Wel elcome to o the e CCIM4C Webinar S r Seri ries! • Before we begin, please type in your first & last name and county in the chat bar. • If there are several people attending the webinar from the same conference room/office/etc., please remember to include everyone that is joining the webinar from your location. • If you would like to receive a copy of the Powerpoint and any additional materials from this presentation, please also type your email address in the chat bar. • Mute your computer speakers to minimize audio feedback from your phone. • Music will play until the webinar begins at 1:00pm.
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 ome! 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. • The presentation will last about 15 minutes. During this time we ask everyone to stay muted so that we minimize any background noise. • Following the presentation, we will have Q&A until the end of 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.
Tod oday’s W 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
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. 8
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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 11
Mercy Health’s comprehensive response to the opioid epidemic received broad support after the Board adopted the “strategic initiative” 12
Pillars of a Comprehensive Approach 1. Prevent Entry 2. Screen early and often 3. Harm Reduction 4.Treat those in need 13
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 14
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 15
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 16
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 17
Treat those in Need Forming the Addiction Treatment Collaborative 18
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A Disintegrated Continuum of Care • Emergency services • Hospital/inpatient services ACUITY/SEVERITY • Residential care (30-day, 6-month, etc.) • Medication-Assisted Treatment (comprehensive services) • Chemical-Dependency Intensive Outpatient Program (CD-IOP) • Primary Care – management of comorbidities 20
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. 21
Substance use disorders are chronic, relapsing, and potentially-lethal medical conditions. Treatment must be imminently available and aligned with best- practiced informed by science. 22
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… 23
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. 24
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. 25
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. 26
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. 27
28 Bias Call it what it is
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