1. Integrating Care Through Partnerships – Missouri’s Experience
Scott Breedlove, MS, MARS, MRSS-P
Missouri Credentialing Board

2. Medication Assisted Recovery (MAR) Milestones in Missouri
May 2009: Secured General Revenue Funding for Addiction
Treatment Medications
October 2008: Advancing Recovery Grant ended / Vivitrol Change Leader Conference Calls Began
April 2008: First use of Vivitrol
November 2007: Provider Contract Amendments added Medication Services
November 2006: Awarded the Robert Wood Johnson Advancing Recovery Grant
Use of Naltrexone and Acamprosate to Treat Alcohol Dependence

3. MAR Milestones cont’d
Present: Implementing a pilot project to provide Vivitrol to incarcerated offenders nearing release and continuing treatment in the community post-release
2012: Partnered with drug manufacturer to provide Vivitrol to St. Louis Drug Court participants prior to release from city jail
October 2011: Results Published on Vivitrol Study in Michigan and Missouri Drug Courts (Journal of Substance Abuse Treatment)
September 2010: Began credentialing for MAR specialty
August 2009: Allowed Medication Services via Telehealth

4. Provider Outreach
Contract amendments: reimbursement for medications, physician time, laboratory services, etc.
Condition of certification
Initial focus of “Change Leader” conference calls with program directors
Technical assistance and training support
Increased support for treatment extension by clinical utilization review

5. Number Served and Discharged
Notes: Based on discharges in FY 2017 (as of )

6. Retention in Treatment
Significance: Research indicates that most addicted individuals need at least three
months in treatment to significantly reduce or stop their drug use and that the best
outcomes occur with longer durations of treatment
Notes: Based on discharges in FY 2017 (as of )
MAT group (n=1,711) and No MAT group (n=11,251)

7. Abstinence: No Use in Past 30 Days
Significance: Although MAT group was more likely to be using at intake, the group
had greater improvement compared to control.
Notes: Based on discharges in FY 2017 (as of )
MAT group (n=1,054) and No MAT group (n=7,236)

8. Employed in Past 30 Days
Significance: Employment changed little for both groups.
Notes: Based on discharges in FY 2017 (as of )
MAT group (n=1,662) and No MAT group (n=10,949)

9. Had No Arrests in Past 30 Days
Significance: Arrest was similar for both groups.
Notes: Based on discharges in FY 2017 (as of )
MAT group (n=1,209) and No MAT group (n=8,446)

10. Disease Management Targets:
Adult individuals with substance use disorder
At least $20,000 in Medicaid costs for 12 months
Not currently receiving services for SUD
Consumers served:
1,239 ADA consumers with ADA EOCs
710 ADA consumers with CPS EOCs
1,749 total

11. Disease Management cont’d
Providers outreach and engage individuals in services and help them manage their chronic health conditions.
Care coordination
Teach self-management of holistic healthcare
Reduce unnecessary costs in ERs and hospitals
Improve health outcomes

12. State Targeted Response to the Opioid Crisis Grants
Missouri: $10,015,898 x 2 years = $20,031,796
Service grant; at least 80% for treatment & recovery support

13. Missouri’s Plan Prevention Treatment Recovery Support
Sustainability and Community Impact
“Combined with coordinated interagency collaboration and sophisticated evaluation, the Opioid STR project will aim to transform the system of care for OUD in Missouri.”

14. STR Prevention Efforts
Implement evidence-based primary prevention school programming in two high need areas in the state
Provide professional telehealth education and case consultation on chronic pain management in primary care settings (ECHOs)
Expand implementation of Overdose Education and Naloxone Distribution (OEND)

15. STR Treatment Efforts
Primary goal: Increase access to MAR for uninsured individuals with (OUD) through provider training, direct service delivery, healthcare integration, and improved transitions of care.
Agonist and partial-agonist evidence-based medications…
Primarily buprenorphine products (Suboxone)
Too many treatment objectives to list…

16. STR Recovery Support Efforts
Provide recovery housing for 500 individuals (per year)
Use Peer Support Specialists with personal substance use experience
Activate four recovery community centers in high-need areas of the state
Provide recovery management checkups to keep individuals engaged in treatment

17. Sustainability and Community Impact
Primary goal: Increase the likelihood of sustainability through policy and practice change
MO HealthNet policy changes…
Research and evaluation of effectiveness…
Gain momentum to change reimbursement structures…
*Catalyze a culture and practice shift in the way we address opioid use… Hospitals play a LARGE role in this

18. Partners
Missouri Department of Mental Health, Division of Behavioral Health
Missouri Institute of Mental Health, University of Missouri-St. Louis
Missouri Hospital Association
Missouri Network for Opiate Reform & Recovery
NCADA
Community Partnership of the Ozarks
St. Louis County Department of Public Health
Community Academic Partnership on Addiction (CAPA), Washington University
St. Louis College of Pharmacy
Southern Illinois University-Edwardsville
Missouri Telehealth Network – ShowME ECHO (University of Missouri-Columbia, University of Missouri-Kansas City, Missouri Primary Care Association)
Regional Health Commission
Integrated Health Network
Missouri Coalition for Community Behavioral Healthcare
Behavioral Health Network of Greater St. Louis
Missouri Recovery Network
MO HealthNet
…and many, many more!

19. Scott Breedlove Representing Division of Behavioral Health Missouri Department of Mental Health