Center of Excellence Kate Henry LCSW, CCDPD Stacey Burroughs, LPC, CAADC Behavioral Health Service Line May 15th 2017

LG COE Program DHS implemented 45 OUD Centers of Excellence (COE) LGH’s COE Care Management team will help individuals with OUD navigate the health care system by: Integrated Counselors representing our 7 geographic regions of care Facilitating initiation into OUD treatment from emergency departments & primary care physicians Helping individuals transition from inpatient levels of care as well as correctional facilities to ongoing engagement in outpatient treatment Motivating & encouraging individuals with OUD to stay engaged in both physical health and behavioral health treatments

Why Medication Assisted Recovery? Medication Assisted Treatment (MAT) is clinically and cost effective Saves lives, saves money (healthcare and societal) Only 30% of treatment programs offer MAT 3% of US physicians have DEA waiver-1% active Less than half of eligible patients have access to MAT MISSED OPPORTUNITY to use most effective medications we have to treat OUD amidst a crisis

Buprenorphine and naltrexone treatment Lancaster County COE LGH/ Penn Medicine receive the Lancaster County Primary Health COE award. Buprenorphine and naltrexone treatment Through the HealthChoices physical health network T.W. Ponessa & Associates receive the Lancaster County Community COE award. Licensed drug and alcohol provider that provides counselling, methadone, buprenorphine, or naltrexone assisted treatment

COE Team

SUSQUEHANNA COE RCM COE THE BUCK COE

LGH COE Regional Approach DOWNTOWN-Recovery Care Medicine operating out of Comprehensive Care Medicine COE start date 1/1/17 4 physicians rotating 1/week 1 LCC 1 LPN SOUTHERN- The Buck Family Practice COE start date 2/8/17 1 physician 1/week 1 CMA COLUMBIA/YORK- COE at Susquehanna Family Practice April ‘17 2 physicians rotating 1/week

COE PHYSICIAN COE LCC Patient 1 1300 Patient 1 1315 Patient 2 1315 COE LCC will need additional intake time with patients (1 hour time slot) Need to be seen every 30 days Intake template Progress note template Patient agreement Patient 2 1315 Patient 2 1330 Patient 3 1330 Patient 3 1345

Inpatient Referral Process

Outpatient Referral “AMB REF 385”

Patient Story 36 year old female 23 weeks pregnant arrives to Women's and Babies Hospital in opiate withdrawal Struggling with using opiates and cocaine throughout pregnancy SW at WBH initiated D&A consult on 2/17/17 COE LCSW met with patient at WBH completed level of care assessment for office based MAT 2/17/17 Coordination between COE physician and COE LCSW able to provide script for Subutex to patient 2/17/17 COE LCSW referred to Blueprints for D&A counseling on 2/17/17 Intake completed at Blueprints on Monday 2/20/17 Patient arrived for follow up at COE clinic on Tuesday 2/21/17 Provided UDS-negative for illicit substances, positive for Subutex Referral for prenatal care and social worker initiated to Healthy Beginnings Plus TIMELINE Referral initiated to COE 2/17 LOC assessment completed 2/17 MAT started 2/17 Treatment intake 2/20 MAT follow up appointment 2/21 HBP referral 2/21