Introducing The ASAM Criteria Navigator, 4th edition

Chrissy Finn: Hello everyone and thank you for joining today's webinar, Introducing The ASAM

Criteria Navigator: shift to the fourth edition with ease. Before we begin, please note the following housekeeping items. At the bottom of your audience console are multiple application widgets you can use to customize your viewing experience. If you have any questions during the webcast, you can click on the Q&A widget at the bottom of your screen to submit a question. And we hope you do. We do capture all questions and will be providing follow up to the questions as appropriate. If you experience any technical difficulties, please click on the help widget. It covers common technical issues. You can also expand your slide area by clicking on the maximize icon on the top right of the slide window or by dragging the bottom right corner of the slide window. There's also a survey widget, which you can use at the end of the webcast to provide us with feedback on today's presentation. And additionally, this presentation uses streaming audio. You may listen to the presentation through your computer speakers or headphones. To ensure the best possible system performance, please be sure to shut down any VPN connections and connect directly to the internet. We can move on to the next slide. I'd like to introduce our presenter for today's session. I'm Chrissy Finn and I'm joined by Dr. Sarah Johnson. I'm the director of the InterQual content products. As the product owner, I'm responsible for the content roadmap, and managing and defining our product enhancements. I have been with Change Healthcare and now Optum Insight for 15 years, that have flown right by. I am a registered nurse with an MSN from Mansfield University and a BSN from Northeastern University. I have a clinical background in critical care cardiac surgery. So I will be serving as the moderator and Q&A person on today's call. Dr. Sarah Johnson is board certified in psychiatry and addiction psychiatry, and holds an EMBA. She's been with the InterQual products for three years and leads development of the InterQual Behavioral Health content. Dr. Johnson has extensive clinical experience in inpatient and outpatient settings and remains in practice at substance use facilities in Kentucky today. And now I'll turn it over to Sarah.

Dr. Sarah Johnson: Thank you, Chrissy, and thanks to all of you for joining us this afternoon to talk about the ASAM criteria. For anyone who worked either on the payer or provider side of the SUD arena, you know that it's a very important and hot topic. So let's start by looking at why the ASAM criteria are important. The ASAM criteria are mandated in 14 states for use by payers. In California, Connecticut, Delaware, Illinois, Maryland, New Hampshire, and Oregon, payers are required to use them for all lines of business. Several other states require them for managed Medicaid only. And of course, they're also important to payers because all payers are concerned about mental health parity. Most of you have hopefully heard of the Wit v. United Behavioral Health case, which is in various states stages of appeals. That was a president setting legal ruling that named ASAM criteria as the standard of care for substance use disorders. So even in states where there aren't mandates, payers are overwhelmingly interested in the ASAM criteria and how to use them. For Medicaid, all payers and providers except in South Dakota managing Medicaid members and patients are encouraged to move towards use of the ASAM criteria, and this holds especially true for demonstration projects approved under section 1115 waivers. And finally, providers. Having done clinical work in many states, there is really a trend in the industry moving towards use of ASAM criteria in some way or fashion. Providers are mandated to use ASAM criteria in 23 states for all patients receiving SUD services, but many others recognize ASAM as the gold standard for addiction treatment quality and choose to model their programs and treatment services after the standards set forth in ASAM. So for those of you that may be interested in the ASAM criteria because of regulatory reasons, how can you meet the regulatory requirements? There are some historic ways that you can do this. And then we will talk about the ASAM navigator, the new and exciting tool that also fulfills these mandates. Many of you are likely familiar with a third edition, and were using ASAM criteria for many years before the update, and that continues to be one way that you can meet state mandates. The print and digital book are both available for the fourth edition of the ASAM criteria. You can purchase a subscription for the ebook on the ASAM site for $180, and they've been taking pre-orders for the print book. And we heard last week that those are starting to be distributed from the publisher. So that is one way that you could meet the mandates. However, in creating this tool, we did empathy interviews across the country with both payers and providers. And one limitation to using this format to fulfill the mandates is that the book is subject to interpretation. And also, the ability to translate the information from the book into workflow tools. Having worked as a health plan medical director in past jobs, I've experienced the fun of translating a book into workflow and tools for people using utilization review. And it's a big lift, and it's also not consistently done. Another way that the mandates could be met with a third edition was the software program called the ASAM CONTINUUM that some of you may be familiar with. It was developed by ASAM for providers caring for patients, and does a wonderful job going through all of the dimensions and the risk ratings. However, it's meant for clinicians that are caring for patients, not for utilization management, and takes on average 60 to 90 minutes to complete an assessment. And that's just not feasible in the UM arena. And then third, the software program, the ASAM CONTINUUM CO-Triage, which was also produced by ASAM and launched as a referral tool. It was on the opposite end of the spectrum and took only 10 minutes to complete an assessment. However, it often did not cover enough information that would be required to do UM type work. Our partners at ASAM told us that there are plans to update both of those for the fourth edition, but those aren't available at this time. So after talking with payers and providers across the country in preparation for creating this tool, we found there were many challenges and objectives that the tool needed to achieve. The first obviously would be to meet regulatory and legislative requirements for use of the ASAM criteria for SUD patients in a consistent and user-friendly, efficient manner. The second would be to meet consistency and accuracy requirements for regulatory bodies such as URAC, and also to assist clients in meeting state mandates for inter-rater reliability, which can improve consistency and also identify potential gaps and areas for improvement of employee knowledge base. Efficiency was something that we heard time and time again that not only did potential clients and people want a solution, but they wanted an efficient solution, so that they could move through their workflows and get patients moving through the system, in a way that would ensure the safest, least restrictive level of care is approved for members who need lifesaving SUD treatment. Another ask from the marketplace was to improve workflow with providers to increase efficiency, and remove historic manual and oftentimes burdensome processes for authorization. When I worked for a health plan, and also working on the provider side of things as a medical director, there was nothing less fun than a Friday afternoon peer-topeer review, when fax machines were involved. In talking with clients, I learned that that's not something that only happens in Kentucky, but it was happening across the country. And it was amazing how many people that we talked to were still faxing records back and forth between payers and providers. And this tool offers a solution that is much more reliable and efficient than that. And the ultimate goal of all of these asks is to allocate the limited number of VH and SUD treatment beds to only those who need them and to move patients safely through the continuum of care so that all SUD patients can have their needs met and utilize the full continuum of care. For those of us that work in SUD, we know that patients who end up on waiting lists to get into treatment are often the patients who end up with overdoses or other poor health outcomes. So the ultimate goal of all of this is to increase access to quality care for the patients who really need it. So after talking with payers and providers across the country, the ASAM Criteria Navigator was created through a unique partnership with ASAM to help increase efficiency and consistency of the utilization review process, and aligning with the ASAM criteria decision roles. The navigator offers a seamless workflow integration that streamlines the review process for existing InterQual users as well as non InterQual users within their care management systems. It integrates with most electronic medical record systems, but can also be used by perhaps smaller providers, or health systems that use smaller systems, or even paper charts through its web-based applications. It uses an interactive question and answer format that improves efficiency and is modeled after real world workflows. It starts with the level of care that's been requested for the client or patient and moves through a series of question that guides users throughout the risk ratings in a way that identifies if that level of care is appropriate for the patient or will prompt the user to consider another level of care. And beta testing, it consistently required 15 minutes or less to complete a review. And the users felt as though this meant the ask of efficiency. Its content is considered fully consistent with the ASAM criteria, which means that it is the criteria, the actual criteria. I was asked today if there was a reference list for this tool, and the answer is that it is the ASAM criteria. So it takes the criteria in the book format in a very comprehensive manner and puts it into this efficient, very user-friendly tool. And when we're doing the demo later, I'll show you some examples. But it goes beyond just the questions that are used for the risk ratings to include a lot of supplemental information that can provide reminders and even initial education about some of the topics that are included, to help users easily transition from the third to the fourth edition. And then finally, it also offers an inter-rater reliability tool, which can be used to meet mandates and support users, and education that are offered to all clients as they learn to use the tool. And additional in-depth education and enhanced sessions are also planned to support the fourth edition of the navigator, and we'll have more information available about that in the near future. So we'll take a closer look when we look at some case demonstrations. But as you see here, this tool takes the book or the digital book and it translates it into an actionable question and answer format, that starts with the level of care requested, and takes users through a very user-friendly and simple algorithm that leads to a recommendation. However, don't be fooled by the simplicity that you'll see in the program, because there are so many permutations going on under the hood here, that it's really impressive. It simplifies the workflow so easily. And using this tool, it can alleviate that load from leadership at health plans or in treatment organizations that may have to do that without the aid of technology and all the development that went into this product. So we are currently in a time of transition as we move from the third edition, which this tool was originally created from, into the fourth edition. When we do our demo, you will see that both of those are included in the product at this point in time, and it's a great opportunity for anyone who may not currently be using the tool to start to use it and let it support the transition at the organizational level. This is something that I continue to be involved with through clinical work, and know that my organization is gearing up for a pretty big lift in terms of education and considering internal workflows. And that something that this tool can provide a great deal of assistance with. So this is not meant to be comprehensive, and going into too many specific details would be beyond the scope of this webinar. But before we look at the tool, it would be important just to look at some of the major changes that occurred between the third and fourth edition. And for those of you that are using the third edition of the navigator, you'll see some of those reflected in the tool as well. So the fourth edition moves towards five dimensions. The third edition had six that drive the level of care recommendations, and each has two to three sub dimensions. The previous level six is now a patient considered recommendation and is not actually involved in driving the level of care recommendation. However, it can be important when formulating a collaborative treatment plan with the patient, but it is no longer a driver of care. In the third edition, there were separate withdrawal management levels of care. However, in the fourth edition, these have been integrated into the main continuum of care in the levels 1.7, which is medically managed outpatient treatment, 2.7, medically managed intensive outpatient treatment, and level 3.7, medically managed residential treatment. Level 0.5 and 3.3 were removed from the third edition in the update. However, the patients that were previously treated in 3.3 are now addressed in a chapter in the book, where it can give more information about working with patients who may have cognitive issues and integrating their care into the main continuum as well. And you will also see that the ASAM fourth edition describes sites of services, where all of these levels of care may be delivered. In general, levels one and two are delivered in outpatient settings. And those may include outpatient offices, community mental health centers, ambulatory centers for behavioral health treatment centers. Residential services included in level of three include substance treatment centers and recovery residences. Unique service requirements are further outlined in the text, and supplemental information on many of these are also included in educational notes in the ASAM navigator tool that I'll be happy to show you shortly. There's an expectation that medically managed services can be able to provide withdrawal management, and that clinically managed services be able to support those therapies when they're provided in an outside office. So another important addition to the fourth edition is recovery residents recommendations. Those are longstanding important things in the SUD treatment community. However, they did not receive a lot of attention in previous edition of the ASAM criteria. But they have been added here, and we'll actually look at a case that has recovery residence as a component of the authorization review. Another... I'm sorry, I was distracted by the Q&A. Another change that you'll note is the previous level one in the third edition has been shifted to be 1.5 outpatient therapy. That replaced the level 1.0 outpatient services in the third edition. And there is a new level one which is long-term remission monitoring. You won't see that in the navigator tool, because it's not a level that authorization is performed for. However, it is reflective of the chronic care model for addiction. There are enhanced continued stay criteria in the fourth edition. And as we work through fourth edition criteria for our adult cases and then look at our third edition for an adolescent case, you'll see the difference there. And it's important to note that at this time, only the adult criteria have been updated for the fourth edition. ASAM did not want to delay getting this update out to the marketplace, because they knew that it was time, and the marketplace wanted that, and patients needed an update in the criteria. So they did not want to delay release. However, the adolescent criteria were not completed and they are currently working on those, they're in development, and their hope is to have those out within the year. At that time, we will obviously update the navigator tool to reflect that, and we hope that we will be able to do it as soon as those are finalized and released. But for the foreseeable future, users will be able to access the third edition for adolescent. And they will also be able to access the third edition for adult for some period of time which can further support transition. This next slide illustrates the fourth edition continuum for adults as well as the third edition levels of care for adolescents. And as you can see in bold, the 1.0, 1.7, 2.5, 2.7, and 3.7 levels of care are either new levels of care or levels of care that have been significantly changed. And then across the bottom, you will see the adolescent levels of care in the third edition that remain. Another major change with the fourth edition update of the ASAM criteria was that it reordered and redefined the patient assessment dimensions, which drive the level of care placement recommendations through their risk ratings. Since readiness to change does not independently contribute to initial treatment recommendations, the dimensions were adjusted. Dimension five and six in the third edition were shifted to four and five respectively. And a new dimension six, which is person-centered considerations, was added. So this sixth dimension is not directly tied to an initial level of care, however it should be considered across the care continuum when working collaboratively with patients for treatment planning. An example of this might be a client whose risk ratings were consistent with a residential treatment program. However, if they had care-taking or job responsibilities that they felt were a barrier to going into a residential program, this level of care would enable their treatment team to work with them towards an alternate care plan, perhaps a placement in a 2.5 program at an outpatient level of care with some additional services provided for support and motivational enhancement if they weren't able or willing to go to a residential program that might be more consistent with their risk rating. Other things that could in this dimension that could factor into care decisions would be social determinants of health or patient perceived barriers to certain levels of treatment. All right, so we will transition into some case scenarios. Just a minute. My computer decided to log me out while we were looking at other things.Okay, our first case is a 45-year-old single female client with amphetamine use disorder. She has multiple recent discharges from level 2.1 and 2.5 treatment programs, and is her words, "Unable to stop using." She has a recent arrest for solicitation and referral to drug court. Her history significant for amphetamine use daily for the past five years. A medical history significant for myomectomy but no acute issues. No depression, anxiety, suicidal thoughts, or other behavioral health issues, and recent high risk behaviors while using including high risk sexual activity, gambling, solicitation charges related to substance use. She has a poor recovery environment, as do many of the clients that we work with. That includes living with family members who also use methamphetamine. And she is open to transitioning to a more intensive level of care. So after assessment, her treatment team is requesting a 3.5 level of care. Okay. So hopefully you all can see my screen, the ASAM criteria powered by InterQual. That's what it's supposed to be showing. And as we move into the review, as you enter the program, you will see the screen with all of the different levels of care within the subset. The third edition, as we discussed earlier, is still located in the tool for now, and the third edition adolescent will remain until the fourth edition comes out. And you would select your level of care here, which is clinically managed high intensity residential treatment for adults. So as we enter the subset overview screen, and for those of you who use our third edition tool, this will look familiar, and you will see some familiar things. In our clinical reference section, you will find review process documents that explain different things about doing the reviews and how to use the tool. It will also discuss when secondary review may be appropriate. Other things that will be added to this section, especially as we get feedback from users and from the marketplace, maybe other documents that would help support the transition from the third to fourth edition. Just last week, we were talking with our partners at ASAM and have decided to include a publication from the book that's included as a supplement document from the book, that discusses the differences between the third and fourth edition criteria. So lots of useful things in the clinical reference section. Another thing that will look familiar is the presence of codes that might be used for these services. And those are located at the subset note screen for all the different levels of care. And you'll also find information here that describes clinical services and other information from the criteria that may be useful as you go through the review. There is one feature that is included in the fourth edition that has been enabled to be included because of the way that they are structured, that was an ask from the third edition. And that's inclusion and the ability to view the full subset of transparency solutions. So as you see here, there are many different recommendations, of the level of care recommendation with enhancements such as co-occurring enhanced services, with medications for opiate use disorder services. So in addition to the level of care, other enhanced services. But you can actually click on these and see the full subset if you are required or want to have transparency solutions. So that's an important addition to this level that will be new for people who were familiar with the third edition tool. So as we start the review, you will see that we have options here for admission, as well as transitioning for a step-up or step down for more or less intensive services. Features that are important to point out for those of you that may be new to the tool. Anywhere that there is a square that looks like a sticky note, you'll find informational notes. Most of these are things that are directly from the ASAM criteria text, that will aid users as they learn the new criteria set or as they learn to do reviews. And also, comment bubbles that you can manually type things that will then carry over to your review summary at the end. So we're doing an admission here. There is a question here that, has the patient been assessed for needs across the six dimensions by staff with appropriate expertise? This is ensuring that licensed staff are actually assessing patients and providing this information. So you can put a time and a date there if you want to. And again, it will translate into the review process. I'm sorry, the review summary at the end. So we'll see questions as we go through. This is, does the patient require any medically managed services? The answer here would be no. And an assessment for addiction medication needs to make sure that those are considered as we proceed through the review process. In this case, she does not have addiction medication needs. So we would select the one here that says that these could be addressed in any level of care. Different answers to these questions would obviously drive towards a more medically managed level of care if those needs were present. We have a question that you'll see in most of the levels of care, pregnancy related concerns. Here, the patient's not pregnant. And then we come to our dimension three assessment, which is active psychiatric symptoms. And if anyone while they're doing a review needs a refresher on what those are, then there's good information here that provides a summary of things that might be available in some of the co-occurring enhanced levels of care, for clients who might have higher acuity needs in these areas. So in this case, we're told that there are no specific treatment needs, so we'll select this option. There's also a question here for persistent disability, and these clients may have been clients with cognitive disabilities or other chronic and ongoing mental health issues that may have previously been addressed in that level 3.3. So this question would include many of them in the new continuum. And there's more informational notes here if anyone is going through the review and isn't quite what that means in the new paradigm. This client does not have any of those needs, so we can select no. And then we get to dimension five, which is looking at safety and support of the patient's living environment. This is a really important question since we're in a residential level of care, to determine if that would be an appropriate level based on needs in this area. And we know that, we're told in the history that she does not have a safe living environment. So we would select one of these. And here we have two options, and the new recovery residence is addressed here. The notes, again, would provide more information if a reviewer was new to that concept and they just weren't sure how to answer the question asking if a recovery residence would be appropriate for this patient, if that would meet their needs. Based on her clinical factors, in my clinical opinion, and also with the information given in the supplement notes that I reviewed beforehand, a recovery residence would not provide sufficient support for a patient who had daily use and ongoing air quotes, not being able to stop using. And it sounds like she has a high risk of substance use related behaviors, and also that she would be likely to have some serious harms. And then finally, we have another question here asking if they require medications for opiate use disorder or if they need prompt evaluation for addiction medication needs. And the answer here is none of the above. And we have answered all the questions required for the recommendation, and we go into the recommendation screen and see that evidence supports as medically necessary based on our answers to the questions. We would select this level of care, and we can add codes if we would like to. Not alcohol use. We'll just not add codes for demo's sake. And then we would go into the review summary. One thing that I would like to show you before we go into the review summary is a new feature here. Why didn't a requested intervention meet criteria? So in the event that you get to this screen and you don't get the recommendation that this level of care is supported, you could click on this. And for example, we will go to this recommendation, which would be 3.5 with medications for opiate use disorder. And it would take us to this question here that shows why they wouldn't meet for that level of care. So that's a new feature that we hope users will find helpful. So this is our review summary. And these can be printed or they can be cut and pasted into documentation systems, and it's a great way to have clear, concise communication between providers and payers. Okay. All right. So moving on to our next case, I think we spent a lot of time in the first case showing features. I won't spend as much time, just in the interest of getting to some of the good questions that I keep seeing out of the corner of my eye here. But we'll go through another review in the adult criteria, and then take a look at an adolescent case using the third criteria. So this is our second case, a 26-year-old male with amphetamine use disorder. He has been in 3.1 level of care for the past month and being evaluated for step down. He has recent anxiety related to transitions in care. His history, significant for daily methamphetamine use for the past 18 months. It's a long use history, and his last use was 28 days ago, so still fairly new in recovery. Medical history is significant for stable HIV managed in a community clinic. He has a history of paranoia and hallucinations while using methamphetamine, which is resolved, or resolved while he was in treatment. And he's prescribed fluoxetine by an outpatient psychiatrist for anxiety.He's learned some coping skills while in level 3.1, but is still having using dreams, and just doesn't feel comfortable fully integrating back into the real world. He's single with no dependents, and he can live with his parents, but there's ongoing alcohol use and lots of conflict in the home, and he doesn't feel as though it's the best place for him to achieve long-term recovery. And he notes that there were some parts of residential treatment that he didn't really care for, but he liked the rest, and he was able to take public transportation to work. So they are requesting level 2.1, which is intensive outpatient with addition of a recovery residence. Okay. So going back into the criteria, we would select our level 2.1 intensive outpatient treatment. And note that you do start with the core level of care that was requested. The recovery residents would be an add-on. There will be questions in the review that assess the need for that. We've already seen all the fun extra features, so we'll move on to our review. Again, there are notes that are available if people need reminders or to help them as they transition to this level of care. And in this case, he is actually coming from a more intensive level of care to level 2.1. We're asked if the dimensional drivers have been sufficiently addressed to allow for step down, and also no new signs or symptoms that would require the current level of care. We're asked if the treatment interventions that address their current drivers can be delivered in this level of care. The answer here would be yes. We're again asked if the patient has been assessed for needs by staff with appropriate expertise for necessity of transition. And the answer here is yes. And you'll notice the wording there has been worded in a way that can support variances in different geographic areas, as some states require different people to assess different things, especially physicians, or nurse practitioners, or various types of licensed personnel. So that ensures quality, but also allows for flexibility that is necessary in real world practice. Again, we're asked if they have any medically managed needs. Here, the answer would be no. Addiction medication needs. We are not told that he's on any addiction medications, and presume that those could be addressed in any level of care. He's not pregnant. This is a client who has some past psychiatric symptoms, but we know that those are well controlled and they're already receiving care. This question, for those of you that were perhaps used to using the third edition, it has been refined and provides this option for patients who may have this issue, but it's controlled and does not directly affect the level of care that they require. So this is an update that was based on market feedback, for clarification. We are not told that he has any persistent mental health or cognitive disabilities. But again, an example of where the former 3.3 patients are covered here in the new continuum. When we get to dimension five, safety and support, we know that they are requesting recovery residents. And if we need any further information about what that might look like in a patient, we can go to the informational note here that provides that. And because I read that beforehand and learned about that while developing the tool, I can confidently say that he does sound appropriate for that. It sounds as though he has at least a moderate likelihood of substance use if not in a controlled environment, and here sounds as though he could have some seriously, or negative but not seriously destabilizing consequences. And we have another question here to evaluate functional impairment, and no medications for opiate use disorder. So when we go to our recommendation screen, we will again see that the criteria are met here and can go onto our review summary if we desire. And then we'll take final look at an adolescent case here for our last review. We have a 15-year-old single male with cocaine and inhalant use disorders. He's a ninth grade student, no prior substance use treatment, and he's brought in by his father from the school regarding a change in behavior. He reports daily cocaine and huffing glue for about eight months. He receives special education services due to developmental delays caused by fetal alcohol syndrome. He's on the Special Olympic swim team where he competes in a couple of events, and he lives with his father in an apartment. He lived with an uncle for six months at a time throughout most of his childhood while his father worked on oil rigs. Mother died of a drug overdose when he was three weeks old. So we will go back to our criteria. Let's see. And this time, we will select our third edition partial hospital for adolescents. And you'll see different release versions here. We'll pick the most recent one. And we know that we are doing an admission review. As you'll notice, this looks a little different than you saw in the fourth edition review type because of the enhancements that have been made there to include step up and step down reviews. This is an admission. The patient has been screened for withdrawal. We'll assume that. He does not appear to at risk for acute withdrawal. There's no known major biomedical problems. For our dimension three questions here, we are not told of any co-occurring emotional, cognitive, or behavioral conditions that need treatment at this time. Due to his ongoing daily substance use, it does sound as though that he is having issues making behavioral change without some sort of structured programming that they're requesting here. So we will select the second answer choice. And it sounds as though he's certainly having continued use without any sort of treatment and outpatient monitoring, so we'll select that option. And dimension six here, which looks at recovery environment in the third edition. It sounds as though he lives with supportive father who's bringing him in for treatment. So we'll select none of the above there. And again, evidence supports as medically necessary. So you'll continue to see the third edition criteria for use in adolescent cases, as long as necessary to get to the fourth edition release there. Okay. All right, so we are now entering the question and answer component, but I would just like to leave you with a summary of the ASAM navigator tool, and why it might be a great option for you to meet your day-to-day challenges. It helps to meet regulatory requirements, increase efficiency, facilitate the safest, least restrictive level of care for patients moving through the SUD treatment system. It supports optimal allocation of limited resources within the SUD treatment systems, and it enables consistent decision-making, as well as ease of communication between payers and providers to support patient flow through all these levels of care. And finally, it can support you and your staff in your organization to seamlessly move from the third edition to the fourth edition criteria. All right, and Chrissy, I will turn it back over to you for any questions or answers.

Chrissy Finn: Great, thanks Sarah. Before we get started with the Q&A portion, I want to just take a minute to remind you of the survey. It's located beneath the slide deck in your audience console. We would love it if you would take a moment to provide us with any feedback on today's presentation. If you have a question, you can submit it through the Q&A widget located on the left side of your audience console. So we'll get started with a couple of questions. There are a couple of questions around, when is the fourth edition for adolescents going to be released?

Dr. Sarah Johnson: Thank you for asking that. We are continuing to monitor that situation and meet with our colleagues at ASAM on at least a monthly basis, often much more frequent just to develop the tool. We have been told that they are hopeful in anticipating that it will be released before the end of 2024. That's obviously subject to the work groups getting everything finalized. It's amazing how many hours of work go into an update like this. But they're hopeful by the end of 2024.

Chrissy Finn: Great, thank you. There's a follow-up question to that or a related question around how long the third edition will remain in the navigator content. We plan to keep it in the content until we have our next annual release. So for the 2024 release of content, you will see those third edition adult subsets be removed. You can still access them, you just would have to go back into the 2023 criteria in order to be able to see that. There's also a question here around if there is a crosswalk that's available between the third and fourth edition. I would say the simple answer, the short answer is no. The fourth edition isn't just an update to the third edition. It's really much more of a radical paradigm shift. So the levels of care and dimensions have both really been restructured, which would make it very challenging to crosswalk. The ASAM Criteria Navigator in itself, our tool has been built a little differently as well to help better support transparency into the full algorithm that sort of exists behind the scenes. So that would make crosswalking also very difficult. Let me see here. The question here, Sarah, is if the provider is not utilizing the fourth edition when they submit their clinical, how should they with doing a review?Dr. Sarah Johnson: Thank you for asking that. I think that is one that I'll actually take back to our leadership at ASAM and see if they have any additional recommendations with that. Whether you're using the third or the fourth edition, the patients are going to be the same, and I think that the user would need to just make their best effort if they were completing a utilization review, to apply the clinical information to the questions that they have and do best fit. However, that probably highlights the importance of communication between providers and payers, and the need to make sure that they know which criteria sets the other are using, and that everyone makes efforts to get educated on the fourth edition so that that communication can be maintained.

Chrissy Finn: And I think there are also opportunities, Sarah. When you're utilizing the transparency solution through your payer portal, that's going to help to direct providers to use the right addition of the criteria.

Dr. Sarah Johnson: Absolutely. And we've asked our partners at ASAM when we would expect the changeover to occur, because we've had our clients, payers and providers, ask when they need to be ready. And the answer is they would expect six months to a year for a change of this magnitude, but there's lots of variation going on at the state level.

Chrissy Finn: Great, thank you. And there's a question around what kind of training is going to be available. So we are going to be rolling out our fourth edition training starting in January for those classes that will be held in January. We also have some additional training in development to help support the transition between the third and fourth edition, so look for information on that as that gets finalized. We probably have time for one more question, Sarah. Is there a formal certification that's needed in order to be able to apply the ASAM criteria? Dr. Sarah Johnson: No, not at this time. Not that I'm aware of. ASAM does plan to start offering their education courses in January for providers. And then in the spring, they will offer a more specialized payer education course. And we will be offering the training that comes along with this tool, the two sessions that are web-based and instructor supported, and then also an enhanced training that is going to be case-based for those who may want more indepth exploration of cases and using the tool to apply the criteria.

Chrissy Finn: Great, thank you. Thank you to our presenter today for sharing your insight and expertise with us Sarah. I'd also like to thank you, our audience, for sharing your time. We know how busy you are and we always appreciate your attendance. Please take a couple minutes to complete the survey and let us know how we did. Again, the survey is located within the survey widget in your audience console right below that slide deck. This presentation will be made available on demand within approximately 24 hours of this broadcast, and it can be accessed using the same audience link that you use to enter the live broadcast today. Thank you so much for joining and have a great day.