Wel elcome to o the e CCIM4C Webinar S r Seri ries! Before we - - PowerPoint PPT Presentation

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e CCIM4C Webinar S r Seri ries!

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CCIM4C Webinar S r Seri ries Webinar # r #1 The Mercy Health Ad Addiction Tre reatment Collaborative ve

via Adobe Connect 10/2/2018 1:00-1:30pm

Welcom

• me!

e!

• If you have not already done so, please type in your first & last

name and county in the chat bar. Please include your email address if you would like a copy of the presentation from today.

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the webinar. Please feel free to type your questions in the chat box or unmute your phone to ask your question.

• This webinar is being recorded and will be posted to the CCIM4C

website: http://collectiveimpact.mha.ohio.gov.

What i is the CCIM4C?

• The Community Collective Impact Model for Change Initiative (CCIM4C)

is funded under the federal 21st Century CURES Act as part of Ohio’s state-targeted response to the opioid crisis.

• OhioMHAS awarded funding to 12 Ohio communities to address opioid

use and misuse in their communities by combining a strategic planning process with an emphasis on working across the continuum of care and utilizing a trauma-informed approach.

• OhioMHAS also partnered with Ohio University, the Pacific Institute for

Research and Evaluation, and Prevention Institute to develop training and technical assistance and provide evaluation services to the 12 communities.

• Goals: To prevent opioid use and abuse, reduce opioid-related deaths,

and increase access to treatment, including medication assisted treatment, in the state of Ohio.

• For more information about the CCIM4C, please visit the website:

http://collectiveimpact.mha.ohio.gov.

What i is the CCIM4C Webinar S r Seri ries?

• The CCIM4C Webinar Series aims to:
• Bring together those in the field to share their

experiences, successes, and challenges and offer nuggets of wisdom to other communities that are facing similar issues or challenges.

• Provide additional resources, strategies, and

content to the CCIM4C communities, their partners, and those working at the local, state, and national level to address opioid use and misuse.

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Web ebin inar a and P Presenters: “The Mercy Health Addiction Treatment Collaborative”

Presenters:

• Dr. Navdeep Kang and Dr. Larry Graham

Mercy Health

The Mercy Health

Addiction Treatment Collaborative

Building a Collaborative Continuum & Developing Internal Capability

Larry Graham, MD – President, Behavioral Health Navdeep Kang, PsyD – Director of Operations, BH-Cincinnati

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OBJECTIVES 1.Describe Mercy Health’s comprehensive response to the opioid epidemic. 2.Describe the formation of the Mercy Health Addiction Treatment Collaborative. 3.Delineate the development of Mercy Health’s internal capability.

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• The largest healthcare system in Ohio & Cincinnati.
• Provides over $1 million in charity care and

community benefit every single day.

• Cincinnati is a highly competitive marketplace:

– Several dozen primary care & specialty locations – 5 acute-care hospitals & 4 free-standing EDs – Not much in terms of “addiction treatment services”

• Ohio is a Medicaid Expansion state, with 5 managed

Medicaid payers.

Scope of the Problem

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Mercy Health’s comprehensive response to the opioid epidemic received broad support after the Board adopted the “strategic initiative”

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Pillars of a Comprehensive Approach

• 1. Prevent Entry
• 2. Screen early and often
• 3. Harm Reduction

4.Treat those in need

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Prevent Entry

Outreach & Education

• As many as 80% of new users enter by

experimenting with meds at home

• Education programs
• Pre-teens – describe / where to go for help
• Young teens – discuss peer pressure / entry

behaviors

• Older teens => risk taking / sense of invincibility
• Med-safe drop off boxes & Deterra packets
• Non-opiate pain management order sets

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Screen Early & Often

Standardized SBIRT Protocol

• Risky drinking/drug use and mood difficulties are a significant

public health problem

• Risky drinking, drug use causes more than 100,000 preventable

deaths each year

• Risky drinking/drug use and mood disorders is a drain on the

American Economy – costing $700 billion annually

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Effective Prescribing Practices

The “Opiate Data Cube”

• Monitor Rxs for MED > 30
• Physicians can see their data compared to peer/system
• Identify outliers and have conversations with CCO
• PDMP Integration

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Harm Reduction

A Partnership with Public Health

• Blood borne pathogen
• Needle exchange program
• Position van in Mercy hospital parking lots to reduce

community concerns

• Narcan Distribution

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Treat those in Need

Forming the Addiction Treatment Collaborative

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A Disintegrated Continuum of Care

• Emergency services
• Hospital/inpatient services
• Residential care (30-day, 6-month, etc.)
• Medication-Assisted Treatment

(comprehensive services)

• Chemical-Dependency Intensive

Outpatient Program (CD-IOP)

• Primary Care – management of

comorbidities

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ACUITY/SEVERITY

What is Addiction?

Definition from the American Society of Addiction Medicine

• Addiction is a primary, chronic disease of brain reward,

motivation, memory and related circuitry.

• Dysfunction in these circuits leads to characteristic biological,

psychological, social and spiritual manifestations.

• This is reflected in an individual pathologically pursuing reward and/or

relief by substance use and other behaviors.

• Addiction is characterized by inability to consistently abstain, impairment

in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

• Like other chronic diseases, addiction often involves cycles of

relapse and remission.

• Without treatment or engagement in recovery activities, addiction is

progressive and can result in disability or premature death.

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Substance use disorders are chronic, relapsing, and potentially-lethal medical conditions. Treatment must be imminently available and aligned with best- practiced informed by science.

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So what do we do about it?

Business as usual: a healthcare arms race?

• We could build addiction treatment centers.
• Or we could collaborate with those already

doing the work… if they have any capacity.

• If that works, we have an opportunity to

redefine and execute what falls in our wheelhouse…

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2017 Timeline

Forming the Addiction Treatment Collaborative

• June/July – Initial Request for Information (RFI).
• August – First Collaborative group meeting.
• September/October – Site visits & agreements signed.
• November – First Medical Directors’ group meeting.
• December – Second Collaborative group meeting.
• 2018-and-beyond:
• Build out internal capability… training, training, communication cascade,

training, and more training!

• Real-time case debriefs & consults.
• Monthly data-sharing & quarterly aspirational discussions.

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What are the central elements to bend the mortality curve?

• 1. Narcan distribution and availability.
• 2. Treatment-on-demand.
• 3. Clinical & operational integration of the

health system with specialty addiction medicine providers.

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Collaboration Agreements

Creating Treatment-on-Demand

• Addiction Treatment Provider Responsibilities
• Provide data submission updates requested by Mercy Health.
• Adhere to Care Coordination procedures established by Mercy Health
• Use best reasonable efforts to accept patients in need of addiction treatment

services when those services are not available by Mercy and are provided by addiction treatment provider.

• Monthly Medical Directors’ Group meeting.
• Mercy Health Responsibilities
• Provide remote access to CarePath (EPIC) where available.
• Provide secure text-messaging capability (PerfectServe) so AOD providers

can reach any employed/affiliate Mercy Health providers.

• Use best reasonable efforts to accept patients in need of services provided by

Mercy.

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Mercy Health CLINICAL Work Group

Developing health system integration An internal CLINICAL Workgroup was responsible for representing diverse clinical constituencies to develop and align on what our capability should look like… for defining our “wheelhouse.” These responsibilities were written and disseminated in the form of an interprofessional “Clinical Practice Guideline.” This will standardize internal clinical practices across care sites.

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Bias

Call it what it is

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“I’ll administer buprenorphine today – but I won’t if they come back in the next day or two.”

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“3 strikes and you’re out. We’re not sending EMS after that.” “You have to prove that you’re motivated before we will treat you.”

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Clinical Practice Guidelines

Keys to Success

1. Each service line has clearly-delineated, standardized clinical protocols (ex. COWS, CIWA, etc.) and responsibilities across levels-of-care. 2. Our care teams must be appropriately equipped with the tools and knowledge to respond when patient needs are identified. 3. The continuum cannot be fragmented, even if delivered by different facilities or by different organizations. The most-likely outcome we will encounter would be that Mercy Health initiates treatment – and collaborating organizations would continue treatment – with all 5 Mercy Health hospitals in Cincinnati operational with our clinical practice guidelines.

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Building awareness of treatment-on-demand

www.FindLocalTreatment.com

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How the platform works

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Step 1 – Individuals enter location, addiction, insurance type, gender, and age.

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Step 2 – They review accurate treatment options and easily contact a provider.

How the platform works

Where are people actually searching for treatment?

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Hope for the future…?

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Through May/2018, Hamilton County has seen:

a)375% increase in Narcan distribution b)34% decrease in overdose deaths (mortality) c)33% decrease in EMS runs for overdose in prior 6 months vs. the previous 6 months d)36% decrease in overdose visits to EDs e)50% increase in patients entering treatment for opioid use disorder

Work for the future…!

Assuming mortality trend continues:

a)Integrate the other health systems; b)Comprehensive payer credentialing; c)Engage the community at large to address stigma; d)Identify “the Magic Johnson” of this epidemic; e)Get people back to work, in pursuit of their dreams; f)Mainstream addiction medicine and propagate the understanding of substance use disorders as chronic medical conditions warranting a comprehensive healthcare response.

Larry Graham, MD lagraham@mercy.com Navdeep S. Kang, PsyD nskang@mercy.com

Qu Ques estion

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Closing & & N Next Steps

• If you would like a copy of the presentation from today and have not already

done so, please type your email in the chat box.

• The recording of this webinar will be posted on the CCIM4C website under the

“CCIM4C Webinar Series” tab here: http://collectiveimpact.mha.ohio.gov/

• Thank you to our presenters today! If you would like to contact them, please

refer to the previous slide.

• The next webinars in the CCIM4C Webinar Series will be:

“Key Strategies for Helping Faith Leaders to Impact the Opioid Crisis” Tuesday, October 9, 2018 – 2:00-2:30 pm via Adobe Connect

• Mr. Tracy Johnson, CCIM4C Training, Technical

Assistance, and Evaluation Team To connect: https://connect.ohio.edu/rmtbw2dz8k7f/ “Youth-Led Prevention as an Evidence- Based Prevention Strategy” Wednesday, October 17, 2018 – 10:30- 11:00am via Abode Connect

• Dr. Jessica Collura, Ohio University Voinovich

School of Leadership and Public Affairs To connect: https://connect.ohio.edu/ruq62y2zpge4/