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CEO Update

CEO Update | 46

HHS Assesses Impact of Parity in Large Group Employer-Sponsored Insurance Market
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 had a “significant positive impact” on the frequency of outpatient services for both mental health and substance use disorder (SUD), HHS reported this week in Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market.

The 111-page report from the department’s assistant secretary for planning and evaluation office of disability, aging, and long-term care policy defined frequency as the average number of outpatient services used per service user. HHS concluded the magnitude of the law’s impact on SUD outpatient services was about 10 times larger than the magnitude for mental health outpatient services.

Meanwhile, the analysis found that while the 2008 law had a positive and significant impact on average spending by the insurer (for both mental health and SUD outpatient services) and the enrollee (for SUD outpatient services), there was little impact on enrollee cost sharing and no impact on reimbursement rates to providers. The report also evaluated the findings in the context of the nation’s ongoing opioid crisis

“The impact of MHPAEA on utilization of SUD outpatient services was not due to the OUD (opioid use disorder) epidemic,” the study said. “MHPAEA affected both OUD and other non-OUD SUD diagnosis groups in a similar way, increasing confidence that the changes observed at the point of parity implementation were due to parity and not to the OUD crisis,” it continued. “However, we did observe a greater magnitude of impact of MHPAEA for OUD outpatient services, suggesting that the influx of individuals with OUD diagnoses during the same timeframe as parity implementation interacted to some extent.”

CMS Updates Data for the Inpatient Psychiatric Facility Quality Reporting Program
The Centers for Medicare & Medicaid Services’ Hospital Compare website this week added six new measures to the Inpatient Psychiatric Facility Quality Reporting Program (IPFQRP).

Hospital Compare reports information on about 100 quality measures for more than 4,000 hospitals nationwide, including Veterans Administration (VA) medical centers and Department of Defense (DoD) military hospitals.

For questions about the IPFQRP, please e-mail the Hospital Inpatient Value, Incentives, and Quality Reporting Outreach and Education Support contract team through the Questions and Answers tool or call either of these toll-free numbers on weekdays between 8 a.m. and 8 p.m. ET: 844-472-4477, or 866-800-8765.

VA Helps Veterans Manage Chronic Pain Without Opioids
The Veterans Affairs (VA) Department’s new virtual reality program is helping the nation’s veterans manage chronic pain without opioids.

The program provides veterans with different medical issues—including traumatic brain injury, spinal cord injury, stroke, amputations, or Amyotrophic Lateral Sclerosis (ALS)—with an alternative to using drugs such as opioids. Instead, veterans use a virtual reality headset or a large monitor screen to experience virtual scenic settings with music and narration.

“Virtual reality is able to take the user someplace else they’d rather be,” Jamie Kaplan, a recreational therapist at the VA, said in a blog post. “For example, virtual games and activities can allow the wheelchair use to experience freedom from the limitations they face in everyday life.”

Click here to learn more about the VA’s Recreation Therapy Service.

JAMA Article Studies Geographical Distribution of Opioid-Related Mortality Nationwide
Opioid-related mortality—driven by the use of synthetic opioids—has increased rapidly in all of the nation’s eastern states, according to a new study in JAMA.

In an analysis of more than 350,000 U.S. residents who died from opioid-related causes, the age-standardized mortality rate from opioids increased more than two-fold every two years in 24 eastern states, reflecting an expansion from lower-income, rural states, the study found. Researchers examined deaths that involved any opioid, heroin, synthetic opioids, and natural and semisynthetic opioids.

“Our findings indicate that policies focused on reducing opioid-related deaths may need to prioritize synthetic opioids and rapidly expanding epidemics in northeastern states,” researchers noted in the study, “and consider the potential for synthetic opioid epidemics outside of the heroin supply.”

AAP Examines Nonmedical Prescription Opioid Use in Parents and Adolescents
Parent-based interventions targeted toward adolescent, nonmedical prescription opioid use should address parental nonmedical prescription opioid use and smoking, and promote positive parenting, the American Academy of Pediatrics (AAP) reported this week in the journal Pediatrics.

According to the AAP, this study is the first to examine intergenerational patterns of nonmedical prescription opioid use. Data came from 35,000 parent-child dyads with an adolescent between the ages of 12 and 17 between 2004 and 2012 from the National Surveys on Drug Use and Health.

Scientists found that associations between parental and adolescent nonmedical prescription opioid use did not differ by adolescent sex or race and/or ethnicity. However, parental lifetime smoking, low monitoring, and parent-adolescent conflict were “uniquely associated with adolescent nonmedical prescription opioid use, as were adolescent smoking, marijuana use, depression, delinquency, and perceived schoolmates’ drug use.”

Register Today for the 2019 NABH Annual Meeting!

The 2019 NABH Annual Meeting is two weeks away! Please register today if you haven’t done so yet.
For complete Annual Meeting details, including preliminary program and speaker information, please visit NABH’s Annual Meeting homepage.

For questions or comments about CEO Update, please contact Jessica Zigmond.

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CEO Update | 45

Commonwealth Fund Summarizes Care Programs for Patients with Complex Needs
The Commonwealth Fund has released a Quick Reference Guide to Promising Care Models for Patients with Complex Needs, which summarizes the target populations and key features of 28 care models for adults with complex needs, including behavioral health.

This guide was updated this year using the original version of the Quick Reference Guide that was developed in December 2016, data from a survey that the Center for Health Care Strategies conducted for the Better Care Playbook’s State Map, and literature searches.

The Commonwealth Fund included models that targeted adults with complex needs; provided at least one element of patient-centered care; and had strong, moderate, or promising evidence on at least one outcome related to quality, utilization, or cost.

Massachusetts to Help Test New Addiction Treatment Rating System
Massachusetts will participate in a new rating system developed to measure the quality of addiction treatment programs, the Associated Press reported earlier this week.

Health officials for the commonwealth said the rating system will use data from insurance claims, provider surveys, and consumer-experience surveys. The information will be made public to those seeking addiction treatment, as well as to public and private payers, states, and referral sources.

The national not-for-profit organization Shatterproof is developing the rating system. If successful, the pilot program will be launched nationwide.

Pew Research Center Reports Teens See Anxiety, Depression Among Their Peers
Seven in 10 teens today see anxiety and depression as major problems among their peers, says a new report from the Pew Research Center.

Anxiety and depression top the list of problems teens see among their peers, ahead of bullying, drug addiction, alcohol, poverty, teen pregnancy, and gangs, according to the survey of U.S. teens between the ages of 13 and 17.

The study also noted that mental health concerns cross income boundaries, while teen pregnancy is seen as a much bigger problems by teens in lower-income households.

Stanford Study Finds Opioids Less Effective for Patients on SSRI Antidepressants
Patients who take the most common form of antidepressant and are given the most widely prescribed opioid experience less pain relief, according to a study this month from the Stanford University School of Medicine.

Researchers say the finding could help address the nation’s opioid crisis because poorly managed pain may lead to opioid misuse. The study noted that as many as 1 in 6 American takes antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Stanford’s research team found that SSRIs reduce the effectiveness of hydrocodone and codeine, which are often prescribed to patients who recently had surgery.

“This research is part of our effort to find ways to combat the opioid epidemic,” Tina Hernandez-Boussard, Ph.D., M.P.H., associate professor of medicine, of biomedical data science, and of surgery at Stanford, said in a statement. “We’re very interested in identifying how we can reduce opioid exposure while still managing patients’ pain.”

CMS Presents Podcast Series to Inform Broader Audience
The Centers for Medicare & Medicaid Services (CMS) this week presented CMS: Beyond the Policy, a new podcast series intended to provide important, timely information to a broad audience.

Through its outreach and education, CMS learned from physicians that a podcast would be an effective way to present important and up-to-date information. The first episode in the series focuses on evaluation and management coding, and the agency will release new episodes in the coming months that highlight the agency’s new proposals, policies, and programs.

HRSA Expects to Release Up to 10 percent of Nurse Corps Repayment Program Awards to Psychiatric Nurses
In 2019 the Health Resources and Services Administration’s (HRSA) Nurse Corps Repayment Program expects to make up to 10 percent of loan repayment awards to psychiatric nurse practitioners, the skilled specialists helping to address the nation’s opioid crisis.

The repayment program supports registered nurses, advanced practice registered nurses, and nurse faculty by paying up to 85 percent of their unpaid nursing education debt. In return, participants must serve for at least two years at a healthcare facility with a critical shortage of nurses, or, for nurse faculty, at an eligible school of nursing.

HRSA will accept applications for its Nurse Corps Loan Repayment Program through March 28. Click here for more information.

Remember to Register for the 2019 NABH Annual Meeting!
Please register today for the 2019 NABH Annual Meeting if you haven’t yet! For complete Annual Meeting details, including preliminary program and speaker information, please visit NABH’s Annual Meeting homepage.

For questions or comments about CEO Update, please contact Jessica Zigmond.

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CEO Update | 39

NEJM Article Reinforces Themes from NABH’s ‘Pathways to Care’ White Paper
In a recent issue of The New England Journal of Medicine, authors of a study about the nation’s emergency departments echoed similar themes and recommendations that NABH provides in Pathways to Care: Treating Opioid and Substance Use Disorders.

In their article “Emergency Departments—A 24/7/365 Option for Combating the Opioid Crisis,” Gail D’Onofrio, M.D. and Kathryn Hawk, M.D., M.H.S. of the Yale University School of Medicine, along with Ryan P. McCormack, M.D. of the New York University School of Medicine, recommend encouraging emergency departments to initiate buprenorphine as well as establish relationships with community treatment providers to expedite treatment referrals.

Meanwhile, D’Onofrio notes that providing buprenorphine in the emergency department can reduce withdrawal within 20 minutes, thereby supporting adherence to a 60-90 minute benchmark for discharge in urgent care settings; buprenorphine can reduce violence in the emergency department that may result from the irritability of withdrawal; emergency departments that provide services/medications for opioid use disorder have not seen an influx of new patients, which helps alleviate concerns that patients might overuse the nation’s emergency departments as portals to treatment; and, lastly, that momentum is growing for hospitals to open clinics to continue emergency department-initiated medication treatment.
Vaping the Most Common Use of Any Tobacco-Like Product Among Adolescents in 2017
Vaping was the most common use of any tobacco-like product among adolescents in 2017, reflecting a rapid increase from a near-zero prevalence of vaping in 2011, according to a recent analysis from researchers at the University of Michigan and University of Minnesota.

Data for the study came from Monitoring the Future, which surveys nationally representative independent samples of students in the 8th, 10th, and 12th grades each year. The study’s authors wrote about their findings in a recent letter to the editor of The New England Journal of Medicine.

“The rapid entry of new vaping devices on the market, the latest example of which is the Juul, will require continual updates and modification of strategies to keep adolescents from vaping and its associated negative health effects,” the authors noted.

Register Now for National Drug and Alcohol Facts Week
There is still time to register for National Drug and Alcohol Facts Week, which connects students with scientists and other experts to counteract myths about drugs and alcohol.

This year’s National Drug and Alcohol Facts Week will be held from Jan. 22 through Jan. 27, with a Chat Day scheduled for Jan. 24.

Click here to learn more and register an event.

NABH Immediate Past Board Chair Brent Turner Provides Year in Review for 2018
The SUPPORT for Patients and Communities Act, NABH’s Pathways to Care white paper, and the association’s rebrand were among the industry highlights and association improvements that 2018 Board Chair Brent Turner highlighted this week in his Year in Review for members.

“We still have more work to do to repeal the IMD exclusion completely. At the same time, we should be proud of the work we have done individually and collectively on this issue since 2013,” wrote Turner, president of Acadia Healthcare. “Back then, some industry stakeholders opposed changes to the IMD because they argued it would lead to less community-based care and more institutionalized care. By 2018, many more people recognized that patients need access to the full behavioral healthcare continuum, from inpatient to residential to outpatient care,” he continued. “NABH has been at the forefront advocating this message to policymakers, and the message is getting through.”

Turner completed his term as Board Chair on Dec. 31. Pat Hammer, president and CEO of Rogers Behavioral Health, succeeded him as 2019 Board Chair on Jan. 1.

2019 NABH Exhibitor & Sponsor Guide Ad Deadline is One Week Away!
The deadline to place an ad about your organization in the 2019 NABH Exhibitor & Sponsor Guide is next Friday, January 18.

Download the 2019 Advertising Opportunities form and reserve space now. For questions, please contact Maria Merlie at 202.393.6700 (ext. 104), or ( And for more details about the 2019 NABH Annual Meeting, please visit NABH’s Annual Meeting homepage.

We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019!

NABH Establishes Managed Care Committee
NABH has established a Managed Care Committee to address the behavioral healthcare industry’s growing concern that health plans are micromanaging behavioral health services so intensely that they are restricting patient access to medically necessary care.

The new committee will work with the NABH Board and management team—as well as external consultants who specialize in health plans, regulations, and the parity law—to develop a focused strategy that addresses this issue.

Click on NABH’s Managed Care Committee webpage to learn more and to see a list of committee members.

For questions or comments about CEO Update, please contact Jessica Zigmond.

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