Federal-State Response to the Opioid Crisis. Session 48 February 12, 2019

Transcription

1 Federal-State Response to the Opioid Crisis Session 48 February 12,

2 Conflict of Interest Thomas Novak, Medicaid Interoperability Lead, Office Of The National Coordinator / CMS Shereef Elnahal, MD, MBA, New Jersey Health Commissioner Wesley Sargent, Jr, EdD, MA, Centers for Disease Control and Prevention Melissa Lauer, MPA, Health Information Technology Specialist, Rhode Island Executive Office of Health and Human Services Has no real or apparent conflicts of interest to report. The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 2

3 Leveraging Medicaid Technology to Address the Opioid Crisis June 11, 2018: Leveraging Medicaid Technology to Address the Opioid Crisis (SMD ) Section 5042 of the SUPPORT Act The PARTNERSHIP Act: Medicaid Providers Are Required To Note Experiences in Record Systems to Help In-need Patients Act PDMP/EHR integration Predictive Analytics for case management Substance Use Disorder related CDS tools Medication Assisted Therapy (MAT), including via telehealth Linkages to other noncontrolled RX data & other data (drug court, care teams, etc.) E-prescribing of controlled substances (epcs) Public Health Tools Telemedicine & telepsychiatry Case management & care plans for Neonatal Abstinence Syndrome Patient-facing technology including apps Shared electronic care plans

4 Data Sources Office of Emergency Medical Services Office of the Chief State Medical Examiner (OSME) Division of Consumer Affairs Communicable Disease Service Division of HIV, STD and TB Services New Jersey State Police Division of Mental Health and Addiction Services Healthcare Quality and Informatics U.S. Census Bureau Current Opioid Dashboard Drug-related Deaths Crime Statistics Treatment Statistics Prescription Monitoring Program Naloxone (Narcan ) Drug-related Hospital Visits 4

5 Opioid Data Dashboard: A Picture of Demand Link to public dashboard 5

6 Using NJHIN for Clinical EHR data, surveillance 1) Daily collection of a) Demographic Data b) Rx Data (PMP/SureScripts) c) Claims Data d) HIO/Hospital EMR data/sud providers Maintain Risk table linked to NJHIN MPI 3) Based on elevated Risk Factor patient will: - be considered for ALTO guidelines - receive education and information - referred for f/u pain management 2) Every Patient Admitted in ED generates an ADT alert to NJHIN NJHIN send back a Patient Risk Score in real time. 6

7 Future State: Enhanced Opioid Dashboard Essex County: Demand Drug-related deaths: 271 Drug-death rate (per 100,000): 33.9 Naloxone Incidents: 739 Rate of substance use admissions (per 100,000): 1,091 Number of first time admissions: 8,773 Drug-related hospital visits (rate per 100, 000): Opioid prescription rate (per 100): 44.8 Arrests (possession/use): 4,937 Arrests (sale/manufacture):1684 Essex County: Supply Inpatient treatment capacity (available beds) Ambulatory treatment capacity (SUD clinics, AWD services, etc.) Primary care/family medicine provider slots (Outpatient- Based Addiction Treatment, OR OBAT) Emergency rooms with suboxone induction Peer recovery specialist supply Syringe access program capacity ALTO-trained emergency rooms ALTO-trained providers Smarter Policy Decisions: SUD/integrated license prioritization by region Targeted OBAT training to providers Targeted deployment of opioid alternative training to providers New syringe access program locations Targeted deployment of ALTO training * All data is 2016 data, with exception of Nalaxone incidents, which is 2017 data. 7

8 Questions Shereef Elnahal, MD, MBA New Jersey Health 8

9 Rise in Opioid Deaths Overlapping, Entangled but Distinct Epidemics 9

10 Preventing Opioid Overdoses and Opioid-Related Harms Conduct surveillance and research Empower consumers to make safe choices Build state, local, and tribal capacity Support providers, health systems, and payers Partner with public safety 10

11 CDC Resources CDC Opioid Overdose Prevention Website State Efforts CDC Guideline for Prescribing Opioids for Chronic Pain Resources for Patients Resources for Providers Clinical Decision Support Resources Implementation Guide Output Source for the implementation guide Supporting Java packages for the CQL-to-ELM translator and CQL Engine 11

12 Contact: Wes Sargent Please note that the findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 12

13 Agenda Background: Rhode Island Context RI s HIE Enabled Overdose Prevention Project Components Funding Details on three of the five components Planned next steps 13

14 Learning Objectives Identify creative ways for states to leverage Medicaid Federal Financial Participation (FFP) to address the opioid crisis Consider three technical approaches to getting important opioidrelated data in front of providers Learn how RI plans to continue additional opioid-related HIT work 14

15 The Opioid Crisis in Rhode Island Source: RI Department of Health From 2011 to 2016, overdose deaths nearly doubled 15

16 RI Strategies to Reduce Overdose Deaths Governor Gina Raimondo s Overdose Prevention and Intervention Task Force proposed 4 strategies to reduce overdose deaths Prevention: Take aggressive measures to improve patient safety and better monitor opioid use through the PDMP Rescue: Ensure access to naloxone Treatment: Expand the quality and availability of medication-assisted treatment Recovery: Expand access to peer-recovery services and MAT More detailed data and information is available at 16

17 RI s Health Information Exchange RI has a state designated entity for Health Information Exchange: Rhode Island Quality Institute (RIQI) They operate the HIE which was launched in 2010: RI s HIE is currently opt-in for collecting and sharing data. About 50% of Rhode Islanders have opted-in RIQI also provides full-panel services under BAAs 17

18 HIE-Enabled Opioid Overdose Prevention Project RI Medicaid partnered with the Rhode Island Foundation to develop five components using CurrentCare PDMP-EHR Integrations Intelligent Overdose Alert Emergency Department Smart Notifications Emergency Medical Services Integration Talking about today SBIRT Screening Platform (Public Health Registry) 18

19 Funding these projects SMD # increased the activities with non-eligible Professionals (non-eps) that could be supported with HITECH dollars We requested 90/10 funding under the Medicaid HITECH I-APD to support these five efforts RI s mainstreaming clause = 100% Medicaid cost allocation This requires that any MCOs that have commercial networks much include those providers in their Medicaid networks 19

20 PDMP-EHR Integrations NCPDP Script 10.6 or SMART on FHIR Appriss, Inc., PMP Gateway Provider queries PDMP in one of two ways: Starts to prescribe an opioid Clicks a PDMP button Prescription Drug Monitoring Program NABP PMP Interconnect for other state data Benefits: Reduces the time to check the PDMP from 3-5 minutes to only 5 seconds Ensures compliance with state law/regulations by making it impossible to prescribe an opioid without checking the PDMP 20

21 Intelligent Overdose Alert Adds a *POTENTIAL OVERDOSE* flag to the subject and body of existing ADT Direct message alerts if relevant reason for visit or diagnosis is present Benefits: Makes it easy to find overdose-related ADTs in a crowded alert inbox 21

22 Emergency Department Smart Notifications Patient Registers at Emergency Department If risk is identified, Notification and detailed content displays in patient tracker board ADT Registration RIQI Analytics Environment Risk algorithm looks for: Any ED admissions in last 7 or 30 days Risk of Opioid Use Disorder or Opioid Overdose based on 7 factors ADTs from all Rhode Island Hospitals Clinical data from HIE repository Prescription Drug Monitoring Program Benefits: Provides high-value, actionable information that may not already exist in the EHR to the ED providers within the workflow 22

23 Planned Next Steps SUD/OUD Waiver: Leverage the work already underway to support the requirements of the Health IT Plan under the Medicaid 1115 SUD/OUD Waiver (SMD #17-003) Section 5042 of the SUPPORT Act: Continue to expand these efforts (additional integrations, additional features, PDMP enhancement, etc.) where justifiable with 100% FFP under this new law Continue to leverage HITECH dollars and transition to MMIS funding: Continue to roll out other efforts at 90/10 under HITECH or MMIS where applicable, and transition efforts into RI s MITA 23

24 Questions Contact me for more details: Melissa Lauer, MPA State HIT Specialist Executive Office of Health and Human Services Please complete the online session evaluation! 24