Opportunities to Address the Opioid Crisis with Telehealth

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1 Opportunities to Address the Opioid Crisis with Telehealth Allen Brenzel, MD Department for Behavioral Health, Developmental and Intellectual Disabilities Connie Gayle White, MD Department for Public Health

2 Kentucky We have a problem

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4 US Overdose Death Rates Over 64,000 overdose deaths in 2016 Surpassed Peak Gun, HIV, and car crash deaths Leading cause of death for individuals under 50 4

5 Number and age-adjusted rates of drug overdose deaths by state, US 2016

6 Age-Adjusted Overdose Death Rates by State (2016)

7 KY Resident Overdose Deaths ( ) 7.4 % increase Total Number Year

8 KY Overdose Decedents by Age Group 2015 & 2016 Age Group in Years Number 2015 Number Data Sources: 2015 & 2016 Overdose Fatality Reports

9 KY Overdose Deaths by Age

10 Drug Related ED visits 3248

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12 Composite Risk Index for Opioid Overdose

13 Drug Overdose Death Rates among Women Ages 18-44, Cabinet for Health and Family Services

14 Drug Overdose Death Rates among Women Ages 18-44, Rate per 100,000 Women Ages Kentucky US Kentucky Overdose Deaths in Women of Childbearing Age Year 14

15 Number NAS Hospitalizations of Kentucky Newborns 1,200 1, ,060 1,092 1, NAS Hospitalizations NAS Paid by Medicaid Produced by the Kentucky Injury Prevention and Research Center, May Kentucky Inpatient Hospitalization Claims Files, Frankfort, KY, [ ]; Cabinet for Health and Family Services, Office of Health Policy. Data for are provisional; therefore these results are subject to change. NAS Case Definition: Any mention of ICD9CM diagnosis code AND any mention of ICD9CM diagnosis code V3x AND Kentucky resident AND patient s year of birth matches the reporting year Medicaid data provided by the Department for Medicaid Services and include claims with a diagnosis code of V30-V39 and and for ICD10 P96.1 and Z38

16 Four Major Categories of Response Prevention Treatment Recovery Supports Stakeholder Collaboration Harm Reduction

17 Percentage of adults by region reporting that they had family members or friends who had experienced problems as a result of drug abuse Foundation for a Healthy Kentucky, Kentucky Health Issues Poll, May

18 Counties estimated by the CDC as vulnerable for an HIV or HCV outbreak in IDU

19 Kentucky counties estimated vulnerable for an HIV or HCV outbreak in IDU

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21 Likelihood a person attending a HRSEP will begin a treatment program vs someone with an SUD will begin a treatment program

22 Co-morbidities with the opioid crisis Hepatitis C Endocarditis Osteomyelitis Brain abcesses Soft tissue infection

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24 Declared the Opioid Crisis a Public Health Emergency in October 2017 Outlined need to expand treatment to rural communities Most notably mentioned making telehealth more available 24

25 Kentucky Senate Bill 112 Effective July 1, 2019 Applies to both Medicaid and commercial plans CHFS will provide oversight, guidance and direction to Medicaid providers for telehealth No longer mandate for originating or distant site KY Telehealth Board is eliminated and duties absorbed by the Cabinet 2 25

26 Kentucky Senate Bill 112 (continued) Encounters reimbursed in-person will be reimbursed with telehealth delivery if appropriate Must use interactive audio and video technology unless store and forward technologies mimic standard practice of care (images are sent to a provider for evaluation) Asynchronous (store and forward) technologies meet the requirements for face-to-face if the provider has access to the patient s medical history , text chat, facsimile or standard audio-on telephone calls do not meet the technology standard 26

27 Senate HELP (Health, Education, Labor, & Pensions) Committee Opioid Crisis Response Act of 2018 Reversing the landmark Ryan Haight Act of 2008 Create a rule allowing qualified healthcare providers to administer controlled substances via telemedicine community mental health and addiction treatment centers, along with physicians to physician assistants and nurse practitioners FDA, CDC, NIH, and SAMSHA, as well as mental health experts, state governors and families affected by substance use disorder 27

28 University of Kentucky Blue Angels

29 UK Blue Angel Program Fulfill UK s institutional mission to keep patients as close to home for their treatment as possible Twice-a-month clinic where highly trained obstetricians use special equipment to review fetal ultrasounds remotely, in real time, and talk with the patient simultaneously Increase access to the highest level of health care for the poor and those in the rural areas and promote more equity in the health care system

30 University of Kentucky PATHways (Perinatal Assistance and Treatment Home) 30

31 University of Kentucky PATHways (Perinatal Assistance and Treatment Home) Centering Pregnancy Model 2014 to 2017 >150 women received treatment 77% entered delivery without any illicit drugs on board For every group session attended 15% more likely to have a negative drug test 50% less likely to relapse after delivery Decreased likelihood of their baby showing signs of NAS (30%) if the mother is on MAT (40-58% nationally) 31

32 PCORI grant to UK PATHways Patient-Center Outcomes Research Institute 12 centers 6 in each arm of the study One arm: Pregnancy/parenting support and education groups led by a trained nurse and a peer support specialist every other week One arm: Telemedicine-meeting with specialists in high-risk pregnancy, pediatrics, nurses, substance counseling 3 32

33 PLAN OF SAFE CARE P = Promoting L = Linkages A = Around N = Nurturing 33

34 Lifelong learning and guided practice model Increases workforce capacity to provide bestpractice specialty care and reduce health disparities Hub-and-spoke knowledge-sharing networks 34

35 People need access to specialty care for their complex health conditions. 35

36 There aren't enough specialists to treat everyone who needs care, especially in rural and underserved communities. 36

37 ECHO trains primary care clinicians to provide specialty care services. This means more people can get the care they need. 37

38 Patients get the right care, in the right place, at the right time. This improves outcomes and reduces costs. 38

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45 Possible Roles for Telehealth Direct Provision of Substance Use Disorder Treatment Services Medication Assisted Therapy learning collaborative for providers Virtual co-location of supports with Medication Assisted Therapies In-home therapy and supports Crisis supports Relapse prevention supports (group 12 step) Enhancing Peer Support contact as key engagement strategy Post-residential treatment follow-up Integrating Medical and SUD care (Hep C, etc) 45