Maryland Association of Healthcare Executives presents:

Transcription

1 Maryland Association of Healthcare Executives presents: 1

2 Behavioral Health and Substance Use Disorder Population Health Session 4 2

3 Panel Moderator: Megha Kachalia, MD, MHSA, Assistant Vice President Physician and Ambulatory Care Planning, MedStar Health Dr. Elias K. Shaya, MD, Regional Medical Director and Sr. Associate Executive Director for MedStar Behavioral Health Services Tracey Myers-Preston, CEO Maryland Addictions Disorders Council (MADC) Kathleen O Brien, Ph.D., CEO Walden/Sierra 3

4 Overview Over 10 million Americans suffer from a mental disorder every year with an Annual cost of a half a trillion dollars The bulk of the cost to our society is due to: Lost productivity Disability payments, half of which is due to mental illness About 2 million people with mental illness go to jail every year. The number of psychiatric beds has been cut by more than 30% since October 18,

5 Overview Similar changes have occurred in surgery and the rest of medicine as most surgeries, for example, are now performed on outpatient basis; However, the big difference is that surgical patients were moved from the hospital to a surgi-center, whereas psychiatric patients were moved from the hospital to the street. Patients who went from the hospital to the street, if lucky, they show up at a homeless shelter or jail; but if unlucky, they show up in the morgue. 5

6 The Opioid Crisis In 2015: Drug OD s killed over 52,000 Americans* More than car crashes and gun homicides combined*. In 2016: Further steep increase in Heroin & Fentanyl-related deaths in Maryland, DC, and Virginia Declaration of a state of emergency Maryland s Governor Virginia s Health Commissioner *Source: Centers for Disease Control and Prevention 6

7 Caused by the Healthcare System Introduction of PAIN as the 5 th vital sign Pharma minimized opioid risks Opioid prescribing quadrupled in 2014 vs

8 Highly Complex Crisis Multifaceted, but in part, it is iatrogenically-induced (a medical intervention side effect): 1.Long term opioid use for pain 2.Predisposed vulnerable patients develop addiction May 11,

9 Awareness Double Edge Sword Recently heightened awareness Dramatic drop in opioid prescribing Leaving patients with suboptimal pain control Which is another iatrogenically-induced effect 9

10 More Complicated - Heroin Patients who by now are addicted to pain pills Go to a cheaper option HEROIN 10

11 More Complicated - Fentanyl Fentanyl is 50 times more potent 1 kg heroin = $64K VS fentanyl = $2K 11

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13 Unintentional Fentanyl Overdose Deaths Jan-March 2016 Vs st Quarter Year Maryland Baltimore City

14 Per Capita Deaths (Per 100,000 population) Jan-March 2017 Maryland (excluding Baltimore City) All Drugs Heroin Fentanyl Baltimore City

15 Carfentanil Deaths Potency: Morphine Heroin Fentanyl Carfentanil 1 X 2 X 100 X 10,000 X 15

16 Awareness Double Edge Sword Raising awareness about a highly potent and therefore extremely deadly Fentanyl or Carfentanil Patients suffering from the disease of addiction which causes impaired judgment reach distorted conclusions. Caused the paradoxical effect of patients seeking it out even more, for a BETTER HIGH 16

17 Question #1 As a Substance Use Disorder (SUD) treatment provider, can you tell us how you have worked with local partners to develop population health strategies? 17

18 Walden Integrated Care Special Projects Behavioral health interventionist integrated with primary care services via Medstar St. Mary s Hospital mobile unit Get Connected to Health and Greater Baden Medical Systems site in Leonardtown Rounding at Medstar St. Mary s Hospital by behavioral health interventionist to outreach to inpatients as referred by staff Linkage to medical homes of individuals seeking residential substance use treatment Increased access to mental health and psychiatric care for uninsured/underinsured primary care patients Integrated care management and follow up Tracks ED usage of individuals engaged in care HEZ designation (CHRC/DHMH funding obtained by Medstar St. Mary s Hospital and joint lead partners Medstar, Baden FQHC, and Walden) Integrated care services based in the HEZ Training for integrated care based on national best practices Increased access to behavioral health services in the HEZ (social worker and psychiatrist recruitment) Assistance to lay health promoter program through Mental Health First Aid USA training to increase behavioral health literacy

19 Locally: an over-utilized ED ED visits/population in St Mary s County FY 16 FY16 Currently diverting approximately 15 patients/month from Emergency Departments; working to expand capacity

20 ED Diversion to Treatment: preventing ED usage

21 Primary care takes lead: mobile van for underinsured connects patients to behavioral health care via integrated team approach Community Health Promoters also trained in Mental Health First Aid for outreach

22 Behavioral Health Interventionist screens all new patients using mental health and SUD tools with links to BH treatment as needed

23 Lethality Assessment Protocol tool used in ED: positive screen results in connection to * 24 hour hotline * outreach counselor * shelter services * ongoing counseling, legal & other community supports

24 Question #2 Can you highlight some of the key progress that has been achieved? 24

25 25% reduction of patient usage of the ED of those who had SBIRT, behavioral health treatment & follow up

26 Question #3 What barriers exist that limit SUD treatment from addressing population health goals? 26

27 Key Ingredients Process Clearly defined MOU or Protocol Agreements outlining Scope of Services and Responsibilities of each Partner Information Sharing Release of Information Process/Procedure Contact People During and after key contact information: Clinical & Medical Initial & Final Eligibility Determine initial eligibility prior to referral Determine process for informing patient of final eligibility

28 Key Ingredients Financial Consider risks of accepting patients after hours who rely on third party payment authorization Is there alternate funding for patient if denied? Medical Concerns Establish mutual criteria for non-treatment related medical concerns regarding eligibility and care Prescription Needs Have a process for filling Medication Orders: a temporary fill at hospital-based pharmacy is one option

29 Gather as much information as you Gather hospital records: History & Physical, Lab work, Screening Assessment Treatment Provider: Check previous treatment history can.

30 Question #4 What is the role of harm reduction in the SUD population health landscape? 30

31 Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Harm Reduction Coalition 31

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38 Question #5 What specific advocacy / public awareness opportunities exist? 38

39 Behavioral Health and Social Conditions Significantly Impact Population Health 39

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