Addiction Resource Center’s Experience

1. Addiction Resource Center’s Experience Implementing Medication Assisted Treatment for Opiate Addiction The Business Case

2. April 2005 • Addiction Resource Center’s position on the ever rising opiate addiction problems in Maine. • “We do not know what we are going to do about the whole opiate thing.” • Our financial outlook was strained.

3. November 2005NIATx • ARC receives a PI Grant from the Maine Office of Substance Abuse (OSA) • Objectives: • Learn Rapid Cycle Process Improvement. • Use these tools to decrease client wait times and increase client retention in treatment. • Report your data and share your experiences.

4. STAR SIARC Business Case Wait Times Are Down 77% From Baseline

5. STAR SIARC Business CaseIOP Volume Is Up 205% Over Baseline

6. STAR SIARC Business CaseMedicaid Net is up 53% Over Baseline 3’rd Party and Private Net Is Up 50% Over Baseline

7. A Model for Change • The RWJF and Maine OSA investment in Performance/Process Improvement has provided ARC three key assets which enable larger systems change: 1. Tools to manage change. 2. Experience being successful. (Access and Retention) 3. Institutional Credibility.

8. November 2006 • We still had an opiate problem! • Needed to make a big change!

9. November 2006 • Implement Medication Assisted Treatment (MAT) for opiate addiction. • Not with 20 consumers, but 400. • We needed a PLAN!

10. Key Activities • Form team to work on needs, barriers, staffing model. • Complete draft of “Mission Fit” and “Business Case.” • Within Maine AR Group, borrow model from Aroostook Mental Health Center. • Present business plan to Hospital Administration.

11. Community Response-Mission Fit • ARC took a 4 month snap shot to trend volumes of clients seeking treatment for opiate dependence. • On average 15-20 callers per month request Suboxone assisted treatment. • Of 15 assessments Dx. with opioid dependence in Jan. and Feb. 2007 • Five have admitted to treatment programs and are involved in MAT. • Those not admitted did not access MAT • Anticipated volume of new ARC clients per year is 100-150 clients

12. Community Response-Mission Fit

13. Community Response-Business Case • The 115 patients treated by programs in Westbrook equate to the current volume of ARC Intensive Outpatient Programs (IOP). • Absorbing this volume equates to an additional 2,300 IOP treatment days per year for ARC. • The funding mix from this population is: 34% private insurance 28% Medicaid 17% Medicare 16% Unfunded

14. Capacity Planning • 20% attrition rate is factored for each change in level of care. Induction to Med. Management, during IOP treatment, and from IOP to Aftercare. • Based on national models for suboxone assisted treatment and three years experience at other Maine Hospital-Based programs. • Capacity exists for 832 Med. Management visits in first 18 months. • Based upon the data above, we expect to complete 532 Med. Management visits in first 18 months. • This 300 patient buffer exists to assure optimal pt. care and to avoid overwhelming resources.

15. Community Response-Business Case (Cost)

16. Community Response-Business Case (Revenue)

17. Post ImplementationAccess/Increased Admissions • Access to Buprenorphine services has sustained a 20% increase in New Business.

18. Post ImplementationAccess/Engagement • Admission Conversion rates for opioid addicted clients are up 60% over baseline.

19. Post ImplementationRetention/Increased ContinuationCumulative Measure of active cases by month

20. Post ImplementationPit Falls • Access for new bup. pts. is decreasing • Bottlenecks in maintenance apt. schedule begin drive access for new patients. • Deviation from practice standards to accommodate rapid pace • Work-arounds that compromise pt. and public safety.

21. Business CaseMAT Groups • Increase induction access through use of MAT management groups

22. Business CaseMAT Groups • Used PDCA cycles to pilot one group for 8 wks. • Better use of multidisciplinary team approach • Consistent application of standard of care • Replicate intervention with two 1.5 hour groups per week. • 2 groups per week takes 12 hours per month vs. 26.5 hours per month for MD to see same case load individually. • 2 groups per week absorbs 112 encounters per month. • Increase monthly average from 8 to 16 inductions. • Increase monthly average from 2 to 7 psychiatric evaluations. • Will result in increase revenues in the amount of $41,000.00 per year-NET.

23. Access-Patients Drive ARC Continuum of Care Design

24. Business Case-Room to Breathe • Greater self-reliance during times of social service cuts and legislative unpredictability. • In spite of flat funding, ARC has reduced the percentage it is underwritten by state dollars from 60% in SFY 06 to 42% in SFY 09.

25. Key System Changes • Integrate suboxone services within ARC continuum of care. • Bring physicians on-site, single standard of care, improve communication, decrease staff load. • Working with recovery community to change attitudes. • Focus groups, presentations, well clients. • Maximize billing as the result of State/Payer change projects. • Work with the Maine formulary committee to reduce stigma and assure access to buprenorphine products.

26.  Payer/Provider Partnerships • Support for rapid cycle change approach. • State wants to know barriers to MAT implementation. • Access • Flexibility • Advocacy and Credibility • Operational relief • Licensing regulations