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

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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)

Arkansas

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Number of Overdose Deaths in Arkansas

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Governor Asa Hutchinson Former DEA Administrator 2001-2003

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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.

State Efforts

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Prescription Drug Monitoring Program. Expansion of Drug Take Back Day. State Efforts

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Drug Take Back Arkansas Compared to Neighboring States

Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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.”

Good Samaritan Law Arkansas Act 1222

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Police and First Responders carry Naloxone kits. 471 saves in past15 months.

Increased Use of Naloxone by Police and First Responders

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

State Wide Collaboration Working on Opiates in the Workplace

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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

Together Arkansas- Opiate Response Initiative

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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

• pioid 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.”

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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

• ptions through employee, member and provider

publications

Arkansas Blue Cross Opioid Initiatives

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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 ™ Quantity Limits/Utilization Management/Plan Design

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

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

$147,000 to Psychiatric Research Institute at UAMS for prescriber education on

• pioid management and dependency

reduction. $150,000 for 1,390 Naloxone Kits for First Responders. Community Organizations. NAMI. Recovery Organizations.

Grants by Blue And You Foundation for a Healthier Arkansas

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Plan Response to Covid 19 Pandemic

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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.

ABCBS Expanded Access to Behavioral Health and Substance Use Treatment

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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.

Expanded Access to Outpatient Substance Use Disorder Treatment

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

MD, DO APRN Clinical Psychologists (PhD, PsyD, EdD) Licensed Psychological Examiners (LPE) Licensed Clinical Social Workers (LCSW) Licensed Professional Counselors (LPC)

Opened up Telemedicine to SUD Treatment Providers

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

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 Opened up Telemedicine to SUD Treatment Providers

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Covered individual psychotherapy and family psychotherapy session program components provided by telemedicine.

Partial Hospitalization and Intensive Outpatient Programs

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Office Visits vs Telehealth

• 20,000

40,000 60,000 80,000 100,000 120,000 Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020 PAID MONTH

Total Services by Month

Office Visit Telehealth Visit

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Total Services by Encounter

69,555 89,863 101,819 96,084 104,279 100,266 61,356 151 223 372 275 320 2,517 33,468

OCT-2019 NOV-2019 DEC-2019 JAN-2020 FEB-2020 MAR-2020 APR-2020

TOTAL SERVICES

OFFICE TELEHEALTH

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

99441 5-10 Minutes 99442 11-20 Minutes 99443 21-30 Minutes Telephone Codes Turned On

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Telephone Codes

31 153

MAR-2020 APR-2020

TOTAL SERVICES

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Telehealth Visits for Behavioral Health and Substance Use Disorder

• 2,000

4,000 6,000 8,000 10,000 12,000 14,000 16,000 Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020 PAID MONTH

Behavioral Health Services by Month

Office Visits Telehealth Visits

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Telehealth Percent of Total Behavioral Health Services

50.5% 53.6% 56.7% 47.7% 48.5% 7.2% 0.4% 49.5% 46.4% 43.3% 52.3% 51.5% 92.8% 99.6%

Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

% OF TOTAL BEHAVIORAL HEALTH SERVICES

OFFICE TELEHEALTH

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Opioid and Stimulant Use Disorder Treatment by Place of Service

121 148 327 403 362 437 300 1 2 8 6 14 48 512 1 2 3 4 5 6 7

TOTAL SERVICES

OFFICE TELEHEALTH

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Addressing Opioid Use Disorder Treatment in Arkansas during Covid 19

Opioid and Stimulant Use Disorder Treatment by % of Total Services

99.2% 98.7% 97.6% 98.5% 96.3% 90.1% 36.9% 0.8% 1.3% 2.4% 1.5% 3.7% 9.9% 63.1%

Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

% OF TOTAL SERVICES OFFICE TELEHEALTH

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Opioid and Stimulant Use Disorder by Diagnosis Class

103 122 315 379 346 440 570 26 34 30 37 39 65 299

Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

TOTAL SERVICES

OPIOID RELATED DISORDERS OTHER STIMULANT RELATED DISORDERS

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

% of Total Service Opioid Use Disorder vs Stimulant Use Disorder

79.8% 78.2% 91.3% 91.1% 89.9% 87.1% 65.6% 20.2% 21.8% 8.7% 8.9% 10.1% 12.9% 34.4%

Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

% OF TOTAL SERVICES

OPIOID RELATED DISORDERS OTHER STIMULANT RELATED DISORDERS

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

AA, NA, ALANON, ACA meetings moved to Zoom. “50 States in 50 Days” Zoom Bombing Controlled by passwords. Meeting format- Chair calls on participants. Works well for 120 plus attendees. Explosion of Virtual 12 Step Meetings

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Addressing Opiate Use Disorder Treatment During Covid 19

www.aa.org Alcoholics Anonymous

Click on your state. Look for A.A. groups near you. Go to their local website.

www.na.org Narcotics Anonymous

Search your state for meetings near you.

How to Find Online Meetings

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Arkansas Blue Cross Blue Shield efforts during the Covid 19 pandemic increased access to treatment for Opioid Use Disorder and Stimulant Use Disorder. Use of Telemedicine for Opiate Use Disorder treatment increased exponentially. This will continue after the Pandemic. Recovery Groups successfully went online during the Covid 19 Pandemic. Virtual AA and NA meetings will continue after the Pandemic.

Conclusion

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Excess Slides pulled from Presentation

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Initiatives for Opioid Use Disorder Treatment Before Covid 19 Pandemic

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

The only Southern state to expand Medicaid in 2014 by Section 1115 Waiver. Expanded Medicaid by Private Option. Provided Commercial Insurance Policies for People >120% Federal Poverty Level. Now called Arkansas Works. Resulted in commercial insurance reimbursement rates for Hospitals and

• Providers. Only one Arkansas hospital closed

between 2010-2019 vs 52 hospital closures in surrounding states.

Arkansas Medicaid Expansion

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Major Transport Corridor from Southwest to East Coast for Mexican Drug Trafficking Organizations. Increased Seizures of heroin, fentanyl and methamphetamine in 2019 coming from Mexico. Small amounts coming from China or

• ther countries.

Marked decrease in local manufacturing of methamphetamine.

2021 Arkansas State Drug Threat Assessment

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Addressing Opioid Use Disorder Treatment in Arkansas during Covid 19

“Factors that make Arkansas an attractive place to reside, including its climate, extensive Interstate Highway System and the rural nature of the state contribute to Arkansas’ attractiveness as a drug transit and staging region.”

Source: 2021 Gulf Coast High Intensity Drug Trafficking Area (HIDTA) Law Enforcement and Treatment/Prevention Survey

2021 Arkansas State Drug Threat Assessment

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

2021 Arkansas State Drug Threat Assessment

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Suspended requirement for an in-person encounter to establish professional relationship. Suspended requirements for specialization licenses for telemedicine. Governor’s Emergency Proclamations

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Percent of Total Services

99.8% 99.8% 99.6% 99.7% 99.7% 97.6% 64.7% 0.2% 0.2% 0.4% 0.3% 0.3% 2.4% 35.3% Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

% OF TOTAL SERVICES

OFFICE TELEHEALTH

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Addressing Opioid Use Disorder Treatment in Arkansas During Covid 19

Total Behavioral Health Services

1,142 13,456 Oct-2019 Nov-2019 Dec-2019 Jan-2020 Feb-2020 Mar-2020 Apr-2020

TOTAL SERVICES

OFFICE TELEHEALTH