BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY … Initiative...BERNALILLO COUNTY OPIOID...
Transcript of BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY … Initiative...BERNALILLO COUNTY OPIOID...
NMPHA Annual Conference April 2, 2014
Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council
BERNALILLO COUNTY
OPIOID ABUSE ACCOUNTABILITY SUMMIT
“Turning the Curve on Opioid Abuse in
Bernalillo County”
SUMMIT PLANNING
COMMITTEE
SUMMIT #1 September
19, 2013
IMPLEMENTATION TEAMS
PRIMARY PREVENTION
OVERDOSE PREVENTION
TREATMENT
LAW ENFORCEMENT/
CRIMINAL JUSTICE/ PUBLIC SAFETY
DATA TEAM
COORDINATING COMMITTEE
INTERIM UPDATE
MEETING June 2014
SUMMIT #2 Fall 2014
BERNALILLO COUNTY OPIOID ACCOUNTABILITY INITIATIVE
TIMELINE (Fall 2012 – Fall 2014)
October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014
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
2. Allow for the “shock of the possible”
1. Achieve a perpetual state of simultaneous planning and doing
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
HEADLINE
INDICATOR
#/rate of overdose deaths
associated with opioid use in Bernalillo County
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
Treatment
Indicator
#/rate of hospitalizations for OD
with any opioid involvement
Law Enforcement/
Criminal Justice/
Public Safety
Indicator
Recidivism rates at MDC (within 1 and 3
years)
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
SUMMIT #1 September
19, 2013
IMPLEMENTATION TEAMS
PRIMARY PREVENTION
OVERDOSE PREVENTION
TREATMENT
LAW ENFORCEMENT/
CRIMINAL JUSTICE/ PUBLIC SAFETY
DATA TEAM
COORDINATING COMMITTEE
INTERIM UPDATE
MEETING June 2014
SUMMIT #2 Fall 2014
BERNALILLO COUNTY OPIOID ACCOUNTABILITY INITIATIVE
TIMELINE (Fall 2012 – Fall 2014)
October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014
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 PLANNING
COMMITTEE
SUMMIT #1 September
19, 2013
IMPLEMENTATION TEAMS
PRIMARY PREVENTION
OVERDOSE PREVENTION
TREATMENT
LAW ENFORCEMENT/
CRIMINAL JUSTICE/ PUBLIC SAFETY
DATA TEAM
COORDINATING COMMITTEE
INTERIM UPDATE
MEETING June 2014
SUMMIT #2 Fall 2014
BERNALILLO COUNTY OPIOID ACCOUNTABILITY INITIATIVE
TIMELINE (Fall 2012 – Fall 2014)
October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014
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 decision-makers 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
• 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
1. Make availability of naloxone normal and universal
TREATMENT
IMPLEMENTATION TEAM
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION • 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)*
1. Expand access to MAT
TREATMENT continued
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
• 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
2. Expand full array of treatment services aligned with ASAM guidelines
TREATMENT continued
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
•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*
3. Develop comprehensive and coordinated treatment system in Bernalillo County
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 re-designed 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"
SUMMIT PLANNING
COMMITTEE
SUMMIT #1 September
19, 2013
IMPLEMENTATION TEAMS
PRIMARY PREVENTION
OVERDOSE PREVENTION
TREATMENT
LAW ENFORCEMENT/
CRIMINAL JUSTICE/ PUBLIC SAFETY
DATA TEAM
COORDINATING COMMITTEE
INTERIM UPDATE
MEETING June 2014
SUMMIT #2 Fall 2014
BERNALILLO COUNTY OPIOID ACCOUNTABILITY INITIATIVE
TIMELINE (Fall 2012 – Fall 2014)
October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014
THANK YOU!
Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council
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