PROJECT ADVISORY COMMITTEE (PAC) Thursday, April 4, 2019 9:00 am - - - PowerPoint PPT Presentation

4/17/2019

PROJECT ADVISORY COMMITTEE (PAC)

Thursday, April 4, 2019 9:00 am - 12:00 pm Hilton Garden Inn – Stony Brook Hosted by the Office of Population Health at Stony Brook Medicine

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WELCOME REMARKS

Presented by Linda S. Efferen, MD, MBA Executive Director & VP, Medical Director Suffolk Care Collaborative

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FROM: CHAN, PEGGY SENT: MONDAY, APRIL 01, 2019 4:43 PM

Dear PPS Colleagues: Congratulations DSRIP Nation on the first day of DSRIP Demonstration Year 5! It truly is a moment to reflect on how far we have come since the first announcement of the MRT DSRIP waiver in April 2014. Your achievements to get to this point have truly been inspirational!

• PPS combined efforts statewide have helped to reduce potentially avoidable admissions and potentially avoidable readmissions

by 21% and 20%, respectively through MY4 Month6.

• PPS efforts improved the majority of performance measures statewide enabling us to pass the first statewide accountability test.
• The Independent Evaluator statewide partner survey for 2018 on DSRIP experiences show that 81% of partners report positive change

in services or clinical care at their organization and 75% report patients are experiencing better care since the launch of DSRIP. We’ve all learned so much in pursuing the goals of DSRIP. What resonates across the state - whether it’s Buffalo, Binghamton or Brooklyn – is the collaboration and partnerships that PPS have fostered to move the needle for improving care in your communities. Each PPS experience is unique and is an example of focusing on what CAN be done in enhancing diverse provider networks into “communities of care” for our Medicaid members. Thank you for all that you do as we continue to move forward! Peggy Peggy Chan, MPH DSRIP Program Director

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MEETING AGENDA MODERATED BY: Ashlee McGlone, MA, Provider Relations Manager, SCC

9:00 am – 9:05 am Welcome Remarks Linda S. Efferen, MD, MBA Executive Director & VP Medical Director, SCC 9:05 am – 10:00 Peer Support Programs in Healthcare NYS Office of Alcoholism & Substance Abuse Services (OASAS) Northwell Health Catholic Health Services Suffolk County Community College 10:00 am – 10:15 am Break 10:15 am – 10:45 am Building Community Partnerships to Improve Medication Adherence Brentwood Pediatrics & Adolescent Associates Salumed Pharmacy Suffolk Care Collaborative 10:45 am – 11:30 am Localizing the MAX Methodology through a Community-Based Approach Harbor View Medical Services, PC Hudson River HealthCare’s Elsie Owens Health Center 11:30 am – 12:00 pm Closing Remarks Networking Linda S. Efferen, MD, MBA Executive Director & VP Medical Director, SCC

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Antonette Whyte-Etere, LCSW-R, CASAC, Regional Coordinator Maureen Nguli, Addictions Planning Analyst II, Recovery Bureau NYS Office of Alcoholism & Substance Abuse Services (OASAS) Sandeep Kapoor, MD, MS-HPPL Director, SBIRT Linda M. DeMasi, MBA, Project Manager, SBIRT Northwell Health

Peer Support Programs in Healthcare

Gloria Mooney, MS, CSSGB, Project Manager Samantha Zeller, BS, Project Manager Catholic Health Services Amory Mowrey, CARC, CRPA, CASAC-T, Sherpa Program Manager Family & Children’s Association Kathleen Ayers-Lanzillotta, MPA, CASAC Academic Chairman Allied Health Sciences Program Suffolk County Community College

Presented by

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Bureau of Recovery

Long Island Region

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FOUR RECOVERY DOMAINS

SAMHSA has delineated four major dimensions that support a life in recovery: Health: Overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home: A stable and safe place to live that supports recovery; Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking,

• r creative endeavors, and the independence, income and resources to participate

in society; and Community: Relationships and social networks that provide support, friendship, love, and hope

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https://addiction.surgeongeneral.gov/sites/default/files/su rgeon-generals-report.pdf

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Trad aditi ition

• nal

al Sy Systems stems O Of Ca Care e Ar Are e Lik Like e Dr Draw aw Bri Bridg dges es Cons Constr truc ucted ted With T ith The he Bri Bridg dge e Up Up

Disconnects between:

• Long Term Recovery

and Treatment

• Individual/Family and

Professional

• Community and Care
• Self Help and Service

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What Are Peer Support Services?

Peer Support Services are provided by non-clinical workers with lived experience with SUD who uses their knowledge to support the recovery goals and plan of individuals who are using drugs and/or alcohol. A Peer Worker offers acceptance, understanding, validation and hope. Peer Support Services enhance treatment, are participant-centered and based on lived experience. Peer Services can be considered pre-admission services for outreach & engagement, continuing care or in-community services.

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Developed Peer Culture

In the traditional behavioral health system the “provider” was seen as the expert who had knowledge that could be shared with or taught to the person seeking support and help. In a recovery oriented system this expert/patient way of looking at things shifts to be two (or more) people coming together to solve problems. A peer culture recognizes that everyone in the “community” has knowledge and skills that can be used for solving whatever challenges they face together. In a peer culture, people in recovery are employed at all levels of the system. There is representation

• f recovering people at all levels of the system. This representation is not just a “token”

representation, but based in the shared knowledge that with the recovering voice present, decisions are fully informed. In a true peer culture there will also be services that are “operated by people in recovery.” These are services that are planned, managed and provided by people in recovery.

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Key terms and definitions related to Peer Support

Terms Definitions

Recovery A process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Peer support The process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Peer support group Where people in recovery voluntarily gather together to receive support and provide support by sharing knowledge, experiences, coping strategies, and offering understanding. Peer Worker (certified recovery peer advocate, certified peer specialist, recovery coach) A person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind–body recovery and resiliency. Peer mentorship Where individuals in later recovery provide nonprofessional, nonclinical assistance to individuals in earlier recovery with similar conditions or circumstances to achieve long- term recovery from psychiatric, alcohol, and/or other drug-related problems.

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Defined Peer Role: “Offering & receiving help, based on shared understanding, respect & mutual empowerment between people in similar situations.” ACTIVITIES: Advocacy; Linkage to Resources; Sharing of Experience; Community & Relationship Building; Group Facilitation; Skill building; Mentoring; goal Setting; Supervision of other Peers; Training; Program Administration; Public Education & Awareness. RECOVERY is: A Process of Change Through Which Individuals Improve Their Health & Wellness, Live Self-Directed Lives, and Strive to Reach Their Full Potential

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Characteristics of a Peer within SUD Settings

Lived SUD Experience; Indicators of Stability in Recovery; Positive social connections and support within the community; Actively manages health issues; Maintenance of Housing; Knowledge of local community resources and processes to access supports; Demonstrated ability to utilize principles of MI; Platform skills; Soft employment skills; Willingness to work in teams, practices boundaries, accepts authority; Comfortable working with diversity; Problem solving/critical thinking; empathic; Flexible and adaptable; Resolves conflict calmly and appropriately; Dependable; Open to feedback.

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Peer Support Services

• New workforce created!
• OASAS authorized two entities to award certification of Certified Recovery Peer

Advocates (CRPA), currently there is one NYCB

• NY obtains CMS approval for outpatient and OTPs to employ CRPAs and bill

Medicaid for peer support services

• Provider reimbursement NYC $52/hour Upstate $44.60/hour-soon to be

increased 50%

• NYCB and FOR-NY to share $250K for CRPA training, exam and application fee for

candidates

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Peer Support Services Include:

Developing Recovery Plans Raising Awareness of Existing Social & Other Support Services Modeling Coping Skills Dispelling Myths about SUD Accompanying Participant to Appointments Linking Participants to Formal Recovery Supports

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Why a Peer Support Certification?

Process for acknowledging skills acquired by peers that qualify them to assist another in their recovery journey Includes standards for training and experience Promotes a skilled workforce Allows funding from new sources Establishes the qualifications for “professional” recognition for individuals working in the mental health system or addiction recovery system based on “The Shared Personal Experience” paradigm

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What is a Certified Recovery Peer Advocate (CRPA)?

Provides outreach, advocacy, mentoring and recovery support services to those seeking or sustaining recovery. In order to become a CRPA, the applicant must pass the International Certification and Reciprocity Consortium (ICRC) - An exam offered by an OASAS approved certification board.

Hold a high school diploma or jurisdictionally certified high school equivalency and complete 46 hours of required training-advocacy; mentoring & education; recovery & wellness; ethical responsibility Complete 500 hours of volunteer

• r paid work experience

Receive 25 hours of supervision by an organization’s documented and qualified supervisory staff Pass the IC&RC Peer Advocate Exam

CERTIFICATION REQUIREMENTS

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Resources for CRPA Training

Friends of Recovery – NY (FOR-NY) FOR-NY in partnership with qualified trainers from throughout New York State, is pleased to offer first-rate trainings to peer professionals, treatment providers, prevention specialists, and anyone interested in addiction and recovery. Queensborough Community College-CUNY Josephine Troia, MS Ed., Program Coordinator 222-05 56th Avenue Bayside, NY 11364 718-281-5535, Fax: 718-281-5538 gtroia@qcc.cuny.edu

Suffolk County Community College – COMING SOON

Kathleen Ayers-Lanzillotta, MPA, CASAC Crooked Hill Road, Paumanok Hall P109A Brentwood, NY 11717 631-851-6594, ayersk@sunysuffolk.edu

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FOR-NY BEST PRACTICE TRAINERS

Best Practice Trainers provide comprehensive training and support to budding peer professionals. Trainers:

• conduct a face-to-face screening interview
• provide all 46 hours of NYCB-approved training (Both RCA + Ethics,
• r other approved curriculum)
• mentor students through the CRPA certification process:

* may assist with obtaining volunteer hours, * provide resources to prepare for the exam and * write a letter of recommendation.

• host a monthly student learning collaborative
• provide certification renewal training.

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Long Island Recovery Association BEST PRACTICE TRAINERS Long Island (Nassau & Suffolk)

Primary Contact Richard Buckman rbuckman@lirany.org 631-766-5664 Trainings Provided: CCAR Recovery Coach Academy CCAR Ethical Considerations for Recovery Coaches LIRA Ethics for Recovery Coaches Science of Addiction Recovery Our Stories Have Power-Recovery Messaging Training Legislative Issues and Addiction Recovery- Advocacy Training The Anonymous People Film and Discussion Generation Found Film and Discussion Multiple Pathways To Recovery Trainer(s) Elsie Demers edemersmetro@gmail.com 516-903-1550 Richard Buckman rbuckman@lirany.org 631-766-5664

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Principles for Peer Worker Core Competencies

Recovery-Oriented

Hope & Partnering; Building on Strengths Recognizing There are Multiple Pathways

Person-Centered Voluntary

Peer Choice

Relationship Focused Trauma-Informed

Strength based framework

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Advantages for Providers

• Managed Care plans and other funders will look for peer

integration

• New funding stream:

Outpatient and OTP clinics - Peers & Continuing Care

• Being able to achieve the goal of integrating peers to bridge

access points in the human services systems

• Increase the visibility of your organization
• Better: Engagement, Retention, Census

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Advantages for Providers

• A cost-effective way to increase positive outcomes-Medicaid
• nly needs to pay for the service (provider break even) for peer

integration to be cost effective.

• The opportunity to have new perspectives on addressing

behavioral health issues.

• Several studies document extensive evidence and research

supporting the beneficial use of peer‐support and peer‐delivered services (e.g. Kyrouz, Humphreys, and Loomis, 2002; Bottomley, 1997; Davidson et al., 2006;

Davidson et al., 1999).

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Early Implementation: Building the Foundation

• Buy-in from executive level and bds. of directors
• Means that all have been fully educated on best practices re: peer supports;

analysis of impacts on current practices and changes needed; tolerance of uncertainty and challenges

• Agency readiness self-assessment completed
• Attitudes explored of existing staff-are we welcoming, do existing staff feel

threatened peers will “take over”?

• Forums held to listen to staff concerns/ideas
• Anticipate questions about ADA, ethics
• Identify idea champions at all levels of agency

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OASAS Recovery Support Services on Long Island Recovery Community and Outreach Centers

(Weekend & Evening hours- Strong Participatory Process)

The centers provide health, wellness and other critical supports to people and families who are recovering from a substance use disorder or are seeking recovery services for a family member or friend. They provide a community-based, non-clinical setting that is safe, welcoming and alcohol/drug-free for any member of the

• community. The centers promote long-term recovery through skill-building, recreation, employment

readiness and the opportunity to connect with other community services and peers facing similar challenges.

Family and Children's Association- THRIVE 1324 Motor Parkway, Hauppauge, 11501 516-746-0350 Suffolk 1020 Old Country Road, Westbury, 11590 Opening soon Nassau THRIVE Everywhere Community based

Lisa Ganz, LCSW, CASAC, CRPA Senior Director of Peer Recovery Services, FCA P: 631.822.3396 | C: 631.332.2065 lganz@fcali.org THRIVE Recovery Community & Outreach Center

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Recovery Community and Outreach Centers on Long Island THRIVE Family & Children’s Association (FCA) leads the operations and oversight of THRIVE Recovery Community and Outreach Center in partnership with the Long Island Council on Alcoholism and Drug Dependence (LICADD), Long Island Recovery Association (LIRA), and Families in Support of Treatment (F.I.S.T.).

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OASAS Recovery Support Services on Long Island

Peer Engagement Specialist Services:

The Peer Engagement Specialists use their “lived experience” to engage people on the street and in hospital emergency rooms, developing brief person centered service plans, providing referrals and linkages to needed

• services. PES provide support, encouragement and guidance in linking persons to appropriate services. PES are

particularly effective with people who have been reluctant to participate in traditional behavioral health services. Peer Engagement Specialists Oceanside Counseling Center 71 Homecrest Court, Oceanside, NY 11572 516-766-6283 x14 Nassau Thomas Hope West Babylon, New York 11704 (631) 333-0871 Suffolk Easter Seals Linda Gomez (631) 335-1668 Suffolk

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Family Support Navigators:

The primary goal of the Family Support Navigator is to assist families and individuals with gaining an increased understanding of the progression of addiction and how to navigate insurance and treatment systems. Family Support Navigators develop relationships with local substance use prevention, treatment, and recovery services; managed care organizations; area substance use disorder councils; and community stakeholders to assist families with accessing treatment and support services.

New Horizon Counseling Center, Inc 50 W Hawthorne Avenue, Valley Stream, NY 11580 516-872-9698 Nassau Family & Children's Association (Sherpa) 110 E Old Country Road, Mineola, NY 11501 516-746-0350 x2274 Nassau, Suffolk

OASAS Recovery Support Services on Long Island

Thomas Hope West Babylon, New York 11704 (631) 333-0871 Suffolk

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Hospital Diversion Services

Hospital diversion services can be delivered by peers, case managers, or other specialized workers and are evidence-based recovery support services for people in need of detoxification, stabilization and/or crisis

• management. They offer choices or options to the individual other than a hospital admission.

Wrap Around Services

Wrap Around Services include case management services that address educational resources, legal services, financial services, social services, family services, child care services, peer to peer support groups or services, employment support and transportation assistance.

Hospital Diversion

Catholic Charities of the Diocese of Rockville Centre 155 Indian Head Rd, Commack, NY 20580 516-733-7099 Suffolk Nassau University Medical Center 2201 Hempstead Turnpike, NY 85020 516-572-0160 Nassau Wrap Around Catholic Charities of the Diocese of Rockville Centre 155 Indian Head Rd, Commack, NY 20580 516-733-7099 Suffolk Nassau University Medical Center 2201 Hempstead Turnpike, NY 85020 516-572-0160 Nassau

OASAS Recovery Support Services on Long Island

Thomas Hope West Babylon, New York 11704 (631) 333-0871

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OASAS Recovery Support Services on Long Island Clubhouses

Clubhouses offer services and supports to help young people progress in their recovery, and support at-risk young people who wish to live a substance-free life. Built on a core of peer-driven supports and services that encourage and promote a drug-free lifestyle, the clubhouse model provides a restorative safe, substance free space for youth and young adults in recovery, and those at-risk of substance use disorder, to participate in recovery programming as well as a variety of pro-social, recreational, educational, skill-building, and wellness programs. Clubhouses for youth are for people ages 12 to 17. Clubhouses for young adults are for people ages 18 to 21. Clubhouse HELP Services, Inc 46 Pine St, Freeport, NY 11520 516-378-1111 Nassau

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OASAS Recovery Support Services on Long Island

Centers of Treatment Innovation (COTIs)

COTIs are OASAS Treatment providers focused on engaging people in their communities by offering mobile clinical services as well linking people to other appropriate levels of

• care. COTIs target un/underserved areas and expand access to tele practice, substance

use treatment services, including linkage to Medication Assisted Treatment, as well as peer outreach and engagement within the community.

Family Service League 1235 Montauk Hwy, Mastic, NY 11950 631-427- 3700 Suffolk. Tribal territories: Shinnecock, Poospatuck Central Nassau Guidance 950 South Oyster Bay Road, Hicksville, NY 11801 516-822- 4060 Nassau

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OASAS Recovery Support Services on Long Island

Buprenorphine Induction

OASAS has funded three hospitals on Long Island to support buprenorphine induction within the emergency department combined with peer connections through an

• utpatient provider.

Northwell Health Central Nassau Guidance & Counseling Services (CNG) 516-465-2776 2000 Marcus Ave NY, 11042 Long Island Community Hospital Long Island Community Hospital SUD Program 516-377-5367 101 Hospital Rd, Patchogue NY, 11772 South Nassau Community Hospital Oceanside Counseling Center (OCC) 516-822- 4060 One Healthy Way NY, 11572 Hospital SUD Provider Partner Hospital Phone Hospital Address

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Recovery Bureau Functions

• Management of Statewide Recovery Support Services (RCOCs, PES, FSN, HDWA) and

Outcomes Reporting- http://cps.oasas.ny.gov

• Peer Integration with Provider Agencies (COTIs and others)

Recovery Bureau conducts TA site visits; Peer Learning Collaboratives; Readiness Assessments and Provide Resources

• Management of FOR-NY- https://www.for-ny.org/ - Resource Guides; Training;

Recovery Talks; Community Forums

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Condensed SUD peer competencies adapted from SAMHSA: Appendix 3 (pages 32-34)

PEER SUPERVISION COMPETENCIES

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https://www.oasas.ny.gov/recovery/documents/PeerInte grationToolKit-DigitalFinal.pdf

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IMPORTANT DATES: New York State Recovery Conference October 20-22, 2019

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Contact Information:

Susan Brandau, Director, Recovery Bureau Fredrick Hodges, LCSW, CASAC-MC-G Susan.Brandau@oasas.ny.gov (518) 485-2107 Assistant Director, Recovery Bureau Fredrick.Hodges@oasas.ny.gov (646)-728-4611 Marialice Ryan, MPA, Recovery Bureau Lureen McNeil, Recovery Bureau Marialice.Ryan@oasas.ny.gov Lureen.McNeil@oasas.ny.gov (518)-485-0506 (646)728-4578 Leslie Tabin, MS, ATR, CASAC-MC, Recovery Bureau Maureen Nguli, Recovery Bureau Leslie.Tabin@oasas.ny.gov Maureen.Nguli@oasas.ny.gov (585) 231-1695 (646)728-4672

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We Can't 't do it it ALONE:

ED + CBO = Success

Sandeep Kapoor, MD, MS-HPPL

Assistant Professor of Medicine & Emergency Medicine

Zucker School of Medicine at Hofstra/Northwell

Director, SBIRT

Northwell Health

Linda DeMasi, MBA

Project Manager, SBIRT

Northwell Health

SUBSTANCE USE DISORDER TREATMENT & MANAGEMENT PROGRAM

Gloria Mooney, MS, CSSGB

CHS Project Manager – Facilities Based Projects

Samantha Zeller, BS

CHS Project Coordinator

Amory Mowrey, CARC, CRPA, CASAC-T

Sherpa Program Manager, FCA

4/4/2019

Program Objective: SUD Identification, Treatment and Management

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Combatting Opioid and Substance Use Disorder (SUD) through Community Collaborations

 The region served by CHS is faced with an alarming number of individuals addicted to opioids and

• ther substances that present in the Emergency Departments.

 This population often has repeat visits to the ED, due to either noncompliance or lack of awareness of resources.  To help individuals caught in this cycle CHS has adopted a collaborative approach to not just treat the short-term effects for the ED patient, but connect them with a community-based peer navigator to follow them through the recovery process.  This unique approach has three parts:

• 1) identify the patients in the ED through a specialized screening tool
• 2) ensure medical stabilization and immediate support of the withdrawal process through

Suboxone administration

• 3) provide support beyond the ED through a community-based peer liaison.

 A Plan-Do-Study-Act approach was used to implement the program and included clinicians from the health system, religious agencies, and community agencies leaders with experience with addiction recovery.

Program Objective: SUD Identification, Treatment and Management

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Top Three Outcomes Achieved

SBIRT was implemented on 1/1/2017. The eligible population is 12+.  As of 2/28/2019, CHS has identified 1,525 patients to date in need of a brief intervention with 97% of them receiving an intervention.

• Across GSH, SCH and SJH, ED utilization of this population after the intervention decreased by
• approx. 60% out 90 days, and approx. 47% out 180 days.

 As of 2/28/2019, 266 patients have been referred to the “SHERPA” program. Sherpa represents a community collaboration which provides two navigators: one to guide the patient through treatment and the second focuses on support for the family members or caregivers impacted.  96% of the ED physicians at the original pilot hospitals and about 60% of newly on-boarded hospitals have been trained in Suboxone administration, providing them the medical tools to support the start of the withdrawal process.

Top Three Lessons Learned

As a collaborative effort, lessons learned spanned multiple disciplines and beyond the health system:  The data showed that opioid addicted ED patients were less likely to consent for the peer navigator support versus alcohol or other substances. Efforts will be made to revise the referral process and consider expanding the navigator program to better capture this population.  The community agency providing the peer navigators to follow the patients discovered the need for alcohol related abuse and dependency was greater than expected. The program was originally intended for opioid abusers only, but was expanded to other substances based on the need.  The Emergency Medicine Service Line physician leader of the system shared that while the ED physicians have completed training on Suboxone medication administration, there is hesitancy in administering the drug due to lack of confidence in the connection with longitudinal outpatient care.

Program Scope: SBIRT/SHERPA

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GOOD SAM

• ST. CHARLES
• ST. JOSEPH

MERCY

• ST. CATHERINE
• ST. FRANCIS

Pre-Screen Implemented Full SBIRT Implemented ER/IP TRAUMA EMERGENCY ROOM EMERGENCY ROOM TBD INPATIENT PYSCH TBD EMERGENCY ROOM 4/17/2019 INPATIENT PYSCH TBD EMERGENCY ROOM EMERGENCY ROOM SHERPA Implemented TBD TBD TBD SUBOXONE ADMIN NARCAN

Program Scope:

• Enterprise Collaboration, Establish Best-Practices using Evidence Based SUD Screening Tool, Standardize

Process and Resources, Use Objective Data for Outcomes

Performance Improvement Plan: Decrease in SHERPA Referrals

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What the Data Showed: The number of referrals to Family and Children’s Association decreased. The Identified Cause: Education and workflow related. Action: Identified gaps in workflow and technology; Retrained Staff. Reanalysis of Data Showed: Improved referrals; Identified new gap in referrals of opioid population.

PEER NAVIGATORS ON-SITE:

EPIC Enhancement & Change in workflow: Live 6/20, added Opioid Questions to SBIRT Pre-Screen

EPIC Enhancement: New SHERPA Column and Icon

Performance Improvement Plan: SHERPA Enrollment of Opioid Population

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What the Data Showed: Low SHERPA enrollment in the population of patients self-reporting opioid use. The Identified Cause: Technology and workflow related: inactivated trigger in Pre-Screen and the inability to differentiate and prioritize opioid population. Action: Activated trigger and added new SHERPA column and icon on the ED Whiteboard and on the SW SBIRT. Reanalysis of Data Showed: TBD

Answered Yes to Opioids Referred to SHERPA June 18 2 11% July 27 1 4% August 31 3 10% September 26 1 4% October 27 2 7% November 32 3 9% December 23 1 4% January 15 7 47% February 23 3 13% 222 23 10%

20 40 June July August September October November December January February 18 27 31 26 27 32 23 15 23 2 1 3 1 2 3 1 7 3

Answered Yes… Referred to SHERPA

System Enhancement: Pre-Screen Workflow to incl. Opioid Question

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System Enhancement: SW SBIRT Worklist and ED Tracking Board

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System Enhancement: Referral Workflow to incl. SHERPA Questions

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A Collaboration with CHS

Amory Mowrey, CARC, CRPA, CASAC-T

Sherpa Program Manager, FCA

4/4/2019

What is is it it?

• Sherpa is a collaboration between CHS and FCA that delivers
• n-call peer services to several CHS emergency departments.
• Peers are dispatched based on positive SBIRT screenings and

arrive within 30 minutes of being called.

• Peers meet bedside with patients to assist in linkage to care
• Peers remain engaged with patients post-discharge in the

community to decrease preventable emergency department readmissions, and improve quality of life.

• Peers provide non-clinical services that supplement the clinical

services provided by hospital staff.

Support for Families

• In addition to offering peer support for individuals,

the Sherpa Program offers support for family members and loved ones.

• Families that are present in the hospital can receive

support regardless of whether or not their loved

• ne enrolls in the program.
• Family members may be outreached with the

patient’s permission when not present at the hospital.

Why Peer Services?

• Peer services have been successfully utilized within

several vulnerable populations (veterans, mental health, HIV) and are now widely recognized as an integral component of working with these groups.

• Mutual aid (12 step) groups have been using a peer

model successfully to address substance use disorder for decades.

• Peer services is now being integrated into the

treatment of substance use disorder as a method for improving engagement and retention.

Wrap Around Services

• The Sherpa Program works closely with THRIVE Recovery

Center.

• THRIVE is an OASAS funded Recovery Community and

Outreach Center, the first of its kind on Long Island.

• THRIVE offers FREE peer-lead services 7 days a week, and

is staffed by Certified Recovery Peer Advocates and driven by dedicated volunteers and community members.

• Sherpa is a 90-day program, therefore participants of the

program are linked to THRIVE for ongoing long-term peer support when appropriate.

Success Story

• Individual presented to GSH ED and reported using multiple
• substances. As a result of engaging with Sherpa Peers, the individual

agreed to attend Mercy New Hope crisis respite. While in Mercy New Hope, Sherpa maintained engagement and helped facilitate transfer to Phelps Memorial where she remained for 21 days. The day after she was discharged, Sherpa facilitated linkage to THRIVE where she attended her first peer support meeting. At last follow up, she is still engaged in THRIVE services.

• This demonstrates a continuum of care: Sherpa remained engaged

with her as she moved through 4 different “systems”: a hospital, a crisis respite, a residential facility, and community supports.

Other Considerations / Lessons Learned

• MAT induction in Emergency Rooms and transition to

community-based follow-up.

• Tracking participants through multiple health care

systems.

• Access to care and overcoming barriers; partnering with

CHAMP

• Open Access Centers - FCA and Family Service League’s

DASH program.

Impact on Community

For any providers in the room who are not part of CHS...

• THRIVE accepts referrals from providers and

community members interested in receiving non- clinical, recovery-based peer services.

• ALL of our services are free.

Further questions or want to know more? Please reach out at...

Contact Information

• Sherpa Program: 516-592-7385
• THRIVE: 631-822-3396 | www.thriveli.org
• Amory Mowrey, Program Manager : 516-

592-2817 | amowrey@fcali.org

Outcomes Update: SHERPA Referral Status

58 Patients Served = 266 Patients Served = 196 Patients Served = 124 Patients Served = 73 DY4Q3: 3/19/2018-12/31/2018 DY4Q1: 4/01/2018-6/30/2018 DY4Q2: 3/19/2018-9/30/2018 DY4Q4: 3/19/2018-2/28/2019

Yes/No = whether or not the patient accepted the PEER Navigator’s referral; Unknown/Attended/Engaged/etc. = Referral Outcome

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03/19/2018-12/31/2018 Patients Served = 188 # of Referrals Accepted by Patients: 133 (~71% of Patients Served)

Engaged in Treatment Engaged with Peers Engaged in Treatment Engaged with Peers Engaged in Treatment Engaged with Peers Yes 38% 48% 11% 17% 6% 11% No 18% 8% 11% 5% 11% 6% N/A 26% 26% 42% 42% 50% 50% Unable to Reach 50% 50% 72% 71% 72% 71% Unkown 8% 8% 4% 4% 2% 2% 30 Days 60 Days 90 Days

Referral Rates

Outcomes Update: SHERPA Referral Engagement Status

Outcomes Update: SBIRT and SHERPA ED Utilization

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Questions

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BREAK

15 minutes

4/17/2019 63

Alexandra Kranidis, MPH, CPH, CHES, AE-C Project Manager, SCC Alyse Marotta, MPH Administrative Manager, Behavioral Health Programs, SCC

Building Community Partnerships to Improve Medication Adherence

Juan C. Espinoza, MD Pediatrician, Brentwood Pediatrics & Adolescent Associates Tomas Diaz, RPh President, Salumed Pharmacy Presented by

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Overarching Goal: Impact the 3ai/3bi/3dii medication adherence measures to meet/exceed performance goals Objectives:

• 1. Understand breakdown of communication channels between pharmacies

and prescribers

• 2. Establish meaningful lines of communication between pharmacies and

prescribers

• 3. Identify patients at risk for not picking up/receiving prescribed medications
• 4. Outreach to patients to understand barriers around receiving medications
• 5. Address barriers reported by patients

WHY THE PHARMACY INITIATIVE

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PHARMACY & PCP SELECTION METHODOLOGY

Pharmacies

• Total Medicaid Rx fill volume
• Rx fill volume for each type of medication (Antidepressants, Antipsychotics, Statin, Asthma)
• Volume by PCP practice’s attributed population (identify practices that have most prescriptions filled at

each pharmacy)

PCP Practices

• Total number of Medicaid Rx filled by their attributed population
• Total number of medication adherence performance gaps
• Top Pharmacies where practice’s attributed population is filling prescriptions

Example Example

Total Medication Gaps (10/1/16-9/30/17) Rx Filled (5/1/2017-4/30/2018) PCP Practice 1 219 22,055 Pharmacy 1 219 10,595 Pharmacy 2 219 4,032 Total Medication Gaps (10/1/16-9/30/17) Rx Filled (5/1/2017-4/30/2018) Pharmacy 1 24.4 44,446 PCP 1 219.0 10,595 PCP 2 115.0 6,985

SCC leveraged the DOH Salient Database to analyze claims to inform the selection

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Dyad

Brentwood Pediatrics + Salumed Suffolk Pediatrics + Salumed Allied – Peconic Peds + Barths HRHCare – Patchogue + Brookhaven Pharmacy HRHCare – Wyandanch + New Island Pharmacy

PILOT DYADS

4/17/2019 67

PILOT TIMELINE

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• 1. Percentage of prescriptions not picked up, sent from PCP to partnered pharmacy for

all medications over a retrospective six month period (Baseline data)

• 2. Number of successfully transmitted and received patient reports between pharmacy

and PCP

• 3. Excel log utilized to document barriers to receiving medications reported by patients

during outreach calls

• 4. Percentage of missed prescriptions sent from PCP to partnered pharmacy for

selected medications over the course of the pilot project (Outcome measure)

DATA COLLECTION

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• Tomas Diaz, Pharmacist, SaluMed Pharmacy

SaluMed Bay Shore SaluMed Brentwood 1805 5th Ave 753 Commack Rd Bayshore, NY 11706 Brentwood, NY 11717

PHARMACY-PCP DYAD

• Dr. Juan C. Espinoza, Pediatrician, Brentwood

Pediatric & Adolescent Associates

Brentwood Pediatric & Adolescent Associates 1464 5th Ave Bayshore, NY 11706

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Pharmacy

• Vendor
• Current outreach approach
• Building the report (fields included)
• Uploading the report/ transmission of

report

PHARMACY & PCP WORKFLOW

PCP

• PCP follow-up priority
• Receiving the report
• Workflow adaptations
• Outreaching to patients/staffing
• Logging patient responses (data collection)
• Home care program referrals

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• Independent pharmacies have varied platforms and capabilities to generate and transmit
• reports. At this time, all dyads have been successfully transmitting patient level reports.
• To generate reports needed for pilot, Pharmacists needed to outreach to information

technology vendors to build reports with specific fields. Technical assistance from each vendor varied.

• HIPPA compliant report transmission was the most challenging consideration due to

technology limitations and the capabilities of the pharmacy and PCP office.

• Staff selected at PCP sites to receive reports and make outreach calls varied based on the

population served.

• Language barriers, cultural competence and health literacy was considered at PCP office to
• perationalize plan.

EMERGING PROCESS TRENDS

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• Continue to work with pharmacies and PCP site representatives to ensure

successful transmission of reports.

• Document patient identified barriers for not receiving medications and

explore resources to mitigate barriers.

• This information will inform pro-active workflow strategies at the PCP practice to

improve medication pick up and adherence

• Expand program to additional dyads once best process is identified.

IMMEDIATE NEXT STEPS

4/17/2019 73

Presented by Ashlee McGlone, MA, Provider Relations Manager, SCC For Harbor View Medical Services, PC and Michael Quartier, Regional Practice Manager Carlos Ortiz, VP, Operations Diana Velez, Operations Manager Jillian Annunziata, Sr. Project Manager, Strategy Hudson River HealthCare’s Elsie Owens Health Center

Localizing the MAX Methodology through a Community-Based Approach

74

• NYS DOH launched the Medicaid Accelerated eXchange (MAX) Series to support DSRIP efforts
• Leverages rapid cycle continuous improvement (RCCI) methodology
• Largely deployed as a hospital-centric program
• SCC transformed this program into a community-based approach
• SCC facilitated the program with three community-based partners
• Federation of Organizations
• Harbor View Medical Services, PC
• Elsie Owens Health Center, HRH Care

MEDICAID ACCELERATED EXCHANGE (MAX) SERIES

75

• Brainstorm and operationalize community-level solutions to

engage patients at the practice site/community instead of the ED when avoidable

• Engage an interdisciplinary team who share care of target

patient population

• Identify the most vulnerable population
• Assess the drivers of utilization
• Strengthen linkages with community partners who can

support patients with identified drivers of utilization

• “Do something different”

METHODOLOGY

Man anage Ide dentify ify Patie tient Presents ts Assess/P /Plan Li Link

76

TIMELINE

77

• Workshops 1 and 2 focus on segments of the care pathway
• Modules include brainstorming and improvement idea generation for each stage of the care pathway
• Workshop 3 focuses on consistent implementation
• Modules aimed at achieving high reliability and ongoing improvement idea generation
• Each workshop includes a module on change management
• Prioritization of improvement ideas
• Action plan building
• The SCC facilitator conducts bi-weekly status calls with the action team

WORKSHOP AGENDAS

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• Team builds a Continuous Improvement Plan
• Long-term goals
• Ongoing measurement
• Reporting
• Meeting agenda
• Frequency
• SCC facilitator provides ongoing support

CONTINUOUS IMPROVEMENT

Harbor View Medical Services, PC Pharmacy MAX Project

80

• Affiliated with J.T. Mather Memorial Hospital and Northwell Health
• Multi-site medical practice with locations in Stony Brook, Port Jefferson, Port Jefferson Station and Rocky

Point

• Medical services include cardiology, endocrinology, family medicine, internal medicine, neurology and

vascular surgery

• Staff of more than 40 physicians and six nurse practitioners

HARBOR VIEW MEDICAL SERVICES, PC

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What are your goals for your target population? Your action team?

Provider: “Understand who hasn’t picked up their medications and why?” Population Health Manager: “Improve continuity of care” Administrator: “Ensure that patients are properly cared for and managed” Care Coordinator: “Understand what I can do to ensure the patient can get their prescriptions”

Goal Statement: Work collaboratively with a community pharmacy to improve the quality of care

provided to our patients.

DEVELOPING A GOAL STATEMENT

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Action Team Member Role Dawn DiGregorio, LPN Population Health Manager Robert Giacobbe, DO Chief Medical Director Andrea Fucci Assistant Practice Administrator Sunshine Guarino Care Coordinator Bryan McCutcheon Pharmacist

ACTION TEAM

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Gaps Identified:

• No early warning process in place alerting providers of prescriptions that have not been picked up /

received (informed by the patient at the next scheduled visit)

• Link to care coordination occurs only after provider becomes aware that patient has not picked up /

received medication 30 Day Action Period Outcomes:

• Explored registries to identify a cohort of patients at risk for medication non-adherence
• Social determinants (living and eating alone) and PHQ9 >15
• Identified a community pharmacy to collaborate with
• Selected Echo Pharmacy based on volume and location
• Explored ways that care coordinator workflows can be adjusted to support project goal

30 DAY ACTION PERIOD

84

INITIAL 60 DAY ACTION PERIOD

Improvement Ideas:

• Pharmacy sends to Harbor View

patients who have not picked up prescriptions

• Care coordinator contacts patient

and assesses why prescription has not been pick up

• Care coordinator supports patient

with barriers to picking up the prescription

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• Established a weekly workflow for prescription communications
• Harbor View cohort included anyone who had Echo pharmacy listed as their primary pharmacy and had

a visit within the past 18 months

• Carried out workflow with Rocky Point location site first
• Site selected because volume of Medicaid and proximity to homeless shelter
• Relatively low numbers of patients who did not pick up prescriptions in a week span (~5)
• No barriers identified by care coordinator

Harbor View efaxes updated patient cohort to Echo Pharmacy Echo Pharmacy confirms match of PCP and updates satellite with new information Echo Pharmacy efaxes report of patients who have not picked up medications to Harbor View Harbor View Care Coordinator contacts patients on the report and provides support as needed

INITIAL 60 DAY ACTION PERIOD

86

• Scaled project to include all Harbor View patients whose primary pharmacy is listed as Echo

Pharmacy

• Echo Pharmacy generated a weekly report of anyone in their software with a Harbor View

PCP and included these patients in the satellite report

• Care Coordinator began to notice providers and prescriptions unknown to the care team
• Project focus shifted from improving medication adherence to improving continuity of care
• Update care team records and reach out to unknown providers for consult notes

SECOND 60 DAY ACTION PERIOD

Month # of individuals with missed prescriptions # of patient with providers unknown to the practice December 2018 53 37 (69.8%) January 2019 66 39 (59%) February 2019 67 45 (67.2%) March 2019 45 25 (55.6%)

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• Echo Pharmacy notified Harbor View of specialty providers improving continuity of care
• Echo Pharmacy notified Harbor View of new medications prescribed by providers other than PCP
• Provided the opportunity to medication reconciliation from pharmacy report
• Presented an opportunity to reconnect with patients who have not been seen in the office for over a year
• Helped care coordinator build stronger relationships with patients

UNEXPECTED OUTCOMES & LESSONS LEARNED

88

• Pharmacy continues to send weekly reports to Harbor View of patients who have not picked up / received

a prescription

• Harbor View continues to provide pharmacy with weekly cohort updates and care coordinator continues

to support patients who have not picked up / received their prescriptions

• Project included on Harbor View’s Quality Improvement Meeting as a standing agenda item
• The team is beginning to explore ways that Harbor View can improve continuity of care through care plans with specialty

practices

• Action Team outlined a plan to continue to meet quarterly
• Discuss ways that Echo Pharmacy and Harbor View can continue to collaborate
• Review data collected and continue to generate improvement ideas

NEXT STEPS

HRHCare Community Health Elsie Owens Health Center 2019

Medicaid Accelerated eXchange

New York (MAXny) Series

✚ Largest FQHC in New York State ✚ 3 regions

• Long Island
• Hudson Valley
• New York City

✚ 43 community health centers ✚ 2k employees ✚ 200k patients served

HRHCare, Community Health

Only 10- 20% of factors affecting health outcomes are related to clinical care…

Systems of Community Health Centers like HRHCare are an important link between potentially preventable hospitalizations and the Social, Physical, Environmental, Institutional, Racial, Determinants of Health

Goal

Identify patients who are likely to have preventable hospitalizations and/or ED visits and address the causative factors in an effort to prevent such visits

Methods for Identifying Patients

✚ Pre-visit planning ✚ Reports

• Frequent (2+ in 6 months) visits to hospitals / ED’s for PPVs
• Patients with 2+ chronic diseases of interest / behavioral health Dx, and/or substance use Dx
• Patients without a regular primary care visits in 2+ years

✚ Primary Care Provider for Medical Evaluation ✚ HRHCare Outreach staff for coaching: pts. without a primary care visit

in 24+ months

✚ DSRIP Care Manager: Medicaid patients ✚ Health Home: Qualified patients

Patients At-Risk of potentially preventable TOC visits are referred to:

Which EOHC patients may fall into the target population?

Action Team Discussion:

• Chronic diseases
• Behavioral health
• Bi-lingual/ language
• Lack of education on

additional healthcare

• ptions (i.e. urgent care,

after hours)

• Low-Utilizers - no visit in

last 2 years

• High-Utilizers of

hospitals/ EDs

Reports

HRHCare TOC At-Risk (cont.) + Outreach – No visit in 24+ months HRHCare TOC & TOC At-Risk | Stonybrook University TOC

Target Population

TOC & TOC At- Risk

The Evolution of our MAX Workflow

Current State

(see handout)

Script

Documentation

TOC template in eCW + MAX subgroup

Current Workflow

✚ Primary Care Provider: Assess patient to identify strategies to promote

wellness

✚ Outreach Coaching: Increase patient engagement in health status &

medical care

✚ DSRIP TOC Care Manager: Identify and manage social determinant of health

needs and refer to Home Care Management or other resources & services (e.g. Health Coaching, Community–based organizations) where eligible to address needs.

✚ Health Home Care Manager: Work with qualified patients to identify social

determinant of health needs (i.e., regular primary care visits, transportation, nutrition, risk of falling, medication adherence) - Make referrals to address

Care Coordination

bi-directional referrals and ongoing assessment

Process & Outcome Metrics

✚

PDSAs

✚

Monthly MAX Team Mtgs.

✚

Monthly Reporting

✚

Challenges Identified: Staffing Resources

✚

Build awareness internally

✚

Build out Care Management Workflows

✚

Pilot Lifestyle & SDH Screening Tool

✚

Scale MAX model to Brentwood Health Center in partnership with Northwell Southside Hospital

HRHCare, Intranet

THANK YOU

Action Team:

• Mike Quartier
• Nadia Arif, MD
• Diana Velez
• Bronwyn Gorgone
• Carissa Foss
• Trevor Cross
• Janel Lewis
• Maliha Yunas
• Carlos Ortiz
• Jillian Annunziata
• Alison Rowe, Stonybrook Hospital
• Rebecca Costa, WellLife
• Adam Aponte, UHC

4/17/2019 105

Presented by Linda S. Efferen, MD, MBA Executive Director & VP, Medical Director Suffolk Care Collaborative

CLOSING REMARKS