A Plan to Reform and Realign Virginia’s Behavioral Health Care System
2017 Republican gubernatorial nominee Ed Gillespie today released a detailed, substantive plan to improve Virginia’s behavioral health system and address all facets of the opioid and heroin addiction crisis, including prevention, intervention, treatment and recovery. This is Gillespie’s fifth major policy rollout in his campaign, and the first since becoming his party’s nominee.
“Thousands of Virginians are facing challenges with mental illness and addiction, and too many of them are struggling to find treatment and recovery,” said Gillespie. “My plan will strengthen our mental and behavioral health services and fight the opioid epidemic that has swept across our Commonwealth. As governor, I will work every day to ensure my fellow Virginians facing behavioral and substance abuse disorders receive the care they deserve, and I will work to prevent addiction, provide intervention and welcome those seeking recovery with open arms.”
Hundreds of thousands of Virginians are dealing with a serious mental illness, and many more are dealing with a mental, behavioral, or emotional disorder, oftentimes from behind bars in Virginia’s jails and prisons. Gillespie’s plan is centered on five key principles: 1. Addiction is a disease, not a moral failing; 2. A focus on intervention; 3. We cannot arrest our way out of the epidemic of addiction; 4. There are multiple pathways to recovery; and 5. Help must be immediate.
Honorary Policy Chair and former governor George Allen praised the plan, saying, “Ed Gillespie has put forward a comprehensive plan to address serious challenges facing Virginians in our behavioral health system. Bottom line: this is a most credible, serious understanding of the challenges and a thoughtful path forward.”
“I’ve seen many gubernatorial candidates advance plans to problems that vex our communities,” added Speaker Bill Howell. “Few have been able to capture the complexities of an issue and then put forward solutions that appropriately value the human and government cost to our society. Ed Gillespie has a heart as big as his ideas.”
Senate Majority Leader Tommy Norment said,“We need a Governor who will advance innovative solutions to address the needs of Virginians struggling with mental health and addiction. With this plan, Ed Gillespie has again demonstrated he is the Governor we need, and he will work with the General Assembly to meet this challenge.
“Addiction, opioids, and behavioral health are intersecting, complex issues that will demand the attention of Virginia’s next governor,” said Speaker-designee Kirk Cox. “The General Assembly is making progress in each of these areas, and we’ll continue to do so, but the leadership of a governor with a concrete plan of action is necessary to ensure meaningful, long-term progress in these areas. Ed Gillespie continues to lead with policy proposals that address the issues impacting our Commonwealth.”
“Ed Gillespie is dedicated to serving Virginia’s most vulnerable populations,” added Policy Leadership Team Co-Chair Senator Mark Obenshain. “His serious commitment to improving outcomes for those suffering from behavioral and substance use demonstrates not only his servant’s heart but a sound policy approach to complicated problems.”
Speaking about the plan, Mental Health, Addiction and Recovery Co-Chair Delegate Roxann Robinson said, “This plan demonstrates what we have always known: Ed Gillespie cares deeply about his fellow Virginians, and he is committed to serving them. I look forward to working with him to implement this plan and improve access to care for ALL Virginians.”
“I am proud to help lead Ed’s Mental Health, Addiction and Recovery Working Group,” said Mental Health, Addiction and Recovery Co-Chair Delegate Joseph Yost. “We’ve worked closely with Ed to develop proposals that will improve the lives of Virginians who are facing behavioral health or substance use disorders. Virginia needs a leader like Ed Gillespie in the governor’s office.”
Chesterfield County Sheriff Karl Leonard said, “The opioid epidemic is killing more of our loved ones than car crashes and gun violence combined with no slowing down in our future if we continue the course we are on. It will only occur when the community comes together to work on this emergency will we see any relief from this epidemic. We must look out of the box for a new, unconventional, and comprehensive approach. Ed’s plan is a bold, innovative step in that direction.”
FIGHTING AND TREATING ADDICTION
Virginia is facing a crisis. Ed believes five key principles should guide Virginia’s efforts to combat this epidemic:
- Addiction is a disease – not a moral failing
- Focus on Intervention
- We cannot arrest our way out of the current epidemic of addiction
- Recognize multiple pathways to recovery
- Help must be immediate
With these principles in mind, Ed will work to make the following policy changes:
- Educate our middle and high school students, teachers and parents about recovery from addiction.
- Designate a long-term recovery person in a senior role to provide guidance on reforming the system of care in our communities across Virginia and identifying breaks in the recovery system.
- Reform funding mechanisms to ensure that existing funds can be rapidly deployed.
- Work with Virginia’s health plans to ensure treatment services are covered.
- Work to expand same day services for recovery from substance use disorders and co-occurring related disorders. Virginia should strive for same day admission to recovery residence, medication assisted detox, admission to inpatient or outpatient treatment.
- Ensure those struggling with addiction and mental or behavioral health diagnosis have access to care in the community or in a hospital or other treatment facility if no appropriate community service is available.
- Encourage the use of navigators to assist front line nonprofits and other charitable institutions who help individuals seek treatment.
- Develop a coordinated plan to ensure children entering the Foster Care System due to the crisis have appropriate care unique to their needs.
- Encourage collaboration between Virginia’s criminal justice system and authentic recovery communities to help those struggling with addiction.
- Ensure any Virginians on probation or parole can seek help in obtaining treatment through their probation or parole officer without fear of further prosecution or incarceration.
- Encourage recovery-oriented systems of care (ROCS) through the Department of Corrections and during a prisoner’s reentry to society.
- Encourage the establishment of additional drug courts.
- Reform drug laws to ensure penalties align with the crime committed.
FIGHTING THE OPIOID AND HEROIN EPIDEMIC
To combat the opioid epidemic in our schools, Ed will:
- Direct the Virginia Department of Education to produce model program materials to aid school division leaders in their effort to address opioid drugs and their dangers.
- Train our teachers and administrators to identify the signs and symptoms of opioid addiction among our student population and identify treatment programs available for their students.
- Direct the Secretary of Education to conduct outreach through Virginia’s High School League (VHSL) coaches to enlist the coaching community in sharing opioid risk information among athletes exposed to such drugs after a sports-related injury.
- Encourage our higher education system to assist students in recovery or those struggling with addiction through the opening of sober dorms and collegiate recovery programs.
- Building from Delegate Todd Pillion’s legislation, Ed would work with medical schools to expand and strengthen curriculum for treatment of pain.
In March 2016, the Centers for Disease Control developed voluntary opioid prescribing guidelines for chronic pain. Upon issuance of these prescribing guidelines, the CDC declared, “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.” More needs to be done to widen the use of prescribing guidelines, especially beyond chronic pain treatment into prescribing for acute pain conditions.
- Continuing the efforts of the General Assembly, Ed would direct his Secretary of Health and Human Resources, working in consultation with Board of Medicine, Board of Pharmacy and relevant stakeholders to continue deploying best practices and provide guidance regarding best practices for the prescribing opioids.
Virginia utilizes a Prescription Monitoring Program (PMP), which is an electronic database to track prescribing and dispensing of controlled substances, meant to be used by prescribers, pharmacies, and other law enforcement and health officials. Some states have responded to the overdose epidemic with enhanced policies around PMP use that can help prevent overprescribing, abuse, and diversion and to inform prescribers of their opioid prescribing patterns. Virginia should strengthen its PMP reporting to better identify those who may be abusing opioids and physicians who may be over prescribing.
- Ed would work to increase the use of the PMP to track prescriptions for controlled substances, inform clinical practice, and protect patients at risk. Changes should focus on making the Virginia PMP easier to use and access by providing data more timely and expanding and improving proactive PMP reporting to identify and address inappropriate prescribing patterns.
- Work with leaders to improve prescription monitoring in methadone and suboxone clinics. Currently the PMP does not apply to methadone and suboxone clinics.
During its 2015 legislative session, the General Assembly passed a Safe Reporting law, which encourages those present at an overdose event to make a call to emergency or law enforcement personnel. Virginia’s law still subjects those present and making a call for assistance to potential arrest for a variety of specified infractions.
- Ed will work with law enforcement and relevant stakeholders to modify Virginia’s Safe Reporting law to an improved Good Samaritan law. Good Samaritan immunity laws provide protection from arrest and prosecution for witnesses who call 911. Currently, Virginia’s policy only protects the caller from arrest and prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence. Exceptions would be included to ensure that dealers continue to be held accountable. If a victim or caller rejects offered treatment they will forfeit immunity.
According to the recent US Surgeon General’s report on the nation’s opioid addiction epidemic, only one in ten people suffering from Substance Use Disorder receive meaningful treatment. Clinical data supports the use of evidence-based treatment involving a number of medications that demonstrate higher recovery rates from opioid addiction than traditional abstinence-only approaches.
- Ed will work to ensure access to evidence-based treatment for those who are or may become addicted to opioids. He will work to ensure that treatment options are expanded according to leading research and medical expertise.
TRANSFORMING BEHAVIORAL HEALTH TO SUPPORT RECOVERY
CONNECT MENTAL HEALTH AND PHYSICAL HEALTH
For far too long behavioral health has been isolated from physical health – in treatment and through state government silos. We must do more to ensure that mental health is connected to the whole of Virginia’s health care system.
- As governor, Ed Gillespie will evaluate potential realignment of Virginia’s community based services at the Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS). DMAS is currently the primary payor for many of Virginia’s community based services. Ensuring DMAS coordination with community based programs will better align funding and oversight for community based services. It will also permit the DBHDS to enhance focus on the operation of Virginia’s mental health facilities, fulfilling the Commonwealth’s responsibilities under the settlement with the Department of Justice, the sexually violent predator program and a stringent licensure program to ensure Virginians in search of treatment receive high quality care. More important than government efficiencies, this will improve the continuum of care for Virginians working within the behavioral health system. We can no longer allow organizational silos to force Virginians into a maze of government bureaucracies and service providers to get the care they need.
PROVIDE REGIONAL BEST PRACTICES WHILE MAINTAINING LOCAL CONTROL OF CSBs
We also must take action to reform our systems approach to behavioral health. Our Community Service Boards (CSBs) have done what has been asked of them, but often that has meant doing more with less. This results in a system that does not provide care equally or with the same high standards from one region of the Commonwealth to the next. In some cases we see points of pride and success, and in other cases we see inconsistent service and care. It is important to note that CSBs are in this situation through no fault of their own. Pursuing consistent high quality care while retaining the flexibility that comes with local control is central to Ed’s plan.
- As governor, Ed will work with the General Assembly and localities to create a regional system for CSBs to collaborate, share best practices and work together to ensure all Virginia residents receive the high quality care they deserve. The governing body of the regional system will keep the executive and legislative branches apprised of its efforts and will make recommendations for strengthening our CSBs. This regional management approach to our Community Service Boards will ensure excellence. The core principle of this transformation will be to ensure high and consistent quality while maintaining local control. A regional, systems approach with local leadership is a patient-centered formula for success.
SET LONG-TERM STRATEGY FOR MANAGED CARE
Virginia currently operates two Medicaid managed care programs. Virginia Medicaid Managed Care, known as the Medallion program, is now Medallion 3.0. The next iteration of the Medallion managed care program will be Medallion 4.0, which will be implemented in 2018. The second is Commonwealth Coordinated Care Plus known as “CCC Plus,” is a statewide Medicaid managed long-term services program being implemented over the next several months. Once CCC Plus and Medallion 4.0 are successfully implemented, Virginia should explore improving alignment between the Medallion program and CCC Plus to ensure greater efficiency for the benefit of all Virginians, including those in need of services along the behavioral health continuum.
- As governor, Ed will work to set long-term strategy to better coordinate Medicaid managed care programs to reduce duplication and improve services and coordination. This patient-centered approach is right for Virginia.
ENSURE MONEY FOLLOWS THE PERSON IN BEHAVIORAL HEALTH
In order for our behavioral health system to provide a true continuum of care, we must ensure our incentives are properly aligned. To date, we have disincentivized primary care physicians from helping those with behavioral health problems from seeking care. We must create a system where dollars follow the patient. Virginia has successfully implemented the “Money Follows the Person” concept to ensure appropriate services are available for those transitioning from an institutional setting to a community setting for care. We need to expand this concept to allow state and federal funds to follow individuals in the community who are seeking mental health or substance use disorder treatment.
- As governor, Ed will direct his Secretary of Health and Human Resources to develop a resources strategy to include legislative, regulatory and executive action that will allow resources to follow the patient in the community, whether seeking mental health or substance use disorder treatment.
Virginians in need of mental health or substance use disorder treatment do not fit neatly in one Secretariat. Accordingly, Ed will continue to roll out policy ideas to address these important issues over the coming weeks. In addition, Virginia’s behavioral health system touches many different Virginians across secretariats and Ed will roll out policy ideas specific to these populations in the weeks ahead.
The full plan can be found HERE. Gillespie has released five major policy proposals, including:
- The “Cutting Taxes for ALL Virginians” Plan cuts individual income tax rates by ten percent across-the-board, putting nearly $1,300 more in the pocket of a family of four and creating more than 50,000 new full-time private sector jobs.
- The “FAITH In Our Government for ALL Virginians” Plan will close loopholes and give Virginians a better opportunity to hold elected leaders accountable for their actions.
- The “Efficiency + Effectiveness: A Government that Works for ALL Virginians” Plan will reorient government to more successfully address Virginia’s problems, demand evidence-based solutions, right-size our government to better steward taxpayer dollars, and incentivize our state government workforce to be more responsive to the needs of all Virginians.
- The “Removing Barriers to Job Creation for ALL Virginians” Plan will bring meaningful reform to remove barriers to job creation, making it easier for businesses to grow and thrive in the Commonwealth. It focuses on standing up for Virginia’s job creators, reforming Virginia’s regulatory climate, reforming occupational licensing and streamlining business formation.