction, suicide, depression, and anxiety.

BestNotes Serves Behavioral Health and Addiction Treatment Providers in California

If you are a behavioral health and addiction treatment provider in California, you have a range of unique client and regulatory needs. BestNotes EHR and CRM solutions were designed with you in mind, offering customized options that help you improve care and streamline operations while staying up-to-date with regulatory changes. Contact us today to learn more or schedule a free demo.

date:  Dec 10, 2019
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