Ask the Expert
Recovery and the Health Care/Insurance Systems: Improving Treatment and Increasing Access
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Ask the Expert:
Renata Henry, M.Ed., Deputy Secretary for Behavioral Health and Disabilities, at the Maryland Department of Health and Mental Hygiene
- What challenges have you encountered in your move from a small state such as Delaware to a much larger state system in Maryland? Are there processes in Delaware that you would like to implement in Maryland?
Answer: Besides learning a lot of new faces and names, the most dramatic change is the structure. Maryland is a county-based state, while Delaware did not have a county health structure. The difference is in the role of the State Behavioral Health Agency vis-à-vis the provider system. In Delaware, I had significant direct contact with the provider system, in Maryland we are “once removed” from direct involvement with the provider network. That being said, I believe it is critical for the provider system to have significant relationships with each other, so I am working on a regional basis to get providers in the same room to share my vision and direction, discuss system strengths, and problem solve.
- Building off your experiences in Delaware, have you implemented performance-based contracting for addiction services in Maryland?
Answer: The Alcohol and Drug Administration has some limited performance based contracts in place. We will be working to encourage the local jurisdictions to put performance based contracts in place with their providers.
- The current fiscal crisis is affecting behavioral health services across the country. In Pennsylvania we are challenged to find creative ways to provide opportunities for substance abuse and addiction recovery with less treatment dollars. I am interested in how Maryland is meeting this challenge - any new ideas for triage responses to what we see as a crisis of care.
Answer: We are all going to be challenged in the next two years with limited and dwindling resources. I encourage everyone to be involved in the solution to doing more with less, providers as well as bureaucrats. Where can we gain economies and efficiencies, particularly in administrative functions? Another area to explore is developing more peer supports to help consumers maintain their wellness and remain out of the higher levels of care.
- How is Maryland transforming its system to become more recovery-oriented? What systemic changes, trainings, consensus building is the state going through to become more recovery-oriented and implement a recovery-oriented system of care.
Answer: The Maryland State Drug and Alcohol Council has endorsed the implementation of ROSC. We are currently in the process of completing a strategic implementation plan.
- Given the current fiscal crisis, how is Maryland going to pay for services covered under the Wellstone Act? Have you worked with other state’s systems to learn from their experiences on how to cover addictions and mental health services with parity to general health care services?
Answer: Maryland has expanded the population covered by Medicaid (Primary Adult Care) and increased the substance abuse benefit. We continue to find ways to maximize federal funding sources as a mechanism.
- With the approval of CPT codes for screening and brief intervention services and given the limited education primary care and other general health providers receive regarding addiction services, has Maryland provided and required trainings for its publically contracted primary care providers on screening and brief intervention? Has Maryland provided other addictions education services to general health care providers?
Answer: An active and excellent partnership exists between the network of Federally Qualified Healthcare Centers and the ADAA in the area of buphrenophine. We are growing that partnership to include addiction and mental health screening, services and training. Look for us to hold a FQHC/ADAA summit in 2010 as a result of this partnership. The goal is to educate the providers on integration models. We hope to showcase effective programs, share research, and ultimately increase our primary care/behavioral health networks.