# 20231105 ☕️ Sunday Morning Coffee Notes Three `random notes` from my Obsidian vault, today's `music` selection from MailTape, and a `photo` from the past week from my phone. --- ## 📸 "Dude, Where's My Car?" ![[Looking for My Car.png]] #photo #icm I flew to Chicago last week to speak at the annual #HMA Conference. Health Management Associates is a __. I took a picture of where I parked so I could find my car on returning, and I must have taken an unintentional picture. It is pretty abstract, but knowing the context, one can imagine the bright fluorescent tube lights and some car accents in the streaks resulting from camera movement. I submitted the image to Google Image Search, and most of the found images are some version of metal, chrome, mylar, glass, and mirror images. It's AI algorithm seems to be unaware that this could be an [[ICM]] image, pointing out how AI image search models are still primarily focused on `what` or `who` but now `how`. If it first determined how the image was taken (based on the pattern of parallel elements and the motion blur), it could then compress the pixels along the motion axis and attempt to reconstruct what a non-motion image of the subject would display. It could probably then determine `parking garage`. --- Anyway, I was invited to speak on a panel at this conference to address the payer perspective of transitioning to the new 4th edition of _[The ASAM Criteria](https://www.asam.org/asam-criteria)_. My role at Optum Maryland includes the use of clinical judgment in applying the #ASAM criteria, which are evidence-based guidelines used to determine the appropriate `Level of Care` (hospital inpatient with medical management, residential with or without medical management, intensive outpatient with or without medical management, outpatient with or without medical management) for treatment of substance use disorders (SUDs). These ASAM standards have evolved over the last 30 years, as standards of care and the evidence base has also evolved. Early standards were very provider-focused, while later standards include medications for addiction treatment or MAT (eg, naltrexone, buprenorphine, methadone, disulfiram, acamprosate), harm reduction, shared decision-making, and patient-centered approaches of meeting people where they are in the recovery continuum. (It is interesting to note that, while I am one of the section editors for the 4th edition, I also had some (minimal) input on one of the earlier editions, which I reviewed in the early 1990s when I was at Western Psych (#WPIC) in Pittsburgh.) - The widely used 3rd edition of the textbook, _The ASAM Criteria_, was published in 2013. - After 3 years of planning, preparation, literature review, writing, and editing, the digital 4th edition was released last month on October 4. The print edition is expected to be available within the next few weeks. After 4 years at Optum, applying the 3rd edition ASAM criteria to utilization management decision-making, I have developed some informed perspectives on the managed care side of applying these standards. >[!list] 8 Payer Challenges for Implementing the New ASAM Standards >1. Lack of awareness of ASAM Criteria >2. Prior auth requests that fail to address the ASAM Criteria relevant for that level of care >3. Trying to maintain a 28-day program mentality >4. Lack of integration with other levels of care >5. Inflation of Risk Severity levels >6. Lack of recognition of programs that are co-occurring capable or enhanced level of care >7. Lack of a “clinical quarterback” to monitor their patient’s transitions across the levels of care >8. Updating state regulations that “hard code” the 3rd edition of ASAM I skipped issuing my Coffee Notes last Sunday because of the travel for the HMA conference. Today's Notes are random notes that mention ASAM (the American Society of Addiction Medicine). --- ## ![[Open random note.png]] Three notes from the Random Note core plugin. This is how I am dipping my toe into [Obsidian Publish](https://publish.obsidian.md) by adding at least 3 notes per week from my library of 6600+ notes. --- ## 🎲 [[ASAM Definition of Addiction]] From the 3rd edition of _The ASAM Criteria_, this note includes the definition used for `addiction`. Because the word addiction is rather generic and has a broader use than just for the disease of addiction, `substance use disorder` (SUD) is the least ambiguous technical term used nowadays. --- ## 🎲 [[Overdose bup ED|Opioid overdose management in the 2017 E.R.]] (2017) This note is about 6 years old, containing references to four sources that address this topic. --- ## 🎲 SAMHSA & Privacy: [[42CFR Listening Session - SAMHSA 20180131|42 CFR Part 2 Listening Session ]](2018) This note reflects the notes I took for the 1/31/2018 SAMHSA Listening Session. I captured public comments from 35 people. Note that these notes are my own paraphrasing, so could contain errors. It is a good reflection of where we were 5 years ago regarding how to optimize the balance between privacy, stigma, safety, quality, and shared decision-making regarding SUDs. --- ## ![[logo.mailtape.png|64]] #539 - [Léon Phal](https://www.mailta.pe/539/leon-phal/) #mailtape/bliss This is the selection from last Sunday, from [Léon Phal](https://leonphal.bandcamp.com/album/stress-killer). These pieces are each quite relaxing/energizing to listen to. --- [[20231022 ☕️ Sunday Morning Coffee Notes|Prior]] <> [[20231112 ☕️ Sunday Morning Coffee Notes|Next]] [[20230625 Thinking about ☕️ Sunday Morning Coffee Notes|About coffee notes]] [[Home#Contact|Contact me]]