Ohio is considered "ground zero" for the opioid epidemic. The Buckeye State had the dubious achievement of being ranked No. 1 in the nation in deaths due to opioids in 2015. To help turn the tide, Mercy Health has been partnering with 14 addiction treatment providers in Hamilton, Butler and Clermont counties in southwest Ohio to enhance care coordination outside the walls of the hospital for individuals with substance abuse problems.
In a recent interview, Steve Feagins, M.D., vice president for medical affairs at Mercy Health-East Market and medical director for Hamilton County Public Health, described how they initially set out to study the problem.
A first look at the data about how long it took to get somebody into treatment made it appear that they needed more addiction treatment providers and more capacity. But a closer look revealed that in one of the Ohio counties, there were 52 overdoses – but they actually involved only 18 people. Many people overdosed multiple times. Of those 18, 12 were already enrolled in medication-assisted treatment therapy, and six were enrolled in more than one program. “They were already using available services, so it wasn’t an issue of care availability, it was more an issue of care coordination,” Feagins said.
Three years ago, Feagins and colleagues set out to improve communication between treatment providers and the Mercy Health system. “We endeavored to contact all the addiction providers we could find in the region to ask if they wanted to join with others in a group, and many of them did,” he recalled. “That was the beginning of what has grown into one of the strongest addiction treatment provider collaboratives in the United States,” he added.
To be part of the collaborative, providers sign a memorandum of understanding and have to meet American Society of Addiction Medicine (ASAM) standards for addiction providers. Shared tech tools are part of what brings the collaborative together, Feagins said. “They have read-only access to Mercy’s Epic electronic medical record in an appropriate way, with all the right checks and balances.”
Members of the collaborative can use an app to see real-time bed availability at addiction treatment providers. They also use a messaging tool called PerfectServe for real-time, communication. MercyHealth was already using PerfectServe in its hospital system, and because of issues Mercy ran into communicating with addiction treatment providers via phone calls and texting, they decided to use PerfectServe to coordinate care outside of MercyHealth as well. The new system allows for coordination of care as patients are being discharged from the hospital.
Mercy created a system of on-call scheduling for addiction treatment providers within the collaborative. “I was just testing it yesterday — sending messages to see how quickly I would get a response back,” Feagins said. “The average was four minutes with the on-call addiction treatment provider. This has allowed our emergency departments to begin buprenorphine treatment and connect the patient to care almost immediately.”
The collaborative has set up care coordinator positions to manage that transition. They are peer counselors working in the treatment centers who work to make sure people get from the ED to counseling and treatment. They also offer referrals from a relatively new syringe exchange through the HIPAA-compliant messaging service to addiction treatment providers. Another new aspect of the collaborative involves quick response teams, which go and look in on someone after they have overdosed and are back at home. Those teams also work to connect people to care.
Among the metrics the collaborative is tracking is how long people stay in treatment. “When we started this with the addiction treatment providers that joined our collaborative, less than 10 percent of people who entered treatment were still in treatment after 12 months. Today it is around 45 percent,” said Feagins. “That is a huge thing.”
Feagins said improving communications between hospitals and addiction treatment providers is starting to have an impact. “Things started out completely disorganized and we have moved to slightly disorganized,” he said. Although there is still more work to do, they are starting to see real progress. “We could have waited for someone else to figure this out, but people were dying. We are starting to turn it around. We have had three years of decreased overdose deaths in Clermont County, and we are now turning it around in Hamilton County as well.”
