SBIRT Ad Hoc Committee Report

1. Presentation to the State Council on Alcohol and Other Drug Abuse June 7, 2013 SBIRT Ad Hoc Committee Report

2. Thank you… Duncan Shrout, Chair Pamela Bean Steven Dakai Michael Davis Nina Emerson Jay Ford Tom Fuchs Shel Gross Carol Hanneman-Garuz Claudia Roska Larry Miller Kevin Moore Rich Brown Joyce O’Donnell and the Planning & Funding Committee Ashleah Bennett

3. Wisconsin has an alcohol problem: 70% prevalence of monthly drinking 23% - 30% prevalence of binge drinking 1 million meet criteria for risky drinking 384,000 meet criteria for Alc Use Disorder 1 out of 20 in need of treatment receive it $6.8 billion annual cost from alcohol

4. SBIRT can provide needed prevention, early identification, intervention, and referral resources.

5. Screening  brief assessment Brief Intervention (protocol-guided, ~15 minutes) Referral to Treatment The SBIRT model:

6. S BI RT & Population Health Likely Dependent Problem Drinking Risky Drinking Normative Drinking

7. Wisconsin SBIRT (2006-2011) • 113,642 screens ~ 3% of the primary care population • 16,950 brief interventions • 1,101 referral conversations

8. Wisconsin SBIRT (Outcome Study, N = 675) • 20% reduction of risky drinking • 18% reduction of marijuana use • High patient satisfaction

9. 20% risky drinking is linked to… 20% emergency visits 33% injuries 37% hospital admissions 46% arrests 50% automobile crashes

10. SBIRT saves costs Medicaid ~ $170 million Businesses ~ $895 per employee ETF ~ $52 million

11. If SBIRT is so great, why aren’t health care providers delivering it? • Not enough time • Too many other initiatives - low priority • Lack of recognition that addressing patient AOD use is important • Not a big money maker

12. What would need to happen if SBIRT were to achieve large-scale implementation? • Implementation factors • Focus of services • Workforce • Financing

13. Implementation factors • Integrating SBIRT into clinic flow takes strategic planning • Robust quality improvement process • Implement quality and outcome measures • Develop linkages with treatment providers

14. Focus of SBIRT • Alcohol* • Illicit Drugs* • Tobacco* • Depression* • Diet • Exercise * Reimbursable service

15. A workforce is needed • Current health care professionals don’t have time • Employing paraprofessional “health educators” can be highly effective • Expanding the healthcare team • Training, education, and on-going professional development

16. Financing SBIRT • Medicaid – “effective reimbursement” • Commercial Insurance - ??? • Health care reform codifies SBIRT • Financial incentives may be needed (e.g., pay-for-performance)

17. Recommendations of the SBIRT Ad Hoc Committee relate to… • Coordination • Providers • Purchasers • Payers • Dissemination

18. Motions SCAODA accept the SBIRT Ad Hoc Committee Report dated May 1, 2013; SCAODA forward the accepted Report to the Wisconsin Council on Mental Health and the Wisconsin Council on Public Health for their information and further action; SCAODA forward the accepted Report to the Majority and Minority Leadership of the Wisconsin State Senate and Assembly for their information and further action; and SCAODA forward the accepted Report to Governor Scott Walker for his information and further action.