Bernalillo County NMPHA Annual Conference April 2, 2014 Marsha - - PowerPoint PPT Presentation

NMPHA Annual Conference April 2, 2014 Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council

BER BERNALIL ALILLO O COUNT COUNTY OPIOID OPIOID AB ABUSE USE ACCOU CCOUNT NTABILITY ABILITY SUMMIT SUMMIT “Turning the Curve on Opioid Abuse in Bernalillo County”

SUMMIT PLANNING COMMITTEE SUMMIT #1 September 19, 2013 IMPLEMENTATION TEAMS PRIMARY PREVENTION OVERDOSE PREVENTION TREATMENT LAW ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM COORDINATING COMMITTEE INTERIM UPDATE MEETING June 2014 SUMMIT #2 Fall 2014

BER BERNALIL ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014)

October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014

WORKING IN COLLECTIVE IMPACT REQUIRES A MINDSET SHIFT

OLD WAY

• Technical

Problem-Solving

• Credit
• Silver Bullet

NEW WAY

• Adaptive

Problem-Solving

• Credibility
• Silver Buckshot

Adapted from John Kania

COLLECTIVE IMPACT: WHAT IT TAKES

• 2. Allow for the “shock of the possible”
• 1. Achieve a perpetual state of simultaneous

planning and doing

• 3. Pay attention to relationships
• 4. Listen, listen, listen for how to respond to

unanticipated results

• 5. Adopt an attitude of “burning patience”

Adapted from John Kania

RESULTS-BASED ACCOUNTABILITY has two parts:

Population Accountability

about the well-being of WHOLE POPULATIONS

For communities – cities – counties – states – nations

Performance Accountability

about the well-being of CUSTOMER POPULATIONS

For Programs – Agencies – Service Systems

RESULTS-BASED ACCOUNTABILITY (RBA)

RESULT

What is the desired change in population well-being?

HEADLINE INDICATOR

What data – tracked as a trend over time - would best indicate change toward the desired result? (This represents what we want to “turn the curve” on.)

STORY BEHIND THE CURVE

What are the root causes and multiple forces at work causing the trend? What additional information/data is still needed? (This is the “research agenda”)

WHAT PARTNERS NEED TO BE INVOLVED?

Who needs to be at the table and who’s missing?

WHAT WORKS? (WHAT WOULD IT TAKE TO “TURN THE CURVE”?)

What can each partner contribute? What are some no cost/low cost ideas that can be worked on right away?

Potential Indicators

HEADLINE HEADLINE INDICA INDICATOR

#/rate of

• verdose deaths

associated with opioid use in Bernalillo County

Prevention Indicator

Rate of reported use

• f heroin/painkillers

to get high among youth in last 30 days

Har Harm m Reduction eduction Ind Indica icator tor

# of heroin overdose deaths & Naloxone reversals

Trea eatment tment Ind Indica icator tor

#/rate of hospitalizations for OD with any opioid involvement

Law Law Enf Enfor

• rcement/

cement/ Cr Criminal iminal Just ustice/ ice/ Public Public Saf Safety ety Ind Indica icator tor

Recidivism rates at MDC (within 1 and 3 years)

INDICATORS AND PERFORMANCE MEASURES

• Indicators as used here are specifically related to the

well-being of the population - are we getting better or getting worse as a population?

• Performance measures track data related to the

performance of the system and/or specific programs.

• How much was done?
• How well was it done?
• Is anyone better off?

SUMMIT PLANNING COMMITTEE SUMMIT #1 September 19, 2013 IMPLEMENTATION TEAMS PRIMARY PREVENTION OVERDOSE PREVENTION TREATMENT LAW ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM COORDINATING COMMITTEE INTERIM UPDATE MEETING June 2014 SUMMIT #2 Fall 2014

BER BERNALIL ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014)

October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014

SUMMIT SUMMIT PLA PLANNING NNING COMMITTEE COMMITTEE

Focused on identifying recommendations, indicators, panelists and format for first Summit. ~20 multi-sectoral members representing:

• Advocates, community activists, drug policy analysts, data analysts
• Albuquerque Health Care for the Homeless
• Bernalillo County Community Health Council
• Bernalillo County Department of Substance Abuse Programs/MATS
• Bernalillo County Urban Health Extension
• City of Albuquerque Division of Health & Human Services
• Heroin Awareness Committee (Healing Addiction in Our Community)
• Molina Healthcare
• New Mexico Department of Health – Health Promotion
• New Mexico Department of Health – Office of Injury Prevention
• New Mexico Department of Health – Turquoise Lodge
• Presbyterian Healthcare Services
• UNM Prevention Research Center for Education Policy Research
• UNM Preventive Medicine
• UNM Urban Health Partners – Pathways to a Health Bernalillo County
• UNM Center for Alcoholism, Substance Abuse & Addictions (CASAA)
• UNM RWJF Health Policy Center

SUMMIT PLANNING COMMITTEE SUMMIT #1 September 19, 2013 IMPLEMENTATION TEAMS PRIMARY PREVENTION OVERDOSE PREVENTION TREATMENT LAW ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM COORDINATING COMMITTEE INTERIM UPDATE MEETING June 2014 SUMMIT #2 Fall 2014

BER BERNALIL ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014)

October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014

SUMMIT #1

September 19, 2013 Convened 150 multi-sectoral stakeholders to hear panelists, review recommendations and get commitment to follow-up work over next two years

Four Implementation Teams with volunteers from Summit - plus others - meet monthly to:  strategize and act on implementing recommendations for their specific area, including identifying decision- makers who are key players to bring to the table  select indicator(s) as target to measure desired

• utcome(s) and to develop baseline "report card"

 inventory available services/gaps in their area, identifying need for additional resources  provide ideas for next Summit

PRIMARY PREVENTION IMPLEMENTATION TEAM

What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION

• Develop and implement prevention framework for the county using SAMHSA

SA Prevention Framework, NMPED "Building State Capacity" plan, with tools for community coalitions, schools, faith-based institutions and workplaces

• Expand access to drug counseling services for high school and middle school

students including referrals and how Medicaid could support

• Support policies to expand evidence-based early childhood support programs,

including home visiting focusing first on low-income families

• For pain control, promote evidence-based alternatives for Rx opioids
• Reduce supply of Rx opioid pain medication by increasing access to and usage
• f Prescription Monitoring Program database AND prescribing guidelines to

limit over-prescription of opioids

• NEW: Inventory and evaluation of existing programs
• NEW: Access to mental health care (which could possibly be part of the

Treatment Team work as well)

HARM REDUCTION/OVERDOSE PREVENTION IMPLEMENTATION TEAM What would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION

• Distribute naloxone to persons being released from MDC and their families
• Build on existing programs
• Learn from existing models/pilots
• Provide training for inmates, families, MDC staff and P&P officers
• Restructure P&P policies to allow for parolees to have naloxone rescue kits while on parole*
• Assure all police officers are carrying naloxone and trained in its use
• Support implementation of authorization allowing pharmacists to prescribe naloxone
• Support development of MCO reimbursement mechanisms for kits and

education/consultation

• Assure naloxone rescue kits are stocked at all pharmacies
• Advocate for all providers to co-prescribe naloxone with opioid pain meds for chronic pain

management

• Make naloxone and training available to agencies with outreach programs for injection drug

users, treatment centers and methadone clinics*

• Make naloxone available at all public health offices as walk-in sites
• Normalize naloxone as service
• Assure services are user-friendly
• 1. Make availability of naloxone normal and universal

TREATMENT IMPLEMENTATION TEAM

What works or would work to "turn the curve" on this problem?

RECOMMENDATIONS FOR ACTION

• Increase MD participation in prescribing
• Remove preauthorization for prescribing buprenorphine
• Address issues of stigma
• Continue MAT for MDC inmates already in treatment when incarcerated
• Offer pre-release MAT to MDC inmates not yet in treatment
• Assure access for uninsured populations, including those not eligible for coverage
• Expand buprenorphine beyond detox to ongoing maintenance treatment when

appropriate (Turquoise Lodge and MATS)*

• Address issue of drug courts excluding people on MAT*
• Address BHSD guidelines allowing only psychiatrists to prescribe buprenor-phine and no

payment for methadone*

• Address private insurance payment for methadone*
• Address VA lack of provision and payment for methadone*
• License mid-level practitioners to prescribe buprenorphine (issue of federal regulations)*
• 1. Expand access to MAT

TREATMENT continued What works or would work to "turn the curve" on this problem?

• Expand number and capacity of residential and inpatient programs
• Work with Medicaid, Centennial Care MCOs and private insurance to provide

coverage/ reimbursement

• Assure access for uninsured populations, including those not eligible for coverage*
• Duration of coverage for specific levels of intervention should be flexible and tailored

to patient needs

• Assure identification and treatment of co-occurring disorders
• Eliminate need for diagnosed co-occurring condition as a requirement for Medicaid

funding of treatment of alcohol/drug dependency

• Include wrap-around support services as integral part of funding for treatment

services, including assistance finding housing/jobs

• Identify and offer enrollment to all persons who are drug users or at risk for opioid

use and are eligible for Medicaid, especially persons being released from incarceration

• Advocate for Medicaid coverage of evidence-based non-pharmacologic treatment of

pain, e.g., chiropractic

• 2. Expand full array of treatment services aligned with ASAM guidelines

TREATMENT continued What works or would work to "turn the curve" on this problem?

• Develop a comprehensive inventory and mapping of current treatment services to

determine gaps in capacity and levels of care as basis for an effective, coordinated system

• Develop current, consistently updated database of services accessible to providers

and community (including eligibility criteria and program capacity)*

• Identify opportunities for enhanced linkages among different components of the

system*

• Develop shared measurement criteria to allow for evaluation of system linkages and

accurate cost reports*

• Propose realignment of resources to support prioritized services in alignment with

agreed-upon principles

• Explore feasibility and appropriately plan for expansion of County DSAP as nucleus of

a much-expanded integrated treatment system

• Assure integration of MDC into treatment system linked to community

providers/resources*

• 3. Develop comprehensive and coordinated treatment system in Bernalillo County

DATA TEAM

 Continues gathering of data to support each Implementation Team  Maintains "data development agenda" (list of data still needed)  Develops baseline "report card" with input from Implementation Teams and Coordinating Committee

COORDINATING COMMITTEE

2 co-chairs from each Implementation Team, representative(s) of Data Team, and others with contracted Coordinator

• Assure alignment of implementation activities of 4 teams
• Coordinate interim face-to-face meetings with appropriate policy-makers

and other stakeholders as needed to support implementation of recommendations

• Take input from Teams to plan Interim Update Meeting and Summit #2
• Coordinate data collection
• Develop case statement, including fiscal case statement for changing

where we put our resources

• Develop and coordinate ongoing media and public education campaign
• Coordinate inventories of services and gaps, leading to structure for re-

designed system

• Coordinate input on need for resources to fill policy/services gaps

INTERIM UPDATE MEETING

by June 2014 Convene members of Implementation Teams, participants in Summit #1 and other interested stakeholders to report progress on initiative recommendations to date

SUMMIT #2

Fall 2014 Re-convene multi-sectoral stakeholders to provide update on progress toward implementation to date and get commitment

• f additional stakeholders to continue

re-design of system and actions to "turn the curve"

SUMMIT PLANNING COMMITTEE SUMMIT #1 September 19, 2013 IMPLEMENTATION TEAMS PRIMARY PREVENTION OVERDOSE PREVENTION TREATMENT LAW ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM COORDINATING COMMITTEE INTERIM UPDATE MEETING June 2014 SUMMIT #2 Fall 2014

BER BERNALIL ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014)

October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014

THANK YOU!

Marsha McMurray-Avila

Coordinator, Bernalillo County Community Health Council

mcavila@bernco.gov 505-468-7025 A report on the September 2013 Summit Proceedings, plus videos and handouts from all sessions are available online at:

http://www.bchealthcouncil.org/opioidinitiative