1. Addiction Resource Center’s Experience Implementing Medication Assisted Treatment for Opiate Addiction The Business Case

2. ARC MAT Services Two locations. Brunswick-140 pts. 28 hrs. of MD Time, 4 MAT Grps./ wk. Damariscotta- 90 pts. 16 hrs. of MD Time, 3 MAT Grps./wk. Two locations. Brunswick-140 pts. 28 hrs. of MD Time, 4 MAT Grps./ wk. Damariscotta- 90 pts. 16 hrs. of MD Time, 3 MAT Grps./wk. MAT Program has 4 levels and pts. are in tx. anywhere in the continuum of care. MAT Program has 4 levels and pts. are in tx. anywhere in the continuum of care. MD and Tx. Counselors Co-Facilitate MAT grps. MD and Tx. Counselors Co-Facilitate MAT grps. Billed primarily as 99212’s (10 Min. Est. Pt.- Eval. and Management) Billed primarily as 99212’s (10 Min. Est. Pt.- Eval. and Management) 10 inductions per week, 5 Detox Transfers per week. 10 inductions per week, 5 Detox Transfers per week.

3. Community Response-Mission Fit- 2006 ARC took a 4 month snap shot to trend volumes of clients seeking treatment for opiate dependence. ARC took a 4 month snap shot to trend volumes of clients seeking treatment for opiate dependence. On average 15-20 callers per month request Suboxone assisted treatment. On average 15-20 callers per month request Suboxone assisted treatment. Of 15 assessments Dx. with opioid dependence in Jan. and Feb. 2007 Of 15 assessments Dx. with opioid dependence in Jan. and Feb. 2007 Five have admitted to treatment programs and are involved in MAT. Five have admitted to treatment programs and are involved in MAT. Those not admitted did not access MAT Those not admitted did not access MAT Anticipated volume of new ARC clients per year is 100- 150 clients Anticipated volume of new ARC clients per year is 100- 150 clients

4. Community Response-Mission Fit

5. Community Response-Business Case The 115 patients treated by programs in Westbrook equate to the current volume of ARC Intensive Outpatient Programs (IOP). The 115 patients treated by programs in Westbrook equate to the current volume of ARC Intensive Outpatient Programs (IOP). Absorbing this volume equates to an additional 2,300 IOP treatment days per year for ARC. Absorbing this volume equates to an additional 2,300 IOP treatment days per year for ARC. The funding mix from this population is: The funding mix from this population is: 34% private insurance 28% Medicaid 17% Medicare 16% Unfunded

6. Post Implementation Access/Increased Admissions Access to Buprenorphine services has sustained a 20% increase in New Business. Access to Buprenorphine services has sustained a 20% increase in New Business.

7. Business Case MAT Groups Used PDCA cycles to pilot one group for 8 wks. Used PDCA cycles to pilot one group for 8 wks. Better use of multidisciplinary team approach Better use of multidisciplinary team approach Consistent application of standard of care Consistent application of standard of care Replicate intervention with two 1.5 hour groups per week. Replicate intervention with two 1.5 hour groups per week. 2 groups per week takes 12 hours per month vs. 26.5 hours per month for MD to see same case load individually. 2 groups per week takes 12 hours per month vs. 26.5 hours per month for MD to see same case load individually. 2 groups per week absorbs 112 encounters per month. 2 groups per week absorbs 112 encounters per month. Increase monthly average from 8 to 16 inductions. Increase monthly average from 8 to 16 inductions. Increase monthly average from 2 to 7 psychiatric evaluations. Increase monthly average from 2 to 7 psychiatric evaluations. Will result in increase revenues in the amount of $41,000.00 per year-NET. Will result in increase revenues in the amount of $41,000.00 per year-NET.

8. Business Case-Room to Breathe Greater self-reliance during times of social service cuts and legislative unpredictability. Greater self-reliance during times of social service cuts and legislative unpredictability. In spite of flat funding, ARC has reduced the percentage it is underwritten by state dollars from 60% in SFY 06 to 42% in SFY 09. In spite of flat funding, ARC has reduced the percentage it is underwritten by state dollars from 60% in SFY 06 to 42% in SFY 09.

9. Key System Changes Integrate suboxone services within ARC continuum of care. Integrate suboxone services within ARC continuum of care. Bring physicians on-site, single standard of care, improve communication, decrease staff load. Bring physicians on-site, single standard of care, improve communication, decrease staff load. Working with recovery community to change attitudes. Working with recovery community to change attitudes. Focus groups, presentations, well clients. Focus groups, presentations, well clients. Maximize billing as the result of State/Payer change projects. Maximize billing as the result of State/Payer change projects. Work with the Maine formulary committee to reduce stigma and assure access to buprenorphine products. Work with the Maine formulary committee to reduce stigma and assure access to buprenorphine products.

10. Diversion Concern about diversion and misuse of buprenorphine must be seen in the context of rampant opioid diversion and misuse (see S. Okie, “A flood of opiates, a rising tide of death,” N Engl J of Med, 363;21, Concern about diversion and misuse of buprenorphine must be seen in the context of rampant opioid diversion and misuse (see S. Okie, “A flood of opiates, a rising tide of death,” N Engl J of Med, 363;21,

11. Efforts to reduce impact of opiate addiction on public health and safety: Pt. Adherence Twice weekly clinical huddles to review cases and develop timely interventions. Twice weekly clinical huddles to review cases and develop timely interventions. Rigorous use of Prescription Monitoring Database. Rigorous use of Prescription Monitoring Database. Random, observed UDS may include Buprenorphine levels. Random, observed UDS may include Buprenorphine levels. Random pill counts Random pill counts

12. Efforts to reduce impact of opiate addiction on public health and safety: Pt. Adherence ARC took a snapshot of 20 pt. pill counts conducted prior to attendance at group as a baseline measure of medication adherence. The second sample was with all patients using bubble packs. The adherence rates with bubble packs was double the baseline measure. ARC took a snapshot of 20 pt. pill counts conducted prior to attendance at group as a baseline measure of medication adherence. The second sample was with all patients using bubble packs. The adherence rates with bubble packs was double the baseline measure. ARC has requested that all participating pharmacies use bubble packing for Bup. only. As of Jan. 1, 2011 all participating pharmacies use bubble packs. ARC has requested that all participating pharmacies use bubble packing for Bup. only. As of Jan. 1, 2011 all participating pharmacies use bubble packs. 25% of the ARC MAT clients have random pill counts weekly. This rotates as planned in clinical huddles to assure monthly random counts for each pt. each month. 25% of the ARC MAT clients have random pill counts weekly. This rotates as planned in clinical huddles to assure monthly random counts for each pt. each month.

13.  Payer/Provider Partnerships Support for rapid cycle change approach. Support for rapid cycle change approach. State wants to know barriers to MAT implementation. State wants to know barriers to MAT implementation. Access Access Flexibility Flexibility Advocacy and Credibility Advocacy and Credibility Operational relief Operational relief Licensing regulations Licensing regulations Incentives in Contracting are congruent with 4 AIMS Incentives in Contracting are congruent with 4 AIMS