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Medicaid Tech as Tool to Fight Opioid Crisis- New CMS Incentives

CMS sent a new State Medicaid Director letter (read it here) in early June to help agencies understand options to use federal funding to fight opioid addiction with tech. There is particular emphasis on using the dollars to integrate the systems docs use to identify doctor-shopping for pills (Prescription Drug Monitoring Programs, or PDMPs) into other EHR-systems. The idea is to reduce the steps a doctor has to take to check for abuse if they suspect the patient is an addict and attempting to get opioids illegally.


Here’s a good writeup at Health Data Management

Here’s another good writeup, with more discussion of CMS’s goal of using telehealth to address Neonatal Abstinence Syndrome (NAS) over at mHealth

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Fight crime by treating substance abuse

The article below originally appeared in the Baltimore Sun. Reprinted with kind permission from the author Dr. Dan Morhaim (whom I had the good fortune of working with years ago in Maryland – Clay F)


– Dan K. Morhaim

On March 27, in a House Judiciary Committee hearing, I asked Baltimore County State’s Attorney Scott Shellenberger what percentage of crime in Baltimore County was due to drugs. His answer: “Upwards of 85 percent.” I then asked Baltimore City Police Major Byron Conaway the same question, and his answer was “90 percent.”

As an E.R. doctor, I ask my patients who are substance abusers where they get the $50 a day needed to sustain their habit. Many get others hooked because then those new users become paying customers. There’s also petty crime, prostitution and the major crimes that plague our streets and neighborhoods.

If we are to be serious about reducing crime, then the focus must be on preventing and treating substance abuse. New multi-faceted policies are needed, both in the criminal justice system and in health care.

There is no point in saddling people arrested with small amounts of drugs with a misdemeanor conviction. Instead, users should be provided treatment instead of a criminal record that will haunt them for the rest of their lives. (The small number of people convicted of repeat violent crime felonies, however — especially with firearms — need to be vigorously prosecuted and incarcerated for extended periods.)

Substance abuse treatment ought to be immediately available, 24/7/365, and one of the best places to initiate this is in hospital emergency rooms. Persons with substance abuse disorders already show up in E.R.s for a wide variety of health issues, so why not routinely include drug treatment as part of the care? Treatment plans should be individualized, just as is done for all other medical conditions. Some patients may need long term care, others medicated assistance treatment (e.g. methadone, buprenorphine) and others faith-based approach. One size does not fit all.

Supervised consumption facilities also have been shown to work, reducing deaths, addiction, discarded needles and crime. It may seem to some that this idea condones substance abuse, but the data showing success cannot be denied. It is shortsighted to dismiss this option without seriously considering it first.

Among other efforts we should make: find ways to dispose of all medications safely, especially opioids; make naloxone more available to at least avoid some overdose deaths; allow people go to fire or police stations when they need help without fear of penalty; use methods other than narcotics to treat pain unless absolutely necessary; continue public education regarding substance use, especially in schools.

How can we afford to do this? The real question is how can we afford not to? There are about 30,000 daily drug users in the Baltimore metro area. At an average cost of $50 per day to sustain a habit, that means that $1.5 million per day — or $547 million per year — is spent solely to buy drugs. Statewide, Marylanders spend about $800 million per year on illegal drugs. Then there all the other costs in health care; the criminal justice system; and harm to families, victims, businesses and neighborhoods.

Where does all that money go? Ultimately, it goes to dangerous and violent overseas drug cartels and terrorist organizations, like ISIS and al-Qaida. We’ve been on a policy trajectory that is destroying our society from the inside while shipping vast sums of money to those who would destroy us from the outside.

The economics of the drug war now define the economic activity of many communities. Re-directing “drug money” to legitimate businesses and education would bring jobs, income and safety.

Imagine if only 10 percent or 20 percent of daily users got into treatment today, an achievable goal. Overnight the health care and criminal justice system would be decompressed because those now in treatment would tomorrow not be seeking money for drugs.

Of course, there’s a deeper question that must be confronted: Why do so many of us turn to drugs? Perhaps our focus on material wealth, our endless distractions via media, the daily stress most people endure, hurtful behaviors spanning generations and the emphasis on the individual over community leave too many of us feeling isolated, angry and unfulfilled. As author Johann Hari observed: “The opposite of addiction isn’t just sobriety; it is connection.”
But we’ve got to start somewhere.

Dan K. Morhaim is a physician and Democrat representing Baltimore County in the Maryland House of Delegates. His email is

Copyright © 2018, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad

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Medicaid Who’s Who Interview: John Corlett

1. Which segment of the industry are you currently involved?

A:  I lead a Cleveland based “think tank” called the Center for Community Solutions. Community Solutions among other things works to support cost effective Medicaid policy through non-partisan research, analysis and advocacy.

2. How many years have you been in the Medicaid industry?

I’ve worked in this space for nearly two decades, first as a researcher and policy advocate and then as President of Community Solutions, as an Ohio Medicaid Director, and as the Medicaid and governmental policy Vice President for Ohio’s largest public hospital – the MetroHealth System.

3. What is your focus/passion? (Industry related or not)

My work passion is getting more people and organizations engaged in policy advocacy. My personal passions focus on my Cleveland neighborhood and the great Cleveland food and cultural scene.

4. What is the top item on your “bucket list?”

Visit Cape Town, South Africa

5. What do you enjoy doing most with your personal time?

Spending time with my partner, friends, and family.

6. Who is your favorite historical figure and why?

Martin Luther King because of he showed how one person could change a country and because he led the fight for justice and racial equality. He was a brilliant and inspiring orator who continues to inspire new generations even 50 years after his assassination. Finally his courage and commitment to non-violence even in the face of physical attack and threats.

7. What is your favorite junk food?


8. Of what accomplishment are you most proud?

Working with the State of Ohio, CMS, Cuyahoga County, and the MetroHealth System to get an 1115 waiver approved that expanded Medicaid in Cuyahoga County a year early and provided health care coverage to over 30,000 uninsured adults.

9. For what one thing do you wish you could get a mulligan?

While I was Medicaid Director, during the Great Recession, we focused most of our attention on expansion proposals for different categories of individuals which impacted relatively small numbers. Looking back it would have been much better to have focused on simplification measures that would have affected many more people and kept more people covered longer. I also wish I could have focused more on ways to leverage Medicaid to address social determinants of health.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

November general election results, in many cases (including Ohio), will determine future of state Medicaid expansions. If CMS changes in Medicaid eligibility (e.g. work requirements, et al) are allowed to proceed we will need to pay careful attention to how they are implemented. Expect to see some states pursue a “Medicaid for all” option via a 1332 waiver.

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Be on the Lookout for Results in Michigan Opioid Efforts: Leveraging Medicaid Data to Combat Opioid Addiction

The following info was provided by our friends at Levick Partners. CNSI and IBM just teamed up in Michigan on a tech solution to address opioid addiction.


How predictive analytics can fight the opioid epidemic within the Medicaid population

By Sharif Hussein, CNSI Chief Strategy Officer & President of Health & Human Services


May is Mental Health Awareness Month, which gives lawmakers, government officials, and healthcare experts an opportunity to reflect on the most pressing mental health issues. The stigma associated with mental illness has long prevented the issue from receiving the attention it deserves.


The opioid epidemic is certainly top-of-mind this year, ravaging communities, destroying lives, and killing Americans daily. The staggering statistics associated with opioid abuse have made addressing this epidemic a top priority for almost every Medicaid agency in the country. With more than 115 Americans dying every day from opioids, this epidemic, and the mental health issues that help fuel it, have become too great to ignore.


Now is the time for the health IT community and Medicaid agencies to work together to solve the problem. The Medicaid industry is not alone in the fight – and the only way to combat this growing epidemic is to join forces. If we leverage the data provided by the Medicaid community and the technology developed within the health IT community, we give ourselves a fighting chance to finally tackle this public health crisis.


As the Medicaid community knows all too well, the hundreds of thousands of prescriptions Medicaid beneficiaries are prescribed every day are routed through insurers, resulting in a trove of data. We can use this information to identify where, when, and how opioid abuse is occurring or—better yet—likely to occur. The problem with this data is that the technology to analyze that much information didn’t exist—until now.


CNSI and IBM Watson Health teamed up with the State of Michigan to develop an addiction-identification tool that sorts through health information datasets in Medicaid claims to identify outliers that may be indicative of addictive behavior – such as mental health-related diagnoses, frequent visits to several pharmacies and prescribers, or early prescription refills. By combining the Medicaid administrative data with pharmacy and clinical datasets, the solution can find patterns of opioid abusers at both the client and prescriber level.


Even more, this solution can be used to identify when a patient is most likely to succumb to addiction – ideally preventing an addiction before it even begins.


With reports showing Medicaid beneficiaries are 10 times more likely to abuse substances than the general population, this sort of predictive analytics can be key to solving the growing opioid epidemic. It’s time we focused on how our two industries can play a role in solving the crisis.


Mental illnesses can be incredibly difficult to treat but opioid addiction is preventable. With solutions like the one in Michigan, we can ensure more people get the help they need before they become another casualty.


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May is Mental Health Month…So What…? 13 things to know about Mental Health and Medicaid this May

John Tote, Vice President of Behavioral Health Solutions


  1. May 2018, just like dozens of Mays before, is celebrating and commemorating the 31 days of May as Mental Health Month. So What…?
  2. Millions of people across the United States-indeed, throughout the world-experience mental illness. So What…?
  3. The prevalence rate for mental illness is more than other major health issues combined such as cancer, heart disease, diabetes, etc. So What…?
  4. Mental illness is extremely treatable and, in many cases, preventable-yet we see prevention and treatment funded by governing bodies and others at rates many times less than other major health issues. So What…?
  5. Mental illness serves as a major driver of emergency and other hospital costs because of poor community care-often an astounding lack of integrated care that serves the whole person causing mental illness and other health issues to go un or under-treated. So What…?
  6. While the stigma surrounding mental illness has been reduced somewhat…it still is extremely high and totally unwarranted. So What…?
  7. The general term for mental health treatment in the broader healthcare arena is ‘behavioral’ health care-relegating a significant, though treatable, disease to a self-inflicted character flaw. So What…?
  8. Often times this insidious disease strikes young people as they are just beginning the crucial transition of life from adolescence to adulthood…often times seeing their parents and others in their care and support network aging and preparing for their retirement-leaving hopes and dreams to be re-spun and resources recalibrated. So What…?
  9. People with mental illness are often portrayed in the media-both on commercial shows and so-called journalistic programs-as always being violent, unstable, and untrustworthy…when the reality is individuals living with mental illness are up to 19 times (times, not percent!) more likely to have violence perpetrated against them rather than they themselves being violent in some way. So What…?
  10. Though resources and training are widely available, law enforcement rarely takes the time to understand this condition, which is not a criminal offense, but an illness, and could save millions of dollars and significant trauma for the communities they serve around the country. So What…?
  11. Living with mental illness is simply one aspect of a person’s life…they may be athletic, artistic, a computer whiz, a gardener, a wine connoisseur, and much more…but often, it is their illness that society focuses on to the detriment of all. So What…?
  12. Significant gains have been made in the treatment of individuals with mental illness…in many cases more advancement in the treatment and the technology of treatment of mental illness have been achieved than many other major health areas combined-but somehow that information gets little play and air time. So What…?
  13. Mental illness is a terrible health condition…but one that is treatable and, again, often preventable…treatment works and hope is real. So What…?

The question posed throughout is one worth asking based on all the highlighted features of mental illness in this May is Mental Health Month Mostly Medicaid note…  So What…?
We all must answer this question…during this month and beyond…

However, what we truly must do is fill in the rest of the question…and in reality, number 14 on our list…

So What do I do now that I know?

Mostly Medicaid is proud to celebrate May as Mental Health Month and proud to stand with the men, women, and children and their families experiencing a mental health condition.  We’re here with you and for you…and we’re here for those of you in a provider or payer agency struggling with mental health and Medicaid issues…call anytime, we would love to help!

Let’s work together to answer that question for ourselves, our loved ones, our communities…

Let’s truly celebrate May as Mental Health Month in 2018 and make a difference in someone’s life…perhaps even our own.

Until next time, all the best and much Peace-John Tote


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Monday Morning Medicaid Must Reads: April 30th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment, KFF, Julia Zur, April 11, 2018

Clay’s summary: A good primer on the demographics and coverage patterns for those hit hardest by the Opioid epidemic. Some of the findings may surprise you – almost 2M Americans are addicted to opioids.

Key Passage from the Article

Medicaid covers a disproportionate share of nonelderly adults with opioid addiction, and an even greater share of those with low incomes. In 2016, nearly 4 in 10 (38%) were covered by Medicaid and a similar share (37%) had private insurance. Approximately 1 in 6 (17%) was uninsured (Figure 3). Low-income nonelderly adults with opioid addiction are typically less likely than adults with higher incomes to have jobs that offer health insurance.8 In 2016, over half (55%) were covered by Medicaid, while only 13% had private insurance. Nearly 1 in 4 (24%) were uninsured (Figure 3), although if they lived in states that expanded Medicaid, they would likely be eligible for coverage.

Read it here 

Article 2:   

When it comes to the opioid crisis, Medicaid is part of the solution, Eric Blevins, Richmond Times Dispatch, April 26, 2018

Clay’s summary: Good perspective from a recovering Opioid addict.

Key Passage from the Article

As Virginia legislators consider Medicaid expansion, we need to keep in mind the important role it plays in addressing the opioid epidemic. I live in Southwest Virginia, and I’ve been dealing with addiction since I was 12 years old. It didn’t start out with opioids, but by my 20s I was a heavy opioid user, taking high doses daily just to avoid withdrawal.

Recovery from opioid addiction is never an easy road, especially when you live in a small, rural town like mine. Where I live, there are only two choices for mental health treatment. Neither one specializes in treatment for substance use disorders.

 It becomes much harder when you don’t have health care. Even my family doctor had to stop seeing me because I didn’t have health insurance and couldn’t cover my medical bills. More than once, I was prescribed medications that I couldn’t afford and sent on my way. I’m still trying to pay off a $1,200 bill from my last hospitalization.

Read it here




Article 3:   

GOP panel proposes lifting Medicaid limits on opioid care, Peter Sullivan, April 5, 2018

Clay’s summary: Dems want to look good supporting the fix to the opioid crisis – but don’t want to pay for it with cuts to other programs.

Key Passage from the Article

Republicans on the House Energy and Commerce Committee on Wednesday night unveiled a proposal to lift limits on Medicaid paying for opioid treatment.

The proposal could be one of the more significant and costly steps that Congress takes to fight the opioid epidemic, but there are concerns about how to pay for it. Members of both parties have called for lifting these limits on Medicaid paying for treatment at facilities with more than 16 beds, saying they are a major barrier to care as lawmakers work on a package of opioid bills that could reach the House floor by Memorial Day.

Read it here


Article 4:   

Congressional Hearings Examine Medicare, Medicaid Opioid Crisis Roles, Patrick Connole, Provider Magazine, April 13, 2018

Clay’s summary: A lot of new regulations on physician prescribing behavior will be out soon. Why were they not there before?

Key Passage from the Article

The key witness to appear before the panel was Kimberly Brandt, principal deputy administrator for operations, Centers for Medicare & Medicaid Services (CMS), who told lawmakers that the number of Americans struggling with an opioid use disorder (OUD) is staggering.
“In 2016 alone, nearly 64,000 Americans died from drug overdoses, the majority (over 42,000) of them involved opioids,” she said.
Brandt said CMS recently finalized a series of changes for 2019 to further the goal of preventing OUDs. To reduce the potential for chronic opioid use or misuse, beginning in 2019, the agency expects all Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a seven days’ supply. 
“This policy change is consistent with the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain that states that opioids prescribed for acute pain in most cases should be limited to three days or fewer, and that more than a seven-day supply is rarely necessary,” she said.

Read it here



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Data Set Review: Substance Abuse and Mental Health Data Archive (SAMHDA)

About Mostly Medicaid Data Set Reviews Our data set reviews look at publicly available data sets and tools to help readers get an idea of what can be done with the data out there. Each data set is reviewed along the same elements to identify timeframes, indicators available and general source information. 

Data Set Reviewed: SAMHSA  Substance Abuse and Mental Health Data Archive (SAMHDA)


What you can do with this data

Run crosstabs of variables included in different surveys about drug use and health. There are dozens of variables you can explore.

To give an example, I looked at the relationship between people who had “ever smoked a cigarette” and whether they had ever used OxyContin without doctors orders. Here’s the result:



Public health surveys.

Overall assessment

Its a very powerful data set and the tool is easy to use. If you are looking to explore trends and relationships in the behavioral health space, I highly recommend it.

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Are we still talking about ‘integrated care’? Where are we and what’s going on…

Entering the health and human service world for my vocation, some 30+ years ago, one of the first expressions I heard was ‘co-location’…’we have to have co-location of services’. Being new to the mental health arena, but having listened to the rational for such a concept, I thought…’of course, this makes sense-we should have mental health and physical health care joined…and if they’re in the same place, all the better’!

So…here we are 30+ years later and now it is ‘integrated care’…’we need to take care of the whole person’. Wow…what a long way we have not come! So…why haven’t we moved very far…and how do we get moving now?

Well…there are many reasons for the ‘why haven’t we moved far’ question. Some reasons are understandable-like we live in a highly specialized healthcare world and not many areas truly talk to each other…other reasons are less-understandable…like turf wars and cross-purpose and often pathetic funding for vital services.

The need still exists though-we still need ‘Total Person’ care…we must make sure each individual has all the needs addressed. ‘Well…of course, we do’, you say, but it still is easier said than done. So what is needed structurally or otherwise to make ‘integrated care’ more than just a slogan.

First, there needs to be an understanding of who will do what, where, why, and how. Sounds like Journalism 101…and in some ways, it is. The mental health, intellectual/developmental disability, and substance use disorder world (MH/IDD/SUD-sometimes generically referred to as behavioral health-BH) can look to the overall physical healthcare world for examples of what is happening globally. The size of the specialty care world seems to grow each day. MH/IDD/SUD can see itself as one of those specialty care provider areas-and physical healthcare will be truly grateful for the relationship and assistance that can come from the BH world. However, the BH world must concisely and precisely define what it does and how so that the general healthcare world sees it as a crucial partner for the good of all served-whether someone has a specific disability or diagnosis…or is simply in need of additional supports and services.

Second, there needs to be a clear understanding of who the hub provider for the individual being served is and who the spokes are…in common terms today, we are talking about the ‘medical home’. Rarely are all providers of any type serving one individual effectively linked-whether that’s through an electronic health record or other means. However, via a medical home/hub and spoke model, the communication can be made much simpler and effective. We’ll be looking at this concept more in-depth in upcoming posts.

So who is doing this right? There are actually several great examples of States, regional authorities, and local areas doing amazing work in the area of integrated care. Over the coming months, we’ll be featuring initiatives by States such as Indiana, regional authorities one in the Piedmont and Foothills of North Carolina, and the work of organizations and agencies like Fountain Model Clubhouse programs for adults with mental illness and co-occurring illness. Clubhouses have long been a leader in Total Person care, but have rarely seen their model and influence move to a larger platform within the healthcare environment. We’ll look at the dynamics that have hindered that broader impact. Finally, we’ll be hearing from some leaders and some front line folks in the world of behavioral health and get their perspectives on where we are with integrated care and how we can truly get to the next level.

Stay tuned…there’s a lot to look at…and we’ll want you along for the whole ride-and we’ll want to hear your views as well! Until then, all the best…and here’s to each, Total, one of us!
John Tote

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Key Reads in Behavioral Health: Week of March 12, 2018

Here are a few key articles I found to be important in the past week or so: