Jennifer

Johnstun, RN

CREATING COMMUNITY

IMPACT:

ANSWERING THE CALL TO ACTION

THROUGH REGIONAL

COLLABORATION

OBJECTIVES

Summarize Historical Work

Provide a Summary of Current Regional

Initiatives

Oregon Pain Guidance (OPG)

Coordinated Care Organizations (CCOs)

Oregon Prevention Grant (PDO)

Discuss Alignment

Multiple Root Causes

Issue Crosses Multiple Sectors

Multiple Solutions

OPIATES: A COMPLEX PROBLEM

Do we all understand the problem?

Do we share the same vision about what needs to change?

Do we believe in a joint approach to solving this problem? How

would we support that? Who should be involved?

How will we know if we are actually changing the community?

What is working and what isn’t?

How can we work smarter by leveraging resources through

mutually reinforcing activities?

How can we build and maintain continuous communication?

What is MY part in this?

STEPPING BACK: QUESTIONS FOR

GREATER IMPACT

( Z en S ay in g )

LEAP AND THE NET WILL APPEAR

J i m S h a m e s , M DM e d i c a l O f f i c e r J a c k s o n C o u n t y

H e a l t h a n d H u m a n S e r v i c e s

OREGON PAIN GUIDANCE

(OPG)

FORMERLY CALLED OPIOID PRESCRIBERS

GROUP

The mission of the Oregon Pain Guidance group (OPG)

is to improve the quality of life in our communities

through the understanding, evaluation and application

of best practices for the treatment of complex chronic

pain.

The goal of OPG group is to decrease the morbidity

and mortality associated with the inappropriate use of

opiates AND shift the focus to non-opiate treatments

for complex chronic pain so that patients experience

an overall improvement in well being.

OPG: MISSION

OPG was founded in 2011

OPG is a nonprofit entity that is part of United Way, with funding support from CCOs, JRHA, and DOJ

Leadership is provided by a multi-partner steering committee that meets twice a month

OPG is primarily focused in Jackson and Josephine Counties, though OPG has now spread resources to other communities

OPG: STRUCTURE

OPG’ S APPROACH TO COMMUNITY

ENGAGEMENT: A THREE LEGGED STOOL

Providers

Patients

Public

6 th Annual Pain Conference (May 4-6 2017)

Didactic and Experiential Activities taught by National Leaders, Free

Buprenorphine Training, Compassion-Based Difficult Conversations Training,

Behavioral Medicine Strategies, Community Forum and Public Symposium

Maintain OPG Guidelines for Safe and Effective Treatment of

Pain

Maintain Website

Now being spread across the State of Oregon

Monthly Community Education

Weekly Peer Led Chronic Pain Support Groups

Collaboration with Medical Boards

Media Projects and Public Service Announcements

CURRENT OPG ACTIVITIES

New/Potential Projects

Naloxone Workgroup

NICU Initiative

Academic Detailing/Reverse Drug Rep

Support for Providers Facing Sanctions from the

Oregon Medical Board

Ongoing Projects

Outreach Training for Regional Health Care Providers

OPG PROJECTS

Operationalize the CDC

guidelines

Focus on the practicing

professional

All subjects updated with

latest information

Recognition of the

importance of: Acute

Pain, Pain Specialty,

Tapering and more

STANDARDIZATION

OPG PAIN TREATMENT GUIDELINES

www.oregonpainguidance.org

• Educat ion

• Videos

• Ar t ic les

• Resources

• Guidel ines

• Tools

OREGON PAIN GUIDANCE (OPG)-

MONTHLY MEETING

Attendees: Physicians, Mid-level providers, Nurses, Substance Abuse

Counselors, CCOs, Behavioral Health Providers, Pharmacists, Medical

specialty (Pain Medicine, ED), Dental, Community Justice Partners

PUBLIC EDUCATION

SUCCESSES

Have increased collaborative efforts

Educational Resource

Guidelines-Standardized approach

Experiential Knowledge-What does and doesn’t work.

Ex: Need more alternative therapies and BH at PCP

GAPS

Voluntary Participation

Education Requires

Ongoing Reinforcement

Data Aquizition

Have identified

resources that work

and are needed but

that OPG can’t provide

(i.e. Alternative Therapies)

OPG

COORDINATED CARE

ORGANIZATONS (CCOS)

Oregon’s Medicaid delivery system is provided

through Coordinated Care Organizations (CCOs)

CCOs administer physical health, mental health, and

dental benefits under a global budget

Regional CCOs in Jackson, Josephine, Douglas, Coos

and Curry counties include Western Oregon Advanced

Health (WOAH), PrimaryHealth of Josephine County

(PHJC), Jackson Care Connect (JCC), and AllCare

Health(ACH)

CCOs are charged to improve the health and

wellbeing of the community, beyond CCO

membership

COORDINATED CARE ORGANIZATIONS

CCO Specific Pharmacy Benefit Changes/Guidelines

Local CCO Projects

Coos Heroin/Opiate Workgroup

Participation in OPG

Partnerships with Addiction Treatment Centers

Clinic Specific Support

Historical work was generally not coordinated with

other CCOs

HISTORICAL CCO OPIATE INITIATIVES

Community Partnerships (Beyond and

Within Healthcare)

Expansion and

Refinement of Medical

Home Model

Attention to Integrated Behavioral Health and Addictions

Attention to Social

Determinants of Health

Focus on Improving Population

Health

Expansion of Medicaid Coverage

RELATED CCO WORK

CCOs and the Oregon Health Authority (OHA) chose to focus

the Statewide Performance Improvement Project (PIP) on

reducing high dose opiate use

Four Regional CCOs (ACH, JCC, PHJC, WOAH) made the

decision to work regionally on the Statewide PIP

The focus of the participating CCOs is to reduce high -dose

opiate prescribing in Southern Oregon

OPIATE FOCUSED PERFORMANCE

IMPROVEMENT

Improve community knowledge regarding opiate safety and

risk of overdose.

Educate CCO members about benefits changes, including

medications and treatments.

Improve provider knowledge about:

Opiate prescribing guidelines (MED limits)

Screening and Assessment Practices

Non-opiate pain management modalities for chronic pain and

how to access those modalities.

CCO benefit coverage of opiates and other treatment

modalities

Synchronize member benefit changes to 90 MED under a

single timeline

REGIONAL OPIATE PIP GOALS

Improve consistency between CCOs regarding:

Opiate coverage and Prior Authorization Processes/Guidelines

Coverage of non-opiate treatment modalities

Promote information about strategies that effectively treat chronic pain, along with realistic expectations of pain management.

Increase resources to clinicians that are treating individuals with chronic pain

Improve knowledge, utilization of, and align CCO philosophies related to Medication Assisted Treatment

REGIONAL OPIATE PIP GOALS

PIP Advisory

Group

Community Education

Medication Assisted

Treatment

Policy and Provider Interface

Pain Management

Modalities

PIP GOVERNANCE STRUCTURE

CCO COLLABORATIVE: POLICY AND PROVIDER

INTERFACE WORKGROUP TIMELINE

September

•Initial Provider letter (9/21/16)

•Initial Pharmacy letter (9/21/16)

•Initial member letter(9/28/16)

October

•>90MED restriction (10/01/16) for NEW Rx

•>90MED report identifying current chronic opioid patients

•Provider Education events (each CCO to outreach)

•SW Oregon Opioid Summit (10/27/16) North Bend, Oregon

November

•Provider Taper plan notification; with list of affected members (on or before 11/01/16)

•Member taper plan notice (on or before 11/08/16) stating that their provider has been notified of need to submit taper plan

December

•Notice Of Action (NOA) to members without taper plan (12/01/16)

•Acknowledgement letters of taper receipt to providers and members

January

•Members on current opioids limited to 90MED (or less) for chronic, non-cancer pain (does not include back pain dx)

•Please note: OHA has determined that coverage of opioids for back pain and related dx will be terminated 1/1/18; tapering of opioids should occur during 2017.

•Taper plans should be submitted by 01/01/17; CCO variance may exist

STRENGTHS

United Front

Collective Reach is 111,000 CCO Members

Simplicity for Providers

Closer Link to Provider Network

Have Control over Benefits

Have Data

CHALLENGES

How to Maximize

Alignment without

Duplication

Some Elements are

very Medicaid Specific

Differing Operations

Between CCOs

CCO EFFORTS

OREGON PREVENTION

FOR STATES GRANT

Launched by the CDC in 16 states

To help states end the ongoing

prescription drug overdose epidemic

Grant cycle is 2015-2019

Delivered through Public Health

PRESCRIPTION DRUG OVERDOSE (PDO)

GRANTS

REDUCE PROBLEMATIC PRESCRIBING

PRACTICES BY:

Engage CCOs, Emergency Departments, Health Systems, and Insurers to expand uptake and use of evidence-based opioid prescribing and management guidelines

Fund five high-burden county regions to coordinate PDO prevention activities in public health, health care, and the community

Increase the number and geographic distribution of physicians certified to provide MAT

County Funding for Prevention Coordinator

Each high-burden county region wi l l hire a prevention coordinator to

reproduce the Southern Oregon Pain Guidance model: partnership with

publ ic health, health care, and the community to coordinate and al ign

regional Prescript ion Drug Overdose prevention activi t ies

Funding for 6 regions

Years 1-2 (9/1/15-8/31/17)

Coos, Curry, Josephine

Multnomah, Clackamas, Washington

Lane, Douglas

Years 3-4 (9/1/17-8/31/19)

Clatsop, Tillamook

Lincoln, Linn, Benton

Deschutes, Jefferson Crook

FUNDING

Oregon Prevention for States Grant, 2015 - 2019

StaffKatrina Hedberg, State Health Officer Lisa Millet, Principal Investigator Lisa Shields, Program Coordinator Matt Laidler, Research Analyst Josh van Otterloo, Research Analyst

Implement opioid prescribing guidelines for pain managementEngage CCOs, Emergency Departments, health systems, and insurers to

expand uptake and use of evidence-based opioid prescribing and management guidelines

Fund five high- burden county regions to coordinate PDO prevention activities in public health, health care, and the community

Increase the number and geographic distribution of physicians certified to provide MAT

Aim Primary Drivers Secondary Drivers

Enhance and maximize the Oregon Prescription Drug Monitoring Program (PDMP)

Reduce barriers and increase PDMP registration and useReduce data reporting interval Increase PDMP reporting, surveillance, and data sharingEstablish messaging to PDMP usersAuthorize PDMP to share identified data with researchers, public health,

and health systems

Increase access to naloxone Increase access to naloxone through pharmacies Increase access to naloxone through community-based programs Include co-prescribing of naloxone in model guidelines when prescribing

opioids for at-risk patients

Evaluations of policy and programsEvaluate the public health impact of removing methadone as a preferred

pain treatment drug from the state Medicaid drug formularyEvaluate the impact of 72-hour or “real time” PDMP reporting

Reduce deaths, hospitalizations, and emergency department visits related to drug overdose

Increase and improve the infrastructure of naloxone rescue

Provide Medication Assisted Treatment (MAT) for opioid use disorder

Reduce problematic prescribing practices

Increase access to and reimbursement for non-opioid treatments for chronic non-cancer pain

Provide reimbursement for non-opioid pain treatment therapiesRequire insurers to pay for non-opioid care for chronic non-cancer pain

treatmentEncourage CCOs and other prescribers to increase the use of non-opioid

pain management

Use data to target interventions to populations at highest risk

• Statewide coalition to prevent overdose and misuse of controlled medications

• Launched at the behest of the Governor and the Oregon Health Authority

• Includes medical thought leaders in Oregon connected to statewide leadership

• Facilitates statewide and local efforts through project management and technical assistance

• Successful track record of advocacy for policy change

OREGON COALITION FOR THE RESPONSIBLE

USE OF MEDS (ORCRM)

Implementation of prescribing guidelines

Increased use of the PDMP

Patient education on the dangers of prescription

drugs

Promotion of non-opioid pain management

strategies

Improved access to addictions treatment services

and naloxone

Regional summits to draft Action Plans that:

identify barriers/solutions/champions and

generate community support and momentum for

implementation

ORCRM/OHA: SHARED AREAS OF WORK

STRENGTHS

Funding support

Staff position

Backing from OHA and CDC

Clear objectives

Convener

Policy focused

CHALLENGES

Risk of duplication

Staffing in 1 of 3 geographically large counties

Other efforts are already underway-communication challenge

PDO

Alignment

Duplication

Vision

Structure

OPPORTUNITIES

-Mother Teresa

I CAN DO THINGS YOU CANNOT, YOU CAN DO THINGS I CANNOT. TOGETHER WE CAN DO GREAT THINGS.