The Hawaiian people have a word which embodies two meanings and for which there is no equivalent in the English language.  The word is “Kuleana”.   Kuleana basically blends two things together.  The first is Rights or Privileges and the second is Responsibility or Obligation.  In essence, Kuleana means that with rights and privileges comes responsibility or obligation.

As Signal’s CEO I have the privilege of working with an incredible group of passionate people.  Together we serve a network of dedicated professionals who are equally passionate about helping the clients they serve.  Signal is also privileged to manage most of the State of Colorado’s public funds to help treat those with chronic addictions.

With these privileges, however, comes great responsibility.  I am responsible for making sure that Signal is run efficiently and effectively so that we can be the best stewards of the public funds we manage as well as stalwart advocates for the substance use disorder (SUD) field and the providers in our network.

It is my obligation to take care of not only Signal’s employees but to ensure we are doing everything we can to help take care of the providers we work with, so that they in turn can provide the best care possible to those who need it.

Health Care Reform is based on the notion that everyone has a right to health care.  In the substance use disorder field, the providers in the Signal Network treat the chronically addicted who more often than not cannot afford and do not have insurance.  We are dedicated to helping these people with the brain disorder of addiction that they are afflicted with.  We also believe that their obligation is to whenever possible return to society as productive members, living lives and giving back to their communities.

Signal Behavioral Health Network believes in the concept of Kuleana not simply in the work we do but in the community of people who help those with SUD.  It is truly a privilege for me to be a part of this community and I am emboldened by the challenge of responsibility and obligation I have for that privilege.

The substance abuse treatment field is changing rapidly. Health care reform is moving the field towards insurance-based payment models; integration with primary care is a hot topic with multiple pilot projects occurring; new evidence-based practices such as medication assisted treatment and trauma informed services are becoming available.

Signal is considering hosting a conference to address the many changes to our field. This conference would be a way to help attendees learn about the emerging landscape of substance use disorder treatment and to prepare for new models of service delivery and payment.

This survey asks questions about what topics should be addressed in such a conference and your interest in attending. Please take a few moments to complete the survey. Your responses will help Signal decide whether to host such a conference and, if so, what should the conference look like. The survey can be found at https://www.surveymonkey.com/s/LMCJTYN

Thanks in advance for completing this survey.  And please feel free to send the link to others in your organization.  We would like to get as many responses as possible! 

Wednesday, I went to a meeting on the 2011 Colorado Health Access Survey, which looks at health insurance status, access to health care, and utilization of health care services.  Very nice presentation at the Colorado Trust building – good breakfast, excellent Powerpoint, some jokes about how data is sexy.  And it’s a good telephone survey of over 10,000 households. It’s the results that are disturbing and a little depressing.  The big take home is that 15.8% of Colorado residents have no health insurance coverage, an increase from 13.5% in the 2009 Survey.  That’s an increase from 675,000 to 829,000!  And more than 60% of the uninsured have been uninsured for at least one year. Shows you why people want changes in health care.  Go to http://www.cohealthaccesssurvey.org/ for more info.

 A key part of health care reform is the “essential health benefits.”   The ACA requires that most insurance plans - including those participating in the state exchanges – cover a minimum set of diagnostic, preventive, and therapeutic services and products. In the addiction treatment field, my experience is that most insurance doesn’t provide addiction treatment coverage, or does so minimally.  So, will addiction treatment services be part of the essential benefits?  Well…..let’s hope so.

There are 10 benefits specifically mentioned in the ACA.  One is “Mental health and substance use disorder ser­vices, including behavioral health treatment.”  So, it’s covered, right?  Ah…but this has not yet been defined.  Will outpatient services be part of the benefit?  Almost certainly.  Will residential services be covered?  Much more iffy.  Recovery support services? Even iffier.  And the IOM report which lays out the process for defining in detail the benefit package is recommending that Health and Human Services use the typical benefit package for small employer health plans as the base. We all know how good those plans are at covering addiction treatment!

HHS wants to complete the definition of the essential benefits by the middle of 2012 and is doing a series of “listening” meetings to get input.  The Denver one is November 18 from 10 AM to Noon at 999 18th St. South Terrace, Suite 400, Denver.  If you want to attend, RSVP to Ezra.Watland@hhs.gov. Hopefully there is still space available.

And if you are closely following health care reform, try the Kaiser quiz.  Thanks to Michael Allen to sending this link to me.

NASHVILLE, Tenn., Sept. 14, 2011 – Qualifacts Systems Inc., announced today that two of the largest agencies in the Signal Behavioral Health Network collaborative will implement Qualifacts’ electronic health record. Signal is the largest managed services organization in Colorado, serving 19 substance abuse agencies across the state, and Crossroads' Turning Points and Addiction Research and Treatment Services/University of Colorado Denver are the first of their agencies to take part in this collaborative implementation project.

Signal’s search began several years ago when they researched updating their own electronic system and started looking for a solution that would work for them and their network of providers with varying needs.

“Our mission is to support our network in any way we can, including with technology initiatives, to help them be more efficient and productive and meet the EHR mandate,” says Michael Jenet, CEO of Signal. “Qualifacts’ Software-as-a-Service model – one platform that everyone uses – was the best solution to fit our network and the collaborative venture. And the certified Complete EHR CareLogic Enterprise fulfills the need for a flexible, fully-functional EHR that prepares our providers for Meaningful Use and healthcare reform.”

Crossroads and ARTS were chosen to pilot the program because they are two of the biggest providers in the network that do not have an EHR. As Jenet says, “If we could meet the needs of those two, we are confident we could meet the needs of any provider who wants to join the consortium. We already have other providers that are interested.”

“Signal represents a significant milestone in our company’s storied history as they are the largest network of substance use providers that we can proudly call customers,” says Jason Medlin, vice president of sales for Qualifacts. “And now that we are the exclusive EHR vendor partner for the State Associations of Addiction Services (SAAS), the largest national association representing substance use providers across the country, we are very well-positioned to grow our substance use customer base in this important era of healthcare reform. We look forward to continuing our focus in a market that is crucially important to the overall health and well-being of society.”