Integrating Care Through Partnerships – Missouri’s Experience Scott Breedlove, MS, MARS, MRSS-P Missouri Credentialing Board

Medication Assisted Recovery (MAR) Milestones in Missouri May 2009: Secured General Revenue Funding for Addiction Treatment Medications October 2008: Advancing Recovery Grant ended / Vivitrol Change Leader Conference Calls Began April 2008: First use of Vivitrol November 2007: Provider Contract Amendments added Medication Services November 2006: Awarded the Robert Wood Johnson Advancing Recovery Grant Use of Naltrexone and Acamprosate to Treat Alcohol Dependence

MAR Milestones cont’d Present: Implementing a pilot project to provide Vivitrol to incarcerated offenders nearing release and continuing treatment in the community post-release 2012: Partnered with drug manufacturer to provide Vivitrol to St. Louis Drug Court participants prior to release from city jail October 2011: Results Published on Vivitrol Study in Michigan and Missouri Drug Courts (Journal of Substance Abuse Treatment) September 2010: Began credentialing for MAR specialty August 2009: Allowed Medication Services via Telehealth

Provider Outreach Contract amendments: reimbursement for medications, physician time, laboratory services, etc. Condition of certification Initial focus of “Change Leader” conference calls with program directors Technical assistance and training support Increased support for treatment extension by clinical utilization review

Number Served and Discharged Notes: Based on discharges in FY 2017 (as of 3-27-2017)

Retention in Treatment Significance: Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment Notes: Based on discharges in FY 2017 (as of 3-27-2017) MAT group (n=1,711) and No MAT group (n=11,251)

Abstinence: No Use in Past 30 Days Significance: Although MAT group was more likely to be using at intake, the group had greater improvement compared to control. Notes: Based on discharges in FY 2017 (as of 3-27-2017) MAT group (n=1,054) and No MAT group (n=7,236)

Employed in Past 30 Days Significance: Employment changed little for both groups. Notes: Based on discharges in FY 2017 (as of 3-27-2017) MAT group (n=1,662) and No MAT group (n=10,949)

Had No Arrests in Past 30 Days Significance: Arrest was similar for both groups. Notes: Based on discharges in FY 2017 (as of 3-27-2017) MAT group (n=1,209) and No MAT group (n=8,446)

Disease Management Targets: Adult individuals with substance use disorder At least $20,000 in Medicaid costs for 12 months Not currently receiving services for SUD Consumers served: 1,239 ADA consumers with ADA EOCs 710 ADA consumers with CPS EOCs 1,749 total

Disease Management cont’d Providers outreach and engage individuals in services and help them manage their chronic health conditions. Care coordination Teach self-management of holistic healthcare Reduce unnecessary costs in ERs and hospitals Improve health outcomes

State Targeted Response to the Opioid Crisis Grants Missouri: $10,015,898 x 2 years = $20,031,796 Service grant; at least 80% for treatment & recovery support

Missouri’s Plan Prevention Treatment Recovery Support Sustainability and Community Impact “Combined with coordinated interagency collaboration and sophisticated evaluation, the Opioid STR project will aim to transform the system of care for OUD in Missouri.”

STR Prevention Efforts Implement evidence-based primary prevention school programming in two high need areas in the state Provide professional telehealth education and case consultation on chronic pain management in primary care settings (ECHOs) Expand implementation of Overdose Education and Naloxone Distribution (OEND)

STR Treatment Efforts Primary goal: Increase access to MAR for uninsured individuals with (OUD) through provider training, direct service delivery, healthcare integration, and improved transitions of care. Agonist and partial-agonist evidence-based medications… Primarily buprenorphine products (Suboxone) Too many treatment objectives to list…

STR Recovery Support Efforts Provide recovery housing for 500 individuals (per year) Use Peer Support Specialists with personal substance use experience Activate four recovery community centers in high-need areas of the state Provide recovery management checkups to keep individuals engaged in treatment

Sustainability and Community Impact Primary goal: Increase the likelihood of sustainability through policy and practice change MO HealthNet policy changes… Research and evaluation of effectiveness… Gain momentum to change reimbursement structures… *Catalyze a culture and practice shift in the way we address opioid use… Hospitals play a LARGE role in this

Partners Missouri Department of Mental Health, Division of Behavioral Health Missouri Institute of Mental Health, University of Missouri-St. Louis Missouri Hospital Association Missouri Network for Opiate Reform & Recovery NCADA Community Partnership of the Ozarks St. Louis County Department of Public Health Community Academic Partnership on Addiction (CAPA), Washington University St. Louis College of Pharmacy Southern Illinois University-Edwardsville Missouri Telehealth Network – ShowME ECHO (University of Missouri-Columbia, University of Missouri-Kansas City, Missouri Primary Care Association) Regional Health Commission Integrated Health Network Missouri Coalition for Community Behavioral Healthcare Behavioral Health Network of Greater St. Louis Missouri Recovery Network MO HealthNet …and many, many more!

Scott Breedlove Representing Division of Behavioral Health Missouri Department of Mental Health Scott.breedlove@missouricb.com