Addressing the Opioid Epidemic

Transcription

1 Addressing the Opioid Epidemic Research Practice Policy Policy Practice Research

2 National Opioid Crisis Since 1999 Consumption, prescriptions, overdoses and deaths all have increased approximately 300 percent ,000 overdose deaths More than motor vehicle accidents 50 percent from opioids and heroin Touches every community, every population Source: Opioids: A Strategy to Reduce Misuse and Abuse, December 1, 2015, MHA 2

3 Alarming Trends in Missouri Hospital Utilization for Opioid Overuse 3

4 Hospital Inpatient and Emergency Department Visits for Opioid Overuse Missouri rate per 100,000 by Senate District, FY2015 Source: Hospital Industry Data Institute. 4

5 Hospital Utilization for Analgesic Opioid Overuse: Alarming Trends RATE OF HOSPITAL INPATIENT AND EMERGENCY DEPARTMENT VISITS FOR ANALGESIC OPIOID OVERUSE AND CUMULATIVE PERCENT CHANGE IN MISSOURI, % % 140% 120% 100% 80% 60% 40% 20% 0% Rate Per 100,000 Cumulative Percent Change Source: Hospital Industry Data Institute. 5

6 Hospital Utilization for Analgesic Opioid Overuse by Payer 350% RATE OF HOSPITAL INPATIENT AND EMERGENCY DEPARTMENT VISITS FOR ANALGESIC OPIOID OVERUSE IN MISSOURI, CUMULATIVE PERCENT CHANGE BY PAYER, Medicaid Managed Care Medicaid Fee for Service Uninsured Medicare Other 300% 302% 250% 200% 150% 100% 50% 0% % 183% 122% 81% Source: Hospital Industry Data Institute. 6

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8 Infants Born with Neonatal Abstinence Syndrome MISSOURI INFANTS BORN WITH NAS AND CUMULATIVE PERCENT CHANGE Cases 538 Percent Increase 600% 500% 400% 300% 200% 100% * 0% NAS Births Cumulative Percent Change Source: Hospital Industry Data Institute. *NAS births in 2016 identified with ICD-10 CM codes P961 and P962. NAS births in identified with ICD-9 CM code

9 Increase in NAS Infant Births Statewide, the NAS rate was 1.2 per 1,000 births in 2006 and 7.9 in The NAS rate for Medicaid newborns was more than double the statewide rate in Average charges for a Medicaid NAS birth are $63,000 vs. $14,500 for other births MISSOURI INFANTS BORN WITH NAS: RATE PER 1,000 BIRTHS BY PAYER, Medicaid Self-Pay Other This implies $23,800,900 for 493 Medicaid NAS births in FY * Source: Hospital Industry Data Institute. *NAS births in 2016 identified with ICD-10 CM codes P961 and P962. NAS births in identified with ICD-9 CM code

10 Opioid Reduction Initiative: Practice and Policy 10

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12 Practice: Emergency Department Opioid Prescribing Guidelines 120% Percent Adoption Adoption of ED of Prescribing ED Prescribing Guidelines Guidelines December 2016 (n-40) Encourage Naloxone 100% ED policy Comm w PCP Percent Adoption Percent Adoption Counsel handling 80% Diagnosis Tooth pain 60% 72 hour limit Refuse "lost" 40% Shortest duration Avoid long-acting 20% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% Avoid Shortest Refuse 72 hour Counsel Comm w longacting Tooth pain Diagnosis ED policy Encourage duration "lost" limit handling PCP Naloxone Encourage Counsel Avoid longacting Refuse Shortest 72 hour Comm w Yes Tooth 25 pain Diagnosis Naloxone handling 24 ED 3 policy "lost" duration limit PCP Jun-16 % Adoption(N-61) No 7% 0 71% 0 98% 2 97% 0 90% 1 90% 3 73% 8 92% % 36 55% Dec-16 % Adoption N-40) 8% 79% 100% 95% 100% 100% 66% 97% 92% 62% 12

13 Guidelines for Chronic Pain Determine When Non-pharmacological Non-opioid Opioid treatment goals and education about risks Opioid Selection Start low, go slow for both acute and chronic pain Begin with immediate release Evaluate within 1-4 weeks Assessing Risk Evaluate risk factors before starting and throughout Consider Naloxone Utilize Prescription Drug Monitoring Program Consider urine drug testing Avoid opioids and benzodiazepines Offer or arrange evidencebased treatment for misuse 13

14 Prescription Drug Monitoring Program Update 14

15 Policy Prescription Drug Monitoring Program Policy Objectives Support HB90 and Rep. Rehder for a statewide prescription drug monitoring program As an interim system, facilitate county and municipal ordinances to connect to the St. Louis County PDMP 15

16 St. Louis County PDMP System PDMP Administration St. Louis County Public Health holds license and administration for access, onboarding and dissemination County/City Public Health Agencies Limited access and responsibilities Avoid adding FTEs Responsible for proportionate annual APPRISS license fees St. Louis and Kansas City Jurisdictions Signed 50 percent of Missouri providers and pharmacies Scheduled launch April-May Subsequent quarterly cohorts for signed jurisdictions 16

17 PDMP Assessment Regulatory Policy and advocacy Technology Financing Provider willingness Feasibility 17

18 County and Municipal Authority Article VI, Section 8 of the constitution Charter counties own government, including police powers Non-charter counties lack general legislative power to mandate a PDMP Statute in Section , RSMo This statute provides all counties the power to enact public health ordinances, regardless of their classification or home rule status. Enhance public health similar to tobacco 18

19 Financing the APPRISS PDMP Annual licensing fee: estimated $155,000 Proportional fees for public health agencies Providers No pharmacy data submission fee required Third-party pharmacy data management service optional fees incurred No fee for clinicians to retrieve information directly Interface with electronic health records optional fees incurred 19

20 Assessment: Provider Willingness Possible partners Hospital medical staff Community medical staff Dentists Local pharmacists National pharmacy chains FQHC Public health Law enforcement including sheriffs Coroners EMS Business Hospital-led County Ordinance District (n-54) Hospital and Partners Hospital without Partners Central 93% 69% North 100% 100% Southeast 91% 55% Southwest 100% 80% Average 96% 76% 20

21 Exploring a County-Based System Awareness and education Opioid epidemic and trends APPRISS PDMP system Facilitate passage of jurisdictional ordinances to join St. Louis County PDMP Task force to review resources for hospitals and providers Tool-kit Presentations Dissemination May/June St. Louis County progress State legislative session 21

22 Contact Information Leslie Porth, Ph.D., MPH, R.N. Senior Vice President of Strategic Quality Initiatives Missouri Hospital Association 573/ , ext

23 Cindy Davis, RHIA Community Integration Manager

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25 Increases access to behavioral healthcare for those individuals who need treatment for psychiatric conditions or substance use disorders by improving the coordination of care between hospitals, CMHCs, and substance use treatment providers.

26 The ERE program is part of the Strengthening Mental Health Initiative GOALS: Engaging target consumers into ongoing treatment Coordinating care for the whole person by addressing behavioral health, physical health, and basic needs Reducing the need for future hospitalization Reducing hospitalization stays unnecessarily extended due to non-clinical factors 3-Month Follow-Up Outcomes indicate significant: Emergency room use Hospitalizations Homelessness Arrests

27 3,500+ individuals have engaged in ERE services across the state as of June 30, 2016 Referral Sources 32 law enforcement agencies 65 hospitals, clinics, and FQHCs 19 Community Mental Health Centers (CMHCs) 31 substance use disorder treatment providers 61 local service agencies 9 regional developmental disability offices

28 7 service areas across the state >> Kansas City >> Springfield >> Columbia >> Rolla >> St. Louis >> Poplar Bluff >> Hannibal

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30 Selected States for demonstration Missouri Minnesota New York New Jersey Nevada Oklahoma Oregon Pennsylvania

31 Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization* Screening, assessment and diagnosis including risk management* Patient-centered treatment planning* Outpatient mental health and substance use services* Primary care screening and monitoring** Targeted case-management** Psychiatric rehabilitation services** Peer support, counseling services, and family support services** Services for members of the armed services and veterans** Connections with other providers & systems (criminal justice, foster care, child welfare, education, primary care, hospitals, etc.)** *CCBHC must directly provide *May be provided by CCBHC and/or DCO

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33 Crisis Intervention Team (CIT): A New Model Innovative first-responder model of police-based crisis intervention training to help persons with mental disorders and/or addictions access medical treatment rather than place them in the criminal justice system due to illness related behaviors. Promotes officer safety and the safety of the individual in crisis. Visit for more information.

34 March 29, 2017 Holiday Expo Center Columbia, MO Visit us for more information

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38 Zero Suicide Academy Description: The Zero Suicide Academy is a two-day training for senior leaders of health and behavioral health care organizations that seek to dramatically reduce suicides among patients in their care. Using the Zero Suicide framework, participants learn how to incorporate best and promising practices into their organizations and processes to improve care and safety for individuals at risk. Zero Suicide faculty provide both interactive presentations and small group sessions, and collaborate with participants to develop organization-specific action plans. The objectives of the Zero Suicide Academy are to (a) provide organizations interested in adopting a Zero Suicide approach with the skills and information necessary to launch their effort; (b) create collaborative links between the organizations launching these initiatives in order to provide mentorship and support so that the perspectives, knowledge, and skills of each inform the work of the others; and (c) aid in developing implementation plans for the Zero Suicide initiatives at each participating organization. The Zero Suicide Academy is presented by the Education Development Center, Inc.

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44 Private Insurance 14% Medicare 12% Other 6% Medicaid 39% Uninsured 29%

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47 Improves access to behavioral health treatment for people with behavioral health issues who have frequent interaction with law enforcement and the courts.

48 The CMHL program is part of the Strengthening Mental Health Initiative GOALS: Form better community partnerships between CMHCs, law enforcement, and courts Save valuable resources that might otherwise be expended on unnecessary jail, prison, and hospital stays Improve outcomes for individuals with behavioral health issues Complete follow-ups to ensure progress and success

49 31 CMHLs work across the state to assist law enforcement and courts 20,400+ referrals {Referrals exclusively received from law enforcement & courts} 33,000 contacts with law enforcement 430 POST certified trainings on mental health topics provided to law enforcement at no charge 5,100+ officers trained

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51 Case to Care Motivational Interviewing Nurse Care Managers Show Me Zero Suicide Trauma Informed Care

52 MHA Psychiatric Network Children's Medicaid Managed Care Parity ALYSON HARDER, PROJECT LEAD HEARTLAND BEHAVIORAL HEALTH

53 Goals of the Project Data collection across a variety of C/A programs that will provide the following: Comparison of MCO plans to one another and to FFS Medicaid Provide aggregate data related to LOS, concurrent reviews, denial percentages. Provide quantitative data and qualitative comments that may be used for legislative, contractual and parity discussions Strengthen the psychiatric network s ability to advocate Provide the Network with the opportunity to collaborate with other organizations/coalitions

54 Data to be Collected 5 Monthly stats by each payer: Cenpatico Mo, ABHMO(until the new contract), Missouri Care- Wellcare, and FFS. #of patient days per month in each pay class #of discharges per month in each pay class #of denials per month in each pay class(not days) Denial may be technical or clinical #of reviews per payer each month initial review +# of concurrent reviews # of physician reviews per month by payer

55 Procedure Each participating hospital received a spreadsheet for solely their data to be input each month That data/spreadsheet was sent MHA to be input into a Master Spreadsheet Data will then be automatically configured across all hospitals to provide data monthly and quarterly. Aggregate data is then available to participating hospitals and MHA. Individual hospitals benefit from having their own denial scorecards as well. Quarterly calls to review data trends and the qualitative comments from providers

56 Participating Hospitals Crittenton Children s Hospital St. Luke s North Two Rivers Heartland Behavioral Health Compass-Royal Oaks Centerpointe Lakeland Hopeful for 2017: SSM

57 Denial Scorecard: January-November 2016 Medicaid ABHMO CENPATICO MO MISSOURI CARE Total PATIENT DAYS 22,151 6,952 2,167 3,245 34,515 DISCHARGES 2,712 1, ,853 AVERAGE LENGTH OF STAY # OF DENIALS (DISCHARGES) % OF DISCHARGES DENIED 2.4% 33.7% 20.6% 52.5% 17.3% DENIED DAYS 216 1, ,164 DENIED DAYS % of Patient Days 1.0% 15.5% 9.8% 20.2% 6.3% AUTHORIZED LOS Take-Aways: Considerable difference in Authorized Length of Stay AND Length of Stay across payers Significant % of cases within MCO s with some sort of denial attached-ie: much more work for the clinical teams, as compared to FFS Medicaid Higher denied days within MCO s, specifically in comparison the % of total Patient Days Each hospital has their own individual scorecards as well to use for driving decisions and advocacy.

58 Next Steps: 2017 Enhancing data to include: # of reviews that our hospitals are having to engage inincluding physician level reviews 30-day re-admissions to our facilities and noting if we are aware that the patient has been elsewhere inpatient in another facility Qualitative issues-changes with payers, new processes occurring, changes that are being thrown at providers, phantom or ghost providers, etc. Data is reported to MHA the 15 th of each month for the month prior. Quarterly data will be shared with participating hospitals