BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY SUMMIT Turning the Curve on Opioid Abuse in Bernalillo County

BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY SUMMIT Turning the Curve on Opioid Abuse in Bernalillo County NMPHA Annual Conference April 2, 2014 Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council

BERNALILLO COUNTY OPIOID ACCOUNTABILITY INITIATIVE TIMELINE (Fall 2012 Fall 2014) October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014 IMPLEMENTATION TEAMS PRIMARY PREVENTION INTERIM UPDATE MEETING June 2014 SUMMIT PLANNING COMMITTEE SUMMIT #1 September 19, 2013 OVERDOSE PREVENTION TREATMENT COORDINATING COMMITTEE LAW ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY SUMMIT #2 Fall 2014 DATA TEAM

WORKING IN COLLECTIVE IMPACT REQUIRES A MINDSET SHIFT OLD WAY Technical Problem-Solving Credit Silver Bullet NEW WAY Adaptive Problem-Solving Credibility Silver Buckshot Adapted from John Kania

COLLECTIVE IMPACT: WHAT IT TAKES 1. Achieve a perpetual state of simultaneous planning and doing 2. Allow for the shock of the possible 3. Pay attention to relationships 4. Listen, listen, listen for how to respond to unanticipated results 5. Adopt an attitude of burning patience Adapted from John Kania

RESULTS-BASED ACCOUNTABILITY has two parts: Population Accountability about the well-being of WHOLE POPULATIONS For communities cities counties states nations Performance Accountability about the well-being of CUSTOMER POPULATIONS For Programs Agencies Service Systems

RESULTS-BASED ACCOUNTABILITY (RBA) RESULT What is the desired change in population well-being? HEADLINE INDICATOR What data tracked as a trend over time - would best indicate change toward the desired result? (This represents what we want to turn the curve on.) STORY BEHIND THE CURVE What are the root causes and multiple forces at work causing the trend? What additional information/data is still needed? (This is the research agenda ) WHAT PARTNERS NEED TO BE INVOLVED? Who needs to be at the table and who s missing? WHAT WORKS? (WHAT WOULD IT TAKE TO TURN THE CURVE?) What can each partner contribute? What are some no cost/low cost ideas that can be worked on right away?

Potential Indicators Prevention Indicator Rate of reported use of heroin/painkillers to get high among youth in last 30 days Harm Reduction Indicator # of heroin overdose deaths & Naloxone reversals HEADLINE INDICATOR #/rate of overdose deaths associated with opioid use in Bernalillo County Law Enforcement/ Criminal Justice/ Public Safety Indicator Recidivism rates at MDC (within 1 and 3 years) Treatment Indicator #/rate of hospitalizations for OD with any opioid involvement

INDICATORS AND PERFORMANCE MEASURES Indicators as used here are specifically related to the well-being of the population - are we getting better or getting worse as a population? Performance measures track data related to the performance of the system and/or specific programs. o How much was done? o How well was it done? o Is anyone better off?

SUMMIT PLANNING COMMITTEE Focused on identifying recommendations, indicators, panelists and format for first Summit. ~20 multi-sectoral members representing: Advocates, community activists, drug policy analysts, data analysts Albuquerque Health Care for the Homeless Bernalillo County Community Health Council Bernalillo County Department of Substance Abuse Programs/MATS Bernalillo County Urban Health Extension City of Albuquerque Division of Health & Human Services Heroin Awareness Committee (Healing Addiction in Our Community) Molina Healthcare New Mexico Department of Health Health Promotion New Mexico Department of Health Office of Injury Prevention New Mexico Department of Health Turquoise Lodge Presbyterian Healthcare Services UNM Prevention Research Center for Education Policy Research UNM Preventive Medicine UNM Urban Health Partners Pathways to a Health Bernalillo County UNM Center for Alcoholism, Substance Abuse & Addictions (CASAA) UNM RWJF Health Policy Center

SUMMIT #1 September 19, 2013 Convened 150 multi-sectoral stakeholders to hear panelists, review recommendations and get commitment to follow-up work over next two years

Four Implementation Teams with volunteers from Summit - plus others - meet monthly to: strategize and act on implementing recommendations for their specific area, including identifying decisionmakers who are key players to bring to the table select indicator(s) as target to measure desired outcome(s) and to develop baseline "report card" inventory available services/gaps in their area, identifying need for additional resources provide ideas for next Summit

PRIMARY PREVENTION IMPLEMENTATION TEAM What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION Develop and implement prevention framework for the county using SAMHSA SA Prevention Framework, NMPED "Building State Capacity" plan, with tools for community coalitions, schools, faith-based institutions and workplaces Expand access to drug counseling services for high school and middle school students including referrals and how Medicaid could support Support policies to expand evidence-based early childhood support programs, including home visiting focusing first on low-income families For pain control, promote evidence-based alternatives for Rx opioids Reduce supply of Rx opioid pain medication by increasing access to and usage of Prescription Monitoring Program database AND prescribing guidelines to limit over-prescription of opioids NEW: Inventory and evaluation of existing programs NEW: Access to mental health care (which could possibly be part of the Treatment Team work as well)

HARM REDUCTION/OVERDOSE PREVENTION IMPLEMENTATION TEAM What would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION 1. Make availability of naloxone normal and universal Distribute naloxone to persons being released from MDC and their families o Build on existing programs o Learn from existing models/pilots o Provide training for inmates, families, MDC staff and P&P officers Restructure P&P policies to allow for parolees to have naloxone rescue kits while on parole* Assure all police officers are carrying naloxone and trained in its use Support implementation of authorization allowing pharmacists to prescribe naloxone o Support development of MCO reimbursement mechanisms for kits and education/consultation o Assure naloxone rescue kits are stocked at all pharmacies Advocate for all providers to co-prescribe naloxone with opioid pain meds for chronic pain management Make naloxone and training available to agencies with outreach programs for injection drug users, treatment centers and methadone clinics* Make naloxone available at all public health offices as walk-in sites o Normalize naloxone as service o Assure services are user-friendly

TREATMENT IMPLEMENTATION TEAM What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION 1. Expand access to MAT Increase MD participation in prescribing o Remove preauthorization for prescribing buprenorphine o Address issues of stigma Continue MAT for MDC inmates already in treatment when incarcerated Offer pre-release MAT to MDC inmates not yet in treatment Assure access for uninsured populations, including those not eligible for coverage Expand buprenorphine beyond detox to ongoing maintenance treatment when appropriate (Turquoise Lodge and MATS)* Address issue of drug courts excluding people on MAT* Address BHSD guidelines allowing only psychiatrists to prescribe buprenor-phine and no payment for methadone* Address private insurance payment for methadone* Address VA lack of provision and payment for methadone* License mid-level practitioners to prescribe buprenorphine (issue of federal regulations)*

TREATMENT continued What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION 2. Expand full array of treatment services aligned with ASAM guidelines Expand number and capacity of residential and inpatient programs o Work with Medicaid, Centennial Care MCOs and private insurance to provide coverage/ reimbursement o Assure access for uninsured populations, including those not eligible for coverage* Duration of coverage for specific levels of intervention should be flexible and tailored to patient needs Assure identification and treatment of co-occurring disorders Eliminate need for diagnosed co-occurring condition as a requirement for Medicaid funding of treatment of alcohol/drug dependency Include wrap-around support services as integral part of funding for treatment services, including assistance finding housing/jobs Identify and offer enrollment to all persons who are drug users or at risk for opioid use and are eligible for Medicaid, especially persons being released from incarceration Advocate for Medicaid coverage of evidence-based non-pharmacologic treatment of pain, e.g., chiropractic

TREATMENT continued What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION 3. Develop comprehensive and coordinated treatment system in Bernalillo County Develop a comprehensive inventory and mapping of current treatment services to determine gaps in capacity and levels of care as basis for an effective, coordinated system Develop current, consistently updated database of services accessible to providers and community (including eligibility criteria and program capacity)* Identify opportunities for enhanced linkages among different components of the system* Develop shared measurement criteria to allow for evaluation of system linkages and accurate cost reports* Propose realignment of resources to support prioritized services in alignment with agreed-upon principles Explore feasibility and appropriately plan for expansion of County DSAP as nucleus of a much-expanded integrated treatment system Assure integration of MDC into treatment system linked to community providers/resources*

DATA TEAM Continues gathering of data to support each Implementation Team Maintains "data development agenda" (list of data still needed) Develops baseline "report card" with input from Implementation Teams and Coordinating Committee

COORDINATING COMMITTEE 2 co-chairs from each Implementation Team, representative(s) of Data Team, and others with contracted Coordinator Assure alignment of implementation activities of 4 teams Coordinate interim face-to-face meetings with appropriate policy-makers and other stakeholders as needed to support implementation of recommendations Take input from Teams to plan Interim Update Meeting and Summit #2 Coordinate data collection Develop case statement, including fiscal case statement for changing where we put our resources Develop and coordinate ongoing media and public education campaign Coordinate inventories of services and gaps, leading to structure for redesigned system Coordinate input on need for resources to fill policy/services gaps

INTERIM UPDATE MEETING by June 2014 Convene members of Implementation Teams, participants in Summit #1 and other interested stakeholders to report progress on initiative recommendations to date

SUMMIT #2 Fall 2014 Re-convene multi-sectoral stakeholders to provide update on progress toward implementation to date and get commitment of additional stakeholders to continue re-design of system and actions to "turn the curve"

THANK YOU! Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council mcavila@bernco.gov 505-468-7025 A report on the September 2013 Summit Proceedings, plus videos and handouts from all sessions are available online at: http://www.bchealthcouncil.org/opioidinitiative