1. One Step at a Time
MaineHealth’s Efforts to Respond to the Opioid Crisis Caring for Me December 12, 2018

2. MaineHealth Addresses the Opioid Epidemic
Prescribing Workgroup
Identified a common set of tools and processes to support safe prescribing practices for acute and chronic pain patients to be implemented across the MH System.
Education Workgroup
Developed recommended tools and content to educate prescribers and practice staff about:
* Opioid use disorder and best practice for treating it; *best practices for acute and chronic pain prescribing;
*Opioid use and alternatives for patients, families and the public
Treatment
Perinatal: Identified education and process standards (SnuggleME) to implement across MH system;
Identified Hub and Spoke approach to treat pregnant women and babies.
Treatment: Developed three-part treatment model relying upon behavioral health and primary care to provide MAT & behavioral health supports to patients with opioid use disorder.
Each subgroup developed a set of recommendations that was approved by the broader workgroup and brought to the System’s CMO Council and Board for final approval.
Process was really important. Bottom up decision making allowed for crucial physician buy-in
Learning collaborative supports implementation across the system.

3. Progress: Focus on Unnecessary Opioid Prescribing
# Patients with ≥100 MME* per day at MaineHealth Member-Owned Practices**
MaineHealth Epic Electronic Medical Record (2015 – 2017) 3-year rolling averages
*MME=Morphine milligram equivalents
**Data from practices at Franklin Community Health Network, Memorial Hospital and Southern Maine Health Care are not included, because these practices were not using the EPIC electronic medical record during the whole time period presented (July 2015 – December 2017).

4. Progress: Education & Communications
150 providers trained to provide Medication Assisted Treatment
Training about Opioid Use Disorder, prevention and treatment for clinical teams
Co-Hosting community discussions throughout service area
Conference attended by 130 clinicians focused on IMAT
Patient education materials

5. MaineHealth Board’s Focus on Treatment
“By Sept. 30, 2017, and with support from Maine Behavioral Health, every MaineHealth local health system will actively provide Medication Assisted Treatment in one or more adult primary care practices for patients with opioid use disorder.”
“By Sept. 30, 2018, MaineHealth members will have served 900 patients with OUD through hubs operated by Maine Behavioral Healthcare and primary care Patient Centered Medical Homes located in each local health service area.”
Transition slide Katie will present the slide and Jerry will go from here
By Sept. 30, 2019, MaineHealth members will have served 700 new patients with OUD through hubs operated by Maine Behavioral Healthcare and primary care Patient Centered Medical Homes located in each local health service area.

6. Primary care offices & integrated behavioral health clinicians:
MaineHealth’s Treatment Model: Primary Care + Specialty Substance Use Services
Hubs:
Biddeford
Springvale
Portland
Damariscotta
Augusta
Lewiston
Brunswick
Farmington
Rockland
PCMH
Intensive Hubs
Community-based behavioral health centers:
Medical Evaluation & Screening
Induction of IMAT
Intensive Outpatient Treatment
Stabilization Treatment
Specialty Treatment
Consultative Support for Intermediate& Primary Care Practices.
PCMH
Spokes:
Patient Centered Medical Homes provide MAT and supportive behavioral health services for patients in maintenance phase and with support from behavioral health.
Intermediate:
Primary care offices & integrated behavioral health clinicians:
Screening
IMAT inductions & treatment
Ongoing treatment for stabilization & maintenance phases
PCMH
Intermediate:
North Conway
Norway
Belfast
Patient
Centered Medical Homes throughout the service area will provide treatment for stable patients
This collaborative care model is based on treatment model recommended by successful Boston addiction specialists . This focuses on primary care. NAS is another population – same approach, with hubs being.
PCMH
Goal: Ensure that any patient within the MaineHealth service area has access to evidence-based treatment for Opioid Use Disorder.

7. MaineHealth Member and Affiliate Hub, Spoke, and Intermediate Locations
Farmington
Livermore Falls
Augusta
Belfast
Norway
North Conway, NH
Rockland
Lewiston
Damariscotta
Brunswick
Portland*
Sanford
Biddeford
*Portland Hub in development

8. Goal Met! Patients Served 10/1/17 – 9/30/2018
Local Service Region
Hub IOP Services
Hub
Patients
Total Served by Spokes
Total
Maine Medical Center /
Maine Medical Partners
McGeachey Hall provides IOP for dual diagnosis
131
218
349
Franklin
Evergreen BH provides IOP and therapy 41 23 64
LincolnHealth
Partnered with ARC Damariscotta & Brunswick for hub services
n/a 98
Western Maine Health Care
Partnering with Common Ground, Crooked River & Tri County for hub services
114
Pen Bay
MBH EMBARK Rockland provides hub services
149 16
165
Waldo County General
Working with MBH EMBARK Rockland 10
Southern Maine Health Care
MBH hubs in Springvale and Biddeford
130 7
137
Memorial
No IOP available
109
MBH Other
ACT Team Services
Total Patients Served Since October ‘17
Hidden costs of not doing this – tremendous. Endocarditis, NAS and other medical sequallae of addiction. And medical management of these patients.
Also discuss the fellowship here.
1,056

9. The Investment
MaineHealth has invested significant financial resources in developing these services
Training, education and treatment support for uninsured patients
Currently adopting new Opioid Health Home model across intermediates and spokes
Source of revenue to support uninsured patients
Hubs will follow suit
Maine Behavioral Healthcare’s hub to open in January
Expanded access to acute treatment in greater Portland
Increased capacity for comprehensive primary care in primary care spokes

10. The Challenges
Cultural Differences between community mental health programs and primary care
Medical model not easily aligned with community recovery model (“client” versus “patient”
Substance use services under-resourced
Transportation, transportation, transportation
Funding doesn’t support robust treatment model
42 CFR Part 2 creates significant barriers to aligned treatment
Data collection and outcomes measures
Need for better alignment between housing, employment/educational opportunities and treatment providers