2. Division of Mental Health and Addiction Indiana Addictions Hotline January 29, 2016

3. Indiana Addiction Hotline 1-800-662-4357 Contractor: Bensinger, Dupont & Associates Hotlines for addiction, problem gambling, and consumer service line Master’s Degreed Counselors answering calls 24/7 Referrals to appropriate/DMHA-approved providers Crisis call protocol Repeat caller protocol

4. Indiana Addiction Hotline FY15 Report 6717 addiction calls –4639 referrals made –1369 transferred to provider –391 Info only 26% increase in FY15 58% calls from self: 32% from family members 59% female; 41% male 11 crisis calls; 449 repeat callers Calls from all 92 counties

5. Indiana Addiction Hotline FY15 Report

7. Children thrive in safe, caring, supportive families and communities One number for all substance abuse issues Better identify the effected population Drill down on substance abuse issues Quality process and documentation of hotline information Provide analytical results to the drug task force Expansion

8. Children thrive in safe, caring, supportive families and communities Updating Infrastructure Increase number of highly skilled clinical personnel answering the hotline Personnel would be dedicated to Indiana and would develop Indiana specific training for each hotline employee

9. Children thrive in safe, caring, supportive families and communities Communications Add interactive texting and voice features Revamp existing website to make the hotline more accessible Develop ad campaign around single point of contact Social media monitoring

10. Children thrive in safe, caring, supportive families and communities An expanded hotline could be up and running as early as Q2 2016 Implementation could be all at once or in multiple phases Hotline would be flexible to be able to add or decrease staff on monthly need Timeline

21. Contact Information Dave Matusoff dmatusiff@gov.in.gov Josh Martin jmartin@gov.in.gov

23. Police and Naloxone “The Indianapolis Experience” Daniel O’Donnell, M.D. Medical Director IEMS/IFD Assistant Clinical Professor IUSOM Dept. of Emergency Medicine

24. What are we going to cover Describe the Indianapolis experienceDescribe the Indianapolis experience How we startedHow we started What were the key steps along the wayWhat were the key steps along the way Present the science/evidence that has come out of this experiencePresent the science/evidence that has come out of this experience TrainingTraining Patient outcomesPatient outcomes Give you necessary evidence to support your own programsGive you necessary evidence to support your own programs Goal: Give you the information you need to development your own successful programGoal: Give you the information you need to development your own successful program

25. What is naloxone?

26. How did this all begin? IMPD Southwest District Spring 2013IMPD Southwest District Spring 2013 A “Motley Crew”A “Motley Crew” Police (all divisions)Police (all divisions) EMSEMS Mental health/addiction centersMental health/addiction centers SchoolsSchools Criminal JusticeCriminal Justice One Mission: How can we combat the rising crime that is associated with the opiate epidemicOne Mission: How can we combat the rising crime that is associated with the opiate epidemic CRIME

27. We knew this was a problem

28. Things took a turn All parties realized that we “ cannot arrest our way out of this problem ”All parties realized that we “ cannot arrest our way out of this problem ” Had to take a fundamental approachHad to take a fundamental approach Education in the schoolsEducation in the schools Programs that go beyond current drug education/awarenessPrograms that go beyond current drug education/awareness Not your average “Don’t do drugs talk”Not your average “Don’t do drugs talk” Look at ways to decrease the number of fatalitiesLook at ways to decrease the number of fatalities Police naloxone?Police naloxone?

29. Brief history of police and naloxone Not necessarily a brand new conceptNot necessarily a brand new concept A growing number of police agencies had been successfully delivering intranasal naloxoneA growing number of police agencies had been successfully delivering intranasal naloxone Quincy, MAQuincy, MA Nassau County, NYNassau County, NY Boston, MABoston, MA All had reported a fair amount of successAll had reported a fair amount of success

30. Why we thought it was important Individual OD Bystanders recognize something is wrong Activate 911 Public Safety Response

31. The proposal was born We had the support within the districtWe had the support within the district Had to go to the City County BuildingHad to go to the City County Building Emphasize the growing epidemicEmphasize the growing epidemic Stress the safety of officer delivered naloxoneStress the safety of officer delivered naloxone Highlight the new laws regarding naloxoneHighlight the new laws regarding naloxone HB 227HB 227 Devise a way to make it economically “feasible”Devise a way to make it economically “feasible” After 20 minutes  All in for our pilot projectAfter 20 minutes  All in for our pilot project

32. The procedure All district officers trained:All district officers trained: Recognition of opioid ODRecognition of opioid OD Administration of Naloxone intranasallyAdministration of Naloxone intranasally If deemed an opioid overdose  2mg Intranasal naloxoneIf deemed an opioid overdose  2mg Intranasal naloxone Brief report completedBrief report completed 100% patients transported100% patients transported If refusal  Immediate DetentionIf refusal  Immediate Detention Concern for self harmConcern for self harm

33. The SW District pilot project Goal: Train 150 officers how to deliver a medication they may have only heard ofGoal: Train 150 officers how to deliver a medication they may have only heard of Many were not “excited” about this opportunityMany were not “excited” about this opportunity Potential perceived barriersPotential perceived barriers Viewed as “enabling”Viewed as “enabling” Goes beyond the scope of what a police officer was trained to doGoes beyond the scope of what a police officer was trained to do Will they even be receptive to the trainingWill they even be receptive to the training

34. The training Had to be quickHad to be quick Stress the importance of the problemStress the importance of the problem Answer the question “Why police”Answer the question “Why police” Chain of survivalChain of survival Time is lost in an overdoseTime is lost in an overdose Dispel potential mythsDispel potential myths Combativeness (< 3% documented)Combativeness (< 3% documented) Legal questionsLegal questions

35. attitudes What would they think about the training program?What would they think about the training program? Would they reject?Would they reject? Would it be effective?Would it be effective? Is it even seen as a problem?Is it even seen as a problem?

36. The study Performed a prospective investigation of officer attitudes towards naloxone trainingPerformed a prospective investigation of officer attitudes towards naloxone training 117 subjects117 subjects Asked to complete a standardized evaluationAsked to complete a standardized evaluation Experience with opiate overdosesExperience with opiate overdoses Perceived difficulty of naloxone trainingPerceived difficulty of naloxone training Perceived importance of naloxone trainingPerceived importance of naloxone training

37. What did we find

38. What else They were seeing it as well They were seeing it as well 93.2% on an overdose in 1 year 93.2% on an overdose in 1 year 49.6% last month 49.6% last month Training was not difficult Training was not difficult Officers should be trained Officers should be trained Experience mattered Experience mattered More overdose cases = higher competency More overdose cases = higher competency

39. conclusions Overwhelmingly positive attitudes towards naloxone training Overwhelmingly positive attitudes towards naloxone training Consistent with literature showing that police are receptive to harm reduction interventions Consistent with literature showing that police are receptive to harm reduction interventions Prior experience with opioid overdoses increased confidence Prior experience with opioid overdoses increased confidence

40. The beginning Training was complete in 10 daysTraining was complete in 10 days Officers began using immediatelyOfficers began using immediately Fire department asking about police naloxoneFire department asking about police naloxone “Racing to the scene”“Racing to the scene” 100% feedback to the officers100% feedback to the officers Time to go department wideTime to go department wide

41. continuation Began training each district within IMPDBegan training each district within IMPD Same modelSame model TrainingTraining 100% medical director review100% medical director review 100% feedback to officers100% feedback to officers Data collectionData collection

42. Data collected Basic demographicsBasic demographics Indications for administrationIndications for administration Breathing statusBreathing status Level of consciousnessLevel of consciousness Difficulty with administrationDifficulty with administration Response to administrationResponse to administration Need for Immediate DetentionNeed for Immediate Detention

44. The evidence Reviewed all police naloxone administrations from April 2014-August 2015Reviewed all police naloxone administrations from April 2014-August 2015 Reviewed all required officer administration formsReviewed all required officer administration forms Examined EMS runs and hospital outcomesExamined EMS runs and hospital outcomes N = 121 officer administrationsN = 121 officer administrations

45. Administration by time of year

46. demographics

47. Indicators and response

48. EMS and hospital outcomes Continuing to gather dataContinuing to gather data Roughly 30% receive additional naloxone by EMSRoughly 30% receive additional naloxone by EMS Almost 95% survive to the EDAlmost 95% survive to the ED 90% ultimately discharged from the ED90% ultimately discharged from the ED

49. What does this mean? Police are appropriately recognizing opiate overdoses on the streetPolice are appropriately recognizing opiate overdoses on the street Once recognized, police are safely and effectively administering naloxoneOnce recognized, police are safely and effectively administering naloxone Incidence of combativeness or need for scene escalation are rareIncidence of combativeness or need for scene escalation are rare Patients who receive naloxone from police have similar outcomes when compared to those who receive from EMSPatients who receive naloxone from police have similar outcomes when compared to those who receive from EMS

50. Where do we go from here? More data is needed to analyze impact on patient careMore data is needed to analyze impact on patient care Improved outcomes when compared to EMS?Improved outcomes when compared to EMS? Examine impact on overall mortalityExamine impact on overall mortality

51. Where we need this now Rural communitiesRural communities EMS resources are spread outEMS resources are spread out Includes ALS and BLSIncludes ALS and BLS Volunteer servicesVolunteer services Often times police are first on scene for an extended period of timeOften times police are first on scene for an extended period of time As overdose time increases  increase potential for deathAs overdose time increases  increase potential for death This issue is not just an urban problemThis issue is not just an urban problem

52. What do you do now? Multidisciplinary approach to combatting overdose deaths seams to be workingMultidisciplinary approach to combatting overdose deaths seams to be working Now that lives are being saved  Time to look into treatmentNow that lives are being saved  Time to look into treatment “Outside the box” treatment?“Outside the box” treatment? Home naloxone prescriptionsHome naloxone prescriptions Naloxone Rx from Emergency Dept.Naloxone Rx from Emergency Dept. Alternative treatment opportunitiesAlternative treatment opportunities

53. conclusions This is one stepThis is one step Would not have been possible if not for support from a MULTIDISCIPLNARY teamWould not have been possible if not for support from a MULTIDISCIPLNARY team Officers are receptive to naloxone trainingOfficers are receptive to naloxone training Officers can be trained to correctly identify opiate overdoses and actOfficers can be trained to correctly identify opiate overdoses and act Officer naloxone administration appears safe and effectiveOfficer naloxone administration appears safe and effective

54. Thank you! Questions?

56. Rural Hospital Taking Lead in Opioid & Heroin Abuse Educational Efforts & Outcomes Ann Vermilion, MBA, FACHE Admin. Director Medical Staff Services & Community Outreach Marion General Hospital January 29, 2015 Governor’s Task Force

57. Jump to Conclusion: Estimated decrease in Rx Pills > 64,900 pills in MGH ED @ 34,000 pills in MGH Inpatient discharges & Physician Practices Inpatient discharges & Physician Practices @ 100,000 pills in one year

58. MGH: Mission for Change STEP #1: Evaluate the Opioid & Other Controlled Substance (OOCS) abuse: Pull Measurable Data –MGH - Grant County - Indiana - USA STEP #2: Investigate a. What can we do within our health system? b. Who needs to be involved? STEP #3: Implement OOCS Prescribing Guidelines STEP #4: Educate - MGH employees, physicians & Community

59. Rise in patient requests in ED & Physician Offices Patient’s disposition and aggressiveness Climate: threatening, volatile & disruptive = employee and physician dissatisfaction Q: Research how other hospital system's handling? A: NO MODEL, Create our own roadmap STEP #1 CSR Abuse: Affects at MGH

60. CSR were entering the streets of our community from Rx written from our medical staff. CSR Abuse: Affects in our Community Reality Check

61. STEP #1: A Local Epidemic Grant County Drug Court Stats

62. Education and Awareness of a.Locking up household Rx b.Medication Disposal. Prior Community Tactics

63. STEP #2: Investigate “What can we do within our health system?”

64. DETERMINE MEASURABLE DATA # units of OCCS were administered hospital wide # of doses of OCCS were administered in ED % of patients prescribed OCCS # pills prescribed in ED # average pills per patient in ED # of OCCS Rx written in the Primary Care/Specialty Offices STEP #2: Self Evaluation

65. In 2012-2013 –27,000 Doses (30,000 tablets) of hydrocodone containing pain reliever –10,000 Hydromorphone injections –7,000 Fentanyl injections –11,000 Morphine injections Over 63,000 units of OCCS were administered hospital wide Over 9,600 doses of OCCS were administered in ED 2,343 (21%) patients prescribed OCCS 36,400 pills prescribed 15.5 – average pills per patient Largest single prescription – Lortab 5-500 #60 for rib fracture Second largest prescription – Norco 5-325 #40 for toothache STEP #2: Self Evaluation

66. MGH Prescribing Guidelines in the ED Not to take place of clinical judgment Provide UNIFORM guidance to emergency care providers Treat the pain until they could see the referring specialty (3 days vs. 45 days) Appropriate treatment of acute pain Appropriate treatment of chronic pain

67. ED Prescribing Guidelines (cont.) Attempt to obtain photo ID or patient photograph upon arrival Once triage complete ALL patients will receive a copy of “Pain Management in our Emergency Department” Use of INSPECT – 100% employed 80% non-employed Urine Drug Screen if indicated

68. MGH Outpatient CSR Rx Guidelines: First Do No Harm The Indiana Healthcare Providers Guide to the Safe, Effective Management of Non-Terminal Pain Recommendations

69. MGH Journey towards Education Education for area Physicians, MGH Staff & Community July 2012INSPECT – IN Board of Rx JEAN Team & Judge Spitzer Sept 2013Howard County Dep. Prosecutor “4 Doctors jailed for Opioid Prescribing Patterns” Jan. 2014INSPECT – IN Board of Rx for ED team Feb. 2014MGH Rx Guidelines Education CME for all ED Staff & Physicians, all medical Practitioners and MGH staff Service Line meetings (Medical & Surgical) MGH Primary Care Physicians Meeting MGH Board of Directors Community Discussion and Education – 25 local organizations Mar. 20145 sessions at MPD yearly officer training

70. Communication Timeline Community Roundtable – Feb. 25, 2014 –Law Enforcement Agencies –Healthcare Providers –JEAN (Joint Effort Against Narcotics)Team –Grant Co. Courts and Prosecutor’s Office –Local Pharmacies –Substance Abuse Treatment Providers –Social Services –Medical Providers –Grant County Health Department

71. Community Support a Priority Our mission to provide a safer community is supported by:

72. MGH OOCS (Opioid & Other Controlled Substances) Prescribing Guidelines Launched APRIL 1, 2014 STEP #3

73. How are we doing in Grant County: 1 year later? STEP #5: Evaluate and Awareness

75. > 64,900 pills

76. Estimated decrease in Pills > 64,900 pills in MGH ED @ 34,000 pills in MGH Inpatient DC Inpatient DC & Physician Practices @ 100,000 pills in one year

78. Monitoring Addictive Behaviors in Grant Count: Changes in Drug of Choice

79. JEAN Team Drug Task Force Statistics

80. Type of Cases 20152014201320122011 Marijuana2741343124 Cociane/Crack815172631 Pills/Rx↓ 175031 20 Methmphetamine4231241610 Heroin ↑55 ↑ 40865 Spice/Bathsalts84069 Type of Arrests 20152014201320122011 Marijuana212071716 Cociane/Crack1214161112 Pills/Rx91012513 Methmphetamine201022158 Heroin ↑32 ↑211120 Spice/Bathsalts431200

81. Total since 2013 = 53 Repeat patients = 6

82. Narcan Use – Reversal Agent for Opioid Overdose EMS started administering intra-nasal Narcan June of 2014 –EMS administered Narcan 56 times in 2014 (beginning in June) Average 8 per month –EMS 2015 Year-to-Date has administered Narcan 89 times (average 10 per month) 96 annualized 118 annualized Oct to Dec Estimated June to Dec = 56 Jan to Sept = 89 Jan to May Estimated

83. MGH Data Notes: MGH data: Preliminary cases, labs we report to ISDH. Does not deduct transmission or contracted through intravenous drug use. May not be newly diagnosed, but new to our system. Age breakout ISDH confirmed

84. Rise in Heroin – Community Task Force for Evaluation -Held July/August CME offerings - Presentation – 1 year later - Climate of Heroin abuse Continuous Education

85. September 29, 2015 Broke into Committees: 1. Data Collection 2. Heroin & Substance Abuse Care Plan 3. Education, Outreach & Communication 3. Syringe Exchange Program (Logistics) Heroin Task Force

86. No model or tool kit for our journey. We created our journey from scratch. Not an MGH problem, must engage community entities. Severely lacking in substance abuse treatment centers. (Cut off the abusers ≠ treatment) Journey never STOPS. MGH Take-away

87. Thank you Our MGH mission to provide a safer community is supported by: Ann Vermilion, MBA, FACHE Admin. Director Medical Staff Services & Community Outreach Marion General Hospital

92. ED Prescribing workgroup Interdisciplinary team –Emergency Dept. Leadership –Providers –Nurses –Pharmacists –Social Work –Pain Management –Behavioral Health –Addiction Services

93. Current State Recognition that: –ED’s continue to be a source for many patients to obtain prescription narcotic pain medicine for a variety of chronic and acute conditions. –Emergency practitioners are often challenged to find ways to manage these patients in order to: prevent undue harm address pain management in a sustainable fashion and discourage chronic pain management in the ED setting prevent opiate dependency in patients prevent nonmedical use of opiates in habituated patients who may or may not require narcotic pain medication to manage their medical condition.

94. Process Reviewed national programs Reviewed current state at each member health-system with focus on existing practices and lessons learned Developed future state

95. Process Future state: –Draft guidelines for appropriate ED narcotic prescriber practices including differentiation of acute vs chronic pain –Suggested routing of follow-up and long term management –Scripting to facilitate difficult conversations. –Patient educational materials for consistent message across the community

96. Future State ED Narcotic Prescriber Practices –Patient Assessment –Differential Assessment (acute vs chronic) –Possible indicators for chronic pain –Exclusions –Determine appropriate patient-specific treatment

97. ED Narcotic Prescriber Practices

98. Chronic Pain Patient

99. Patient Communication

101. Taking Care of your Pain in the ED: –Pain relief is important when someone is hurt or needs emergency care –If you are in pain, pain management is one of the most important things we do during your visit to the emergency department –Providing pain relief can be complex –Misuse of pain medication can cause serious health problems and even death –Referenced U.S. Controlled Substances Act of 1970 –Our main focus in the Emergency Department is to look for and treat emergency medical conditions –We use our best judgment when treating pain and follow all legal and ethical guidelines –We treat new pain with the smallest amount of medicine that will work for you. –Narcotics pain medications are not always the best choice and are not used to treat all pain related problems –If you are seen in the emergency department for chronic pain, we will work with you to make a plan to improve your care that may include staying away from medicine that can be abused or addictive

102. Patient Communication For the safety of all patients –We will not refill prescriptions for controlled substances. –We will not replace missing controlled substances (included list) –We will not provide new controlled substances prescriptions to patients with chronic pain complaints. –We will not provide controlled substances prescriptions if you have already received controlled substances prescriptions from another health care provider, Emergency or Urgent Care facility in the recent past for the same complaint. –Any new prescriptions given for a controlled substance will be limited to a small number of pills –All patients seeking relief from chronic pain will be referred to their primary care physician for follow up care –Before prescribing a narcotic or other controlled substance, we check the Indiana Scheduled Prescription Electronic Collection and Tracking Program (INSPECT) or a similar database that tracks your narcotic and other controlled substance prescriptions.

103. Patient Communication It is your responsibility to: –Give us the correct information about all the medicines you are taking and your medical history including information about an existing pain contract so we can give you treatment that is right and safe for you. –Lock up your pain medicine so it is not stolen or used by someone else. –See your doctor often enough so you do not run out of your pain medicine. –Take your medicine the way your doctor tells you to. –Do not give, sell or take pain medicine from anyone else. –Tell all healthcare providers you see that you are taking pain medicine. –Follow up with your healthcare provider or on-going pain treatment

104. Patient Communication Other ways to get help: (customize per facility) –Assistance with ongoing pain management may be obtained from your primary care provider or through a pain treatment specialist. A list of providers in your area is available upon request. –Examples: Go to xxxxxxxxx.org to find the help you need. If you feel you need help with substance abuse or addiction, please call XXXXXXXXXX Behavioral Health Department, The XXXXXXXX Behavioral Health Crisis Hotline, or Central Indiana Area of Narcotics Anonymous: XXXXXXXXXXX Behavior Health 317-xxx-0000 XXXXXXXXXXX Crisis Line 317-xxx-0000 Central Indiana Area of Narcotics Anonymous (317) 875-5459 –Following up with your personal physician or establishing one if you do not have one is vital to your well-being. These things are important and they need to be managed by your longer-term health care team and are not managed the best in the Emergency Department setting.

105. Contributors

107. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT Governor’s Taskforce Presentation January 29, 2016 John J. Wernert, MD Secretary - FSSA

108. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care. The Affordable Care Act further expands the MHPAEA’s requirements by ensuring that qualified plans offered on the Health Insurance Marketplace cover many behavioral health treatments and services.Health Insurance Marketplace

109. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT Ensures that parity applies to intermediate levels of care, such as treatment received in residential or intensive outpatient settings Clarifies the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law Clarifies that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy

110. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT MHPAEA requires many insurance plans that cover mental health or substance use disorders to offer coverage for those services that is no more restrictive than the coverage for medical or surgical conditions. This requirement applies to: Copays, coinsurance, and out-of-pocket maximums Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits that are covered The use of care management tools Coverage for out-of-network providers Criteria for medical necessity determinations MHPAEA does not require insurance plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental and/or substance use disorders.

111. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT Federal MHPAEA laws apply to: Large employer-funded plans (with more than 51 insured employees) Small employer-funded plans (with 50 or fewer employees, unless “grandfathered”) Individual market plans Medicaid managed-care programs CHIP Medicaid Alternative Benefit Plans and benchmark equivalent plans

112. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT MHPAEA requires that plans make certain information available with respect to mental health and substance use disorder benefits. Insurers typically make decisions to cover or deny coverage for specific mental health and substance use disorder services based on whether that service is “medically necessary” for the patient. These insurers must share the criteria that they use to make these medical necessity determinations with any current or potential participant, beneficiary, or contracting provider upon request. MHPAEA also provides that insurers must explain the reason for any denial of reimbursement or payment for services for mental health and substance use disorder benefits to the participant or beneficiary upon request, or as otherwise required.

113. HIP 2.0 SUD UTILIZATION: 388,147 - Unique HIP members enrolled 2/1-12/31/15 $1B total spend 150,589HIP enrollees who received Any MH Service or Pharmacy $156M / $72M pharmacy 23,583HIP enrollees with Any SUD Primary Diagnosis $7.2M services / $7.1M Pharmacy 21,679HIP enrollees received MH Service with SA Primary Diagnosis $20.5M

114. Substance Abuse Services Month With Any SUD Primary Diagnosis (Feb-Dec) % of HIP% of MH Received Any SA Service % of HIP SUD Value of All HIP SA Services Per Member Received SA Treatment Service % of HIP SUD Value of SA Tratment Service Per Member Received SA Medication % of HIP SUD Value of SA Medications 201502 10,8007.6%30.6%2,97927.6% $ 446,254 $ 150870.8% $ 20,163 $ 2321,30012.0% $ 426,091 201503 13,1117.3%31.0%3,77528.8% $ 557,149 $ 1481040.8% $ 24,699 $ 2371,47411.2% $ 532,450 201504 15,6877.0%30.2%4,43128.2% $ 617,091 $ 1391140.7% $ 31,757 $ 2791,65910.6% $ 585,334 201505 17,2626.9%30.1%4,88428.3% $ 622,181 $ 1271160.7% $ 28,090 $ 2421,74310.1% $ 594,091 201506 18,1777.0%29.1%5,22528.7% $ 656,654 $ 1261240.7% $ 31,477 $ 2541,8079.9% $ 625,177 201507 18,8437.0%28.8%5,50629.2% $ 695,495 $ 1261070.6% $ 27,516 $ 2571,90710.1% $ 667,979 201508 19,8286.9%28.7%5,80029.3% $ 698,560 $ 1201060.5% $ 24,436 $ 2312,02110.2% $ 674,124 201509 20,5346.9%28.4%5,80428.3% $ 728,638 $ 1261290.6% $ 21,294 $ 1652,13310.4% $ 707,345 201510 21,0476.9%30.2%6,12329.1% $ 795,358 $ 1301400.7% $ 34,083 $ 2432,24610.7% $ 761,276 201511 21,2066.7%30.2%7,34434.6% $ 778,963 $ 1061460.7% $ 29,080 $ 1992,30510.9% $ 749,884 201512 21,1386.3%30.5%7,62536.1% $ 839,558 $ 1101460.7% $ 23,265 $ 1592,37011.2% $ 816,293 unique23,5836.1%15.7%22,74196.4% $ 7,435,902 $ 3276462.7% $ 295,858 $ 4584,64419.7% $ 7,140,044

115. HIP SUD SERVICES 2/1/15 – 12/31/15 7.2 % had primary SUD Diagnosis 30 % of MH Dx 31 % of all HIP SUD Received Services $7,435,902 20 % received SA Medications 4644 $ 7.14 M 25 % received MH services with SA primary Dx $20.5M Pharmacy spend was $1537/member receiving meds