Opioid Safety Special Innovation Projects Advisory Board Meeting November 29, 2017 Ben Druss Opioid SIP Advisory Board Chair 12/11/2017 1
Today s Agenda The purpose of this meeting is to introduce the two opioid projects, board members and QIO staff Introductions Projects Overview Board Discussion and First Impressions Next Steps and Meeting Schedule
Opioid Safety Special Innovation Projects Advisory Board Members Insert Photo Here Ben Druss MD, MPH Advisory Board Chair Rosalyn Carter Chair in Mental Health Emory University Atlanta, GA Chris Budnick MSW, LCSW, LCAS, CCS Executive Director Healing Transitions Raleigh, NC Insert Photo Here Liza Chapman PharmD, FAPhA Pharmacy Clinical Sales Manager Kroger Atlanta, GA Dallas Gay Opioid Safety Advocate Gainesville, GA Claudia Hamilton Executive Director Living Proof Recovery Rome, GA
Opioid Safety Special Innovation Projects Advisory Board Members Patrice Harris MD, MA Chair, Board of Trustees American Medical Association Atlanta, GA Susan Kansagra MD, MBA Section Chief, Chronic Disease and Injury Section NC DHHS Raleigh, NC Christina Nunemacher PharmD Pharmacist Realo Discount Drug Jacksonville, NC Kimberly Rask MD, PhD Chief Data Officer Alliant Quality Atlanta, GA Wendy Tiegreen MSW Deputy Chief of Staff Office of Medicaid Coordination GA DBHDD Atlanta, GA Crick Watkins DO Assistant Professor of Emergency Medicine (Pediatrics) Wake Forest University School of Medicine Winston-Salem, NC Pending: Family Member: Mental Health Beneficiary
Opioid Safety Special Innovation Projects Alliant Quality Team Kandi Givner MS Mental Health & Opioid Safety SIP Lead Atlanta, GA Mike Crooks PharmD Pharmacy Opioid Safety Lead Atlanta, GA Tod Citron MSW, MS Executive Director, Behavioral Health Atlanta, GA Jackie Brown MHA, MSL Communications Manager Raleigh, NC Jennifer Massey PharmD Medication Safety Lead Raleigh, NC
Opioid Safety Special Innovation Projects Alliant Quality Team Linda Kluge RD, CPHQ Executive Director Medicare QIO Atlanta, GA Adrienne Mims MD, MPH Chief Medical Officer Atlanta, GA Leighann Sauls RN, CDN State Program Director Raleigh, NC JoVonn Givens MPH State Program Director Atlanta, GA
Opioid Safety Special Innovation Projects Advisory Board Guests Neil Campbell MS Executive Director Georgia Council on Substance Abuse Atlanta, GA Insert Photo Here Johannes Hutauruk RN, LCDR USPHS Contracting Officer s Representative, CMS Seattle, WA Insert Photo Here Filita Long MBA, BSN, RN, NE-BC Contracting Officer s Representative, CMS Dallas, TX Trevor Stone MS Contracting Officer s Representative, CMS Kansas City, MO
Trends in Opioid Use, Generally and Among Medicare Beneficiaries
SOURCE: CDC Vital Signs, July 2014. cdc.gov/vitalsigns.
Negative Outcomes associated with Opioid Misuse Figure 3. Cumulative percent change in the rate of opioid-related inpatient stays by State, 2009-2014 AHRQ s Healthcare Cost and Utilization Project (HCUP)
Negative Outcomes associated with Opioid Misuse Figure 5. Cumulative percent change in the rate of opioid-related emergency department visits by State, 2009-2014 AHRQ s Healthcare Cost and Utilization Project (HCUP)
Source: Medicare CSAT Percent of Medicare Beneficiaries using Opioids for 60 Days per Year Highest rates of chronic opioid use in rural areas NW GA: 30.1%; South GA: 26.6%
Hamilton Med Ctr Murray Medical Ctr Gordon Hospital Floyd Med Ctr Cartersville Med Ctr Redmond Regional Med Ctr Polk Med Ctr
Hospital Utilization per 1000 Chronic Opioid-Using Medicare Beneficiaries
Medicare Beneficiaries with serious Mental Illness Diagnosis*
Source: Medicare CSAT Percent of Medicare Beneficiaries using Opioids for 60 Days per Year Highest rates of chronic opioid use in rural areas Lower Cape Fear: 25.2% High Country/Boone: 27.2%
Four Cities of the Nation s Top 25 by Rates of Opioid Abuse in North Carolina Source: The opioid crisis in America s workforce. Castlight Health. 2017. Web (Accessed July, 14, 2017) http://www.castlighthealth.com/typ/the-opioid-crisis/
Columbus Regional Pender Memorial Hospital New Hanover Regional Wilmington Treatment Center Novant Health Brunswick Arthur Dosher Memorial
Hospital Utilization per 1000 Chronic Opioid-Using Medicare Beneficiaries Columbus Regional Pender Memorial Hospital New Hanover Regional Wilmington Treatment Center Novant Health Brunswick Arthur Dosher Memorial
Hospital Utilization per 1000 Chronic Opioid-Using Medicare Beneficiaries Columbus Regional Pender Memorial Hospital New Hanover Regional Wilmington Treatment Center Novant Health Brunswick Arthur Dosher Memorial
Medicare Data: Mental Health & Opioid Use Northwest Georgia Opioid Use and Mental Health Lower Cape Fear 19,234 Number of Medicare Chronic Opioid Users 21,212 30.1% (+9.4%) 47.7% (+10.9%) 24.1% (+8.1%) Percentage of Medicare Beneficiaries who are Chronic Opioid Users Percentage of Medicare-Chronic Opioid Users with Mental Health Diagnosis Percent of All Medicare Beneficiaries with Mental Health Diagnosis 25.2% (+2.8%) 43.4% (+4.1%) 19.5% (-0.8%) Medicare Beneficiary Opioid User Opioid User with Mental Health Diagnosis
Peer Coaching Support in Local Hospitals QIO-Led, 2-year project (October 2017 September 2019) Support patients with mental health diagnoses and history of opioid use Partner with 2 hospital EDs in Northwest Georgia and 6 hospitals in Lower Cape Fear, NC Goals: 1) Reduce ED and Hospital Utilization among opioid users with mental health diagnoses by 25% 2) Reduce inappropriate opioid prescribing by 25%
Peer Coaching Support in Local Hospitals Embed Certified Addiction Recovery Specialist (CARES)/Certified Peer Specialists (CPS) in recruited hospitals in Georgia Peer Recovery draws on lived-experience of those with similar mental health and addiction history Approximately 5500 peer specialists in GA and NC Whole Health Action Management training for CARES/CPS to encourage recovery, wellness and self-managed health among engaged patients
Project Partners: Peer Coaching Support in Local Hospitals Ben Druss: Psychiatrist and Project Consultant, Opioid Special Innovation Projects Advisory Board Chair National Council of Behavioral Health: Conduct 2-day Whole Health Action Management (WHAM) training for CARES/CPS project staff Georgia Council on Substance Abuse: Employ and designate CARES/CPS cross-trained staff for the Georgiahospital based Peer Support Access Program
Medicare Data: Opioid Use and Naloxone Opioid Use and Mental Health Number of Medicare Chronic Opioid Users Percentage of Medicare Beneficiaries who are Chronic Opioid Users 30-Day Readmission rate for Chronic Opioid Users ED Visit rate for Chronic Opioid Users Naloxone units per 1000 Medicare Chronic Opioid Users Pharmacies Dispensing Naloxone to Medicare Beneficiaries South Georgia Atlanta Metro (GA) Lower Cape Fear (NC) 12,321 19,234 21,212 30.1% (+9.4%) 16% (+9.4%) 25.2% (+2.8%) 23.2% (+1.7%) 12.4% (-9.1%) 10.8% (-8.8%) 0.49% (+0.05%) 1.35% (+0.9%) 0.21% (-0.15%) 0 (-3) 6 (+3) 17 (+1) 0 of 128 10 of 124 73 of 131
Opioid Safety at the Pharmacy QIO-Led, 2-year project (October 2017 September 2019) Train pharmacists to assess and counsel on opioid risks and offer naloxone Partner with 20 pharmacies per state in Metro Atlanta and South Georgia, and Lower Cape Fear, NC Goal: Increase naloxone dispensing rate to 50 per 1000 chronic-opioid using Medicare Beneficiaries
Opioid Safety at the Pharmacy Engage pharmacies in monthly coaching calls for pain management, opioid risk assessment and counseling, and naloxone training. Pharmacies select opioid risk screening criteria and report completion of assessments and naloxone dispensing Develop Pharmacy Opioid Risk and Naloxone Dispensing Training Kit Develop marketing materials to promote opioid safety and naloxone availability
Project Partners Opioid Safety at the Pharmacy North Carolina Association of Pharmacists and Georgia Pharmacy Association: Recruit pharmacies and engage in education. Promote best-practices and resources Georgia Alliance for Health Literacy: Review patient education and communications materials University of Georgia College of Pharmacy: Conduct pre/post pharmacy attitudes and beliefs survey. Collect and analyze pharmacy submitted performance data
Board Member first impressions and questions
Next Steps: Please send headshots for future Board meetings Review Monthly update (sent by end of December) Next Meeting Date: January 24 th or January 25 th 90 minutes Early afternoon (1:00-2:30) or late afternoon (3:00-4:30)
This material was prepared by GMCF, for Alliant Quality, the Medicare Quality Innovation Network Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS