CSAT/SOTA Pre-Conference Session AATOD Conference March 29, 2015 Atlanta, GA The State of Rhode Island and Providence Plantations Opioid Treatment Program Health Home Initiative Susan A. Storti, PhD, RN, NEA-BC, CARN-AP OTP Health Home Administrative Coordinator 401.521-5759 x115 sstorti@dataofri.org

OTP Health Home Patient Enrollment Opt out rate: 11.2% (291patients have opted-out) 12/31/14 Common Reasons for Opting-Out Lack of engagement Duplication of services Feeling stable and having no needs Other insurance Take-home status Resistance to change 2

An Overview of The Process….. Development of standardized policies, procedures and general guidelines Creation of standardized forms, Releases of Information, MOUs, Community Resource Guide, etc. Revision of organizational EMRs Outreach to partners (i.e., FQHCs, CMHO Health Homes, hospitals, private practices, etc.) Develop state-wide training network Hire training coordinator Conduct training needs assessment Identification of available training opportunities Engage IT company Collaborate with BHDDH to Revise Health Home Audit Standards and Self-Assessment tool Develop a Plan of Care Conduct Mock Audits Design OTP Health Home Database

OTP Health Home Implementation Plan

System Change Document   Challenge Building A Foundation For Change Defining & Measuring Outcomes Documenting The Current System Defining A New System Implementing Change Re-evaluate & Revise Promoting Team Based Care Refocus clinic culture and environment to adhere to the new comprehensive level of care connecting patients with resources in the health care system and community. - Reliable and timely feedback on successes and failures in both function of the team and achievement of the team’s goals. - Measures include: patient outcomes, patient care processes that lead to improved patient outcomes, and values outcomes - Patient satisfaction survey and/or focus groups - Reallocation of clinical time between medication assisted treatment and Health Home services - Lack of clear understanding of roles and responsibilities of Health Home team members - Broad variation in provider capacities and organizations - Understand and define new roles within the context of the health home service delivery model - Design workflow processes and protocols, clarify roles and responsibilities of team members, and develop a communication mechanism to assess patient’s needs and deliver team-based services. - Meet with existing clinic staff to discuss: how changing positions within clinic practice can potentially affect capability of delivering care; principles of team-based health care (shared goals, clear roles, mutual trust, effective communication); and new rules and systems - Develop new workflow processes in the clinic - Update program policies and procedures to reflect delivery of OTP Health Home services - Design processes to integrate responsibilities to patients, team members, and clinic staff. - Meet with patients to discuss new OTP Health Home program and ensure understanding the goal of improving their quality of life and overall health and have patient sign consent form - Match internal and external resources to team-based care 10.01.13 -12.31.13 10.01.13 -ongoing 10.01.13 - ongoing 10.01.13-ongoing

Data Collection – OTP Health Home Database Health Home Outcomes Goal 1: Reduce Hospital Admissions and Readmissions Goal 2: Reduce Preventable Emergency Room Visits Goal 3: Reduce Skilled Nursing Facility Admissions CMS Core Measures - BMI - Ambulatory Care – Sensitive Admission - Care Transition – Transition Record Transmitted to Health Care Professional - Follow-up After Hospitalization for Mental Illness - Plan – All Cause Readmissions - Screening for Clinical Depression and Follow-up Plan - Initiation and Engagement of Alcohol and Other Drug Dependence Treatment - Controlling High Blood Pressure

Data Collection - OTP Health Home Database OTP Health Home Specific Goals - The # of OTP HH Patients Reporting Housing Stability - Improved Employment/Wages Earned - Reduce Rate of Arrest and Incarceration - Reduction of Illicit Drug Use - Reduction of Smoking Rates - Chronic Disease Management - Coordination of Care for Individuals with Chronic Conditions Medicaid Expenditure Data - Individual - Aggregate

OTP Health Home Database

Reporting

Reports

Data Collection – Patient Satisfaction Survey* Patient Experience…. *Preliminary Results

Data Collection – Patient Satisfaction Survey* Patient Satisfaction…. *Preliminary Results

Data Collection – Patient Satisfaction Survey* Patient Engagement…. *Preliminary Results

Data Collection – Staff Experience Provision of individual care Patient engagement in healthcare; for many it is the first time Sense of empowerment and self-efficacy experienced by patients Increase in activity beyond receiving medication Increase in access to a wide range of services Positive changes within their roles Increase in family involvement Enhanced care coordination with hospitals and extended care facilities Enhanced communication between clinical, medical and Health Home staff Development of collaborative and cohesive teams Excitement about potential innovative programming as a result of Health Homes

Data Collection – Patient Experience Focus Groups - recently completed Held at each clinic; 20-30 minutes with an average of 5 participants Asked to sign a Consent to Participate Audiotaped and transcribed Patients asked to briefly describe and/or respond to the following: - their experience with the Health Home program - how they learned about the Health Home program - ways they are more aware of the importance of wellness and recovery as a result of the Health Home program - how could the program be improved Preliminary results demonstrating positive impact on patient’s lives….

Highlights Successful implementation of Health Homes in 12 clinics across the state 22 Health Home Teams providing services to more than 2,600 patients Employed 59 full-time and 3 part-time staff Overlay of patient acuity model allowing Health Home teams to better address patients needs Development of collaborative relationships with United Behavioral Health, Neighborhood Health Plan of RI, CMHOs, CHCs, CTC, private practitioners, etc. Creation of an OTP Health Home Database Development of a state-wide educational and consultative network Professional development activities Clinic-based pilot programs (i.e., acupuncture, home visits, NHP teams monthly meetings with HH teams, etc.)

Lessons Learned…. Pre-arrange Memorandums of Understanding, Qualified Service Agreements, etc. with community agencies , hospitals, managed care organizations, etc. Develop standardized forms, policies, guidance, etc. Identify and/or develop reporting systems needed for outcomes, payment and patient tracking Provide education to existing and new staff including clarification of roles, team building activities, expectations, responsibilities, etc. Address EMR and re-disclosure issues – HIPPA and Confidentiality Regulations Introduce Health Homes widely to the community at large Consider a phase-in implementation strategy Prepare existing patients for upcoming changes

Opportunities for Continued Growth Continue to work toward ….. Establishing bi-directional communication and referral processes with community based primary care physicians Partnering to extend case management services offered in primary care practices Enhancing collaboration between managed care organizations, primary care physicians, and OTP Health Homes to eliminate duplication of effort Expanding screening, assessment and referral activities through strategic partnerships Developing unified strategies to drive positive patient outcomes 18