A Business Case for Quality: The Baltimore Experience ADAA Annual Management Conference October 2, 2008

The Network for the Improvement of Addiction Treatment (NIATx) National process improvement model founded in 2003 Learning collaborative  University of Wisconsin  Robert Wood Johnson Foundation  SAMHSA Resources –

NIATx Goals & Results ↓ Wait time for treatment – 34% reduction ↓ No shows – 33% reduction ↑ Admissions – 21% increase ↑ Treatment continuation – 22% increase

5 NIATx Principles 1. Understand & involve customers 2. Fix key problems 3. Pick a powerful Change Leader 4. Get ideas & encouragement from others inside & outside the organization & field 5. Use rapid-cycle testing to test effective changes

Baltimore NIATx Providers 1. Baltimore Community Resource Center 2. Damascus House 3. Echo House 4. Mountain Manor Adolescent Program 5. Sinai Hospital Addiction Recovery Program

Provider Role in NIATx Use existing resources to improve services Learn innovate strategies through networking Receive tools, case studies, research information, publications and innovative ideas from NIATx

Advancing Recovery “NIATx Plus” Focus on evidence-based methodologies  Use of medication  Continuing care  Provision of wrap-around & supportive services  Use of specific psychosocial clinical interventions  Screening & brief interventions in primary care settings Includes payer system-level (State/City) as well as provider- level changes Resources:

Baltimore AR Project - AIM Improve the quality of buprenorphine care through increased access to buprenorphine treatment and improved long-term retention of clients. Treatment will be improved by standardized clinical practices, streamlined admissions, integration of buprenorphine & counseling & case management, and coordinated continuing care.

Baltimore’s Business Case Baltimore’s buprenorphine treatment model saves money & maximizes existing resources by:  Using scarce resources to stabilize addicted patients, link patients with health insurance and various rehabilitation services, and transfer patients to the larger medical system  Opening more publicly-funded substance abuse treatment spaces for uninsured patients as stabilized patients are transferred to the medical care system

Business Case (cont.)  Sharing the cost of treating substance abuse among the publicly-funded substance abuse treatment system, and private and public third- party health care insurers  Reducing emergency room costs and costs to treat acute and chronic diseases  Improving public safety, increasing employment of formerly addicted people, and reducing homelessness and poverty

UMBC Reports on Medical Savings See: > Substance abuse, mental health and violence > Heroin addiction treatment correlates in Marylandwww.baltimorecity.gov An evaluation of whether medical savings are associated with expanding opioid maintenance therapy for heroin addiction in Baltimore City (8/28/07) Comparing pre-treatment and post-treatment Medicaid utilization in individuals who enter methadone therapy (8/15/07) Opioid exposure in Maryland hospitals (7/3/07) Review of cost-benefit and cost-effectiveness literature for methadone or buprenorphine as a treatment for opiate addiction (5/9/07) Heroin addiction treatment correlates in Maryland (3/12/07)

Baltimore AR Providers 1. Family Health Centers of Baltimore 2. Total Health Care 3. Universal Counseling Services

Change Processes - Providers  Streamline admission process  Increase # of intakes  Streamline time from intake > first buprenorphine dose  Increase 90-day retention

Change Processes - System Increase buprenorphine slots Increase continuing care physicians Create alternative treatments for patients who do not respond to usual treatment Develop standardized buprenorphine clinical guidelines Streamline approval of provider budget modification requests Start organization-wide CQI process

Next Steps Continue work on original goals & sustain accomplishments Client focus groups and surveys to better understand our customers Collaborate with criminal justice & mental health Explore non-traditional recovery-oriented models of care

Contacts Bonnie Campbell, Baltimore Substance Abuse Systems, ext. 252 Wendy Merrick, Total Health Care, Tracy Schulden, Universal Counseling Services, Catrina Scott, Mountain Manor, Robin Woodell, Baltimore Community Resource Center,