Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 - PowerPoint PPT Presentation

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 Herbert Price MD 18 May 2020

Arkansas � Rural Agricultural State with areas of high poverty along with some booming areas. � Population 3,038,999 � High rate of Opioid Use Disorder � # 2 in Prescribed opiates in 2016. 93.5 per 100 US Rate 51.4 per 100 � #1 Rice Production Delta Counties � #1 Waterfowl Hunting Licenses sold annually (61,000) � # 2 Per capita Gun Ownership 58% (After Alaska) Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 2

Number of Overdose Deaths in Arkansas Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 3

Governor Asa Hutchinson Former DEA Administrator 2001-2003 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 4

State Efforts � Kirk Lane Arkansas Drug Director – Oversees Enforcement Efforts – Oversees Treatment Efforts – Strong Emphasis on Peer Counselors � Jimmy McGill DHS Recovery Coordinator – Directs training program for Recovery Counselors. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 5

State Efforts � Prescription Drug Monitoring Program. � Expansion of Drug Take Back Day. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 6

Drug Take Back Arkansas Compared to Neighboring States Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 7

Good Samaritan Law Arkansas Act 1222 Immunity from arrest or prosecution for controlled substance possession & paraphernalia offenses for: • Calling 911 • Administering Naloxone • Seeking Medical Attention – For an overdosing person. “Don‘t Run. Call 911.” Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 8

Increased Use of Naloxone by Police and First Responders � Police and First Responders carry Naloxone kits. � 471 saves in past15 months. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 9

State Wide Collaboration Working on Opiates in the Workplace Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 10

Together Arkansas- Opiate Response Initiative � Goal of a Drug- Free Workforce � Reduce Opiate Dependence Collaborating Organizations � Arkansas State Chamber of Commerce � Associated Industries of Arkansas � Arkansas Foundation for Medical Care � Arkansas Blue Cross Blue Shield Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 11

Arkansas Blue Cross Blue Shield Curtis Barnett, CEO Arkansas Blue Cross Blue Shield “The opioid epidemic is one of the biggest threats to the foundation of business and our economy today. Providing Arkansas employers tools to address a problem as pervasive as opioid use disorder is critical. Helping employees break the bonds of addiction and get and stay healthy keeps them creative, innovative and productive. And that makes Arkansas strong.” Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 12

Arkansas Blue Cross Opioid Initiatives � Quality of Care Programs – Substance Abuse Prevention Coordinator – Outreach to prescribers identifying members with multiple prescribers & pharmacies – Outreach to prescribers about patients on combinations that are likely to produce overdose – Care Management outreach to members who meet certain thresholds � Communication – Provide opioid utilization reporting to Collaborative Heath Initiative Partners and other physician group partners – Education on risks of opioid misuse and treatment options through employee, member and provider publications Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 13

Quantity Limits /Utilization Management/Plan Design � Limited amount of opiated prescribed at one time. � Limit to a 7 day fill for acute pain patients � 90 morphine milligram equivalents (90 MME)/day � Quantities over 90 MME require prior approval � Max dose allowed 200 MME/day � Require patients to use immediate-release opioids first before moving on to extended-release � Removed the PA from Suboxone™ � Removed member cost-share from naloxone/ Narcan ™ Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 14

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Grants by Blue And You Foundation for a Healthier Arkansas � $147,000 to Psychiatric Research Institute at UAMS for prescriber education on opioid management and dependency reduction. � $150,000 for 1,390 Naloxone Kits for First Responders. � Community Organizations. � NAMI. � Recovery Organizations. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 19

Plan Response to Covid 19 Pandemic 20 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

ABCBS Expanded Access to Behavioral Health and Substance Use Treatment For Inpatient , Residential Treatment , Partial Hospitalization and Intensive Outpatient . � Stopped Prior Approval requirements. � Stopped Concurrent Review. � Requested pre-note notification of above to assist with case management. � No cost sharing for Behavioral Health or SUD- No co-pays, deductibles or co- insurance. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 21

Expanded Access to Outpatient Substance Use Disorder Treatment � For all Fully Insured Plans: � Waived all copays, coinsurance and deductibles for all in network providers. � Opened up Telephone Codes 99441,99442, 99433. � Opened up Telemedicine Codes � Arkansas State Law Required all State Boards to meet the level of stringency equal to Medical Board Standards for Telemedicine. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 22

Opened up Telemedicine to SUD Treatment Providers � MD, DO � APRN � Clinical Psychologists (PhD, PsyD, EdD) � Licensed Psychological Examiners (LPE) � Licensed Clinical Social Workers (LCSW) � Licensed Professional Counselors (LPC) Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 23

Opened up Telemedicine to SUD Treatment Providers 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with E&M 90832 Psychotherapy, 30 minutes with patient 90833 Psychotherapy, 30 minutes with patient with E&M 90834 Psychotherapy, 45 minutes with patient 90836 Psychotherapy, 45 minutes with patient with E&M 90837 Psychotherapy, 60 minutes with patient 90838 Psychotherapy, 60 minutes with patient with E&M 90845 Psychoanalysis 90846 Family psychotherapy (without the patient present), 50 minutes 90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 24

Partial Hospitalization and Intensive Outpatient Programs � Covered individual psychotherapy and family psychotherapy session program components provided by telemedicine. Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 25

Office Visits vs Telehealth Total Services by Month 120,000 100,000 80,000 60,000 40,000 20,000 - Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020 PAID MONTH Office Visit Telehealth Visit Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 26

Total Services by Encounter TOTAL SERVICES OFFICE TELEHEALTH 320 372 2,517 275 223 33,468 151 104,279 101,819 100,266 96,084 89,863 69,555 61,356 OCT-2019 NOV-2019 DEC-2019 JAN-2020 FEB-2020 MAR-2020 APR-2020 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 27

Telephone Codes Turned On � 99441 5-10 Minutes � 99442 11-20 Minutes � 99443 21-30 Minutes Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 28

Telephone Codes TOTAL SERVICES 153 31 MAR-2020 APR-2020 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 29

Telehealth Visits for Behavioral Health and Substance Use Disorder Behavioral Health Services by Month 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020 PAID MONTH Office Visits Telehealth Visits Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 30

Telehealth Percent of Total Behavioral Health Services % OF TOTAL BEHAVIORAL HEALTH SERVICES OFFICE TELEHEALTH 43.3% 46.4% 49.5% 51.5% 52.3% 92.8% 99.6% 56.7% 53.6% 50.5% 48.5% 47.7% 0.4% 7.2% Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 31

Opioid and Stimulant Use Disorder Treatment by Place of Service TOTAL SERVICES OFFICE TELEHEALTH 512 48 6 14 8 437 403 362 2 327 1 300 148 121 1 2 3 4 5 6 7 Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19 32