1. Addiction Resource Center’s Experience 2005-2010 Marketing and Finding/Maximizing Revenue Sources for your Evidence Based Practices

2. November 2005 NIATx ARC receives a PI Grant from the Maine Office of Substance Abuse (OSA) ARC receives a PI Grant from the Maine Office of Substance Abuse (OSA) Objectives: Objectives: Learn Rapid Cycle Process Improvement. Learn Rapid Cycle Process Improvement. Use these tools to decrease client wait times and increase client retention in treatment. Use these tools to decrease client wait times and increase client retention in treatment. Report your data and share your experiences. Report your data and share your experiences.

3. Pt. Access is a Program’s Best Marketing Tool Long wait-times. High demand characteristic access systems, and a generalized acceptance of the term “hard to place clients” have become the status quo in public behavioral health. Long wait-times. High demand characteristic access systems, and a generalized acceptance of the term “hard to place clients” have become the status quo in public behavioral health. Immediate access to services is such an anomaly, optimizing access and promoting it will be your agencies’ best social marketing strategy. Immediate access to services is such an anomaly, optimizing access and promoting it will be your agencies’ best social marketing strategy.

4. Social Marketing: What We Did Product = MAT Product = MAT Behavior Change=Referents Expect immediate access and relevant treatment services. Behavior Change=Referents Expect immediate access and relevant treatment services. Population segments= Payers, referring systems (DOC, Judicial, Child Protective, Detox, current abusers of chemicals and other agencies). Population segments= Payers, referring systems (DOC, Judicial, Child Protective, Detox, current abusers of chemicals and other agencies).

5. Indicators of Successful Social Marketing “I always get my clients in at ARC.” “I always get my clients in at ARC.” “You guys don’t believe in impossible clients” “You guys don’t believe in impossible clients” “I knew you’d know what to do.” “I knew you’d know what to do.” “I just texted 40 of my friends.” “I just texted 40 of my friends.” “We need more chairs, parking spaces, staff…” “We need more chairs, parking spaces, staff…”

6. What Happened with Pt. Access? ARC Business Case Wait Times Are Down 77% From Baseline

7. What happened to pt. volumes? ARC Business Case IOP Volume Is Up 205% Over Baseline

8. ARC Business Case Medicaid Net is up 53% Over Baseline 3’rd Party and Private Net Is Up 50% Over Baseline

9. A Model for Change The NIATx Way: Performance/Process Improvement has provided ARC three key assets which enable larger systems change: The NIATx Way: Performance/Process Improvement has provided ARC three key assets which enable larger systems change: 1. Tools to manage change. 2. Experience being successful. (Access and Retention) 3. Institutional Credibility (budget neutrality or better)

10. November 2006 We still had an opiate problem! We still had an opiate problem! Needed to make a big change! Needed to make a big change!

11. November 2006 Implement Medication Assisted Treatment (MAT) for opiate addiction. (Service Gap) Implement Medication Assisted Treatment (MAT) for opiate addiction. (Service Gap) Not with 20 consumers, but 200. (Economies of Scale—Delivery Model) Not with 20 consumers, but 200. (Economies of Scale—Delivery Model) We needed a PLAN! We needed a PLAN!

12. Key Activities Analyze relevance of current services and what gaps exist. Pt. Need, Payor Need. Analyze relevance of current services and what gaps exist. Pt. Need, Payor Need. Analyze community demand for service. Volumes. Analyze community demand for service. Volumes. Analyze Payer Mix for new and existing services. Analyze Payer Mix for new and existing services. Complete draft of “Mission Fit” and “Business Case.” Complete draft of “Mission Fit” and “Business Case.” Present business plan to Hospital Administration/Board. Present business plan to Hospital Administration/Board.

13. Demand Analysis-Mission Fit 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

14. Pt. Volumes Analysis Obtained report from Maine Hospital Association looking at DRG’s of opiate dependence/detoxification. Obtained report from Maine Hospital Association looking at DRG’s of opiate dependence/detoxification. Sorted data by zip code, then payer source. Sorted data by zip code, then payer source.

15. Pt. Volumes Analysis-Mission Fit

16. Community Response-Business Case The 115 patients treated by other programs equate to the current volume of ARC Intensive Outpatient Programs (IOP). The 115 patients treated by other programs 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

17. Payer Priorities Cigna endorses Medication Assisted Treatment. Cigna endorses Medication Assisted Treatment. Anthem puts out report on improved outcomes with MAT. Anthem puts out report on improved outcomes with MAT. Cigna is largest payer in our service area. Bath Iron Works. “The Shipyard”. Cigna is largest payer in our service area. Bath Iron Works. “The Shipyard”. Anthem is largest 3’rd party payer in Maine. Anthem is largest 3’rd party payer in Maine. Ambulatory detox is cheaper than IP. Ambulatory detox is cheaper than IP. 2011- ARC awarded Gold Card Status by Anthem for IOP and PHP based upon low re-admission rates and lengths of stay. Auto auth. initial 14 days of IOP and PHP as a result. 2011- ARC awarded Gold Card Status by Anthem for IOP and PHP based upon low re-admission rates and lengths of stay. Auto auth. initial 14 days of IOP and PHP as a result.

18. Capacity Planning 20% attrition rate is factored for each change in level of care. Induction to Med. Management, during IOP treatment, and from IOP to Aftercare. 20% attrition rate is factored for each change in level of care. Induction to Med. Management, during IOP treatment, and from IOP to Aftercare. Based on national models for suboxone assisted treatment and three years experience at other Maine Hospital-Based programs. Based on national models for suboxone assisted treatment and three years experience at other Maine Hospital-Based programs. Capacity exists for 832 Med. Management visits in first 18 months. Capacity exists for 832 Med. Management visits in first 18 months. Based upon the data above, we expect to complete 532 Med. Management visits in first 18 months. Based upon the data above, we expect to complete 532 Med. Management visits in first 18 months. This 300 patient buffer exists to assure optimal pt. care and to avoid overwhelming resources. This 300 patient buffer exists to assure optimal pt. care and to avoid overwhelming resources.

19. Community Response-Business Case (Cost) FTE’sSalaryFringeG&A Total Cost 1.75$72,800.00$24,024.00$18,493.38$115,317.38 MD Contracts 8 hrs/wk@ $100/hr. $41,600.00 $7,945.00 $7,945.00 $49,545.60 $49,545.60 Equipment Auto BP Cuff 2 Couches Exam Table $2,420.00 $2,420.00 $1644.00 $1644.00 $804.00 $804.00 $4868.00 $4868.00 Total Cost $169,730.98

20. Community Response-Business Case (Revenue) CPT Codes? ServiceCodeDeliverableVolumeChargeGrossNet Induction 1 99205 Office Visit-New 60 min. 12023027,60012,420 Induction 2 99204 Office Visit-New 45-60 min 12021025,20011,340 Subsequent Visits 90862 Med Management 5327640,85218,218 99213 Office Visit 15 min 67956,3652,864 99214 Office Visit 25 min 671248,3753,768 ARC Treatment IOP90853 3 hrs/day 2-5 days/wk. 1536225345,600155,520 OP Group 90853 90 min. 1x/wk. 9246055,44024,948 Assessment90801 60 min. multi-axial 120100120005,400 Totals gross *.45 MeCare Contracts 521,065234,479

21. MAT Pts. as % of total new Pts 2006- 2010 (20% sustained growth)

22. Post Implementation Access/Engagement Admission Conversion rates for opioid addicted clients are up 60% over baseline. Admission Conversion rates for opioid addicted clients are up 60% over baseline. Retaining clients maximizes revenue Retaining clients maximizes revenue

23. Actual Volumes 2007-2010

24. Post Implementation Pit Falls (Keep workin’ it) Access for new bup. pts. is decreasing Access for new bup. pts. is decreasing Bottlenecks in maintenance apt. schedule begin drive access for new patients. Bottlenecks in maintenance apt. schedule begin drive access for new patients. Deviation from practice standards to accommodate rapid pace Deviation from practice standards to accommodate rapid pace Work-arounds that compromise pt. and public safety. Work-arounds that compromise pt. and public safety.

25. Business Case MAT Groups Increase induction access through use of MAT management groups Increase induction access through use of MAT management groups

26. Pt. Flow Analysis: Business Case for 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.

27. 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. Increased volumes, retention and diverse payer mix has dropped our cost 30% Increased volumes, retention and diverse payer mix has dropped our cost 30%

28. Marketing Through Leadership: Community and Professional Education Provided NIDA/CTN endorsed training curricula to 125 participants in Maine since 2009. ( Rockland, Machias, Portland, Lewiston) 8 hour training sponsored by ATTC, Brown University and CCSME. Provided NIDA/CTN endorsed training curricula to 125 participants in Maine since 2009. ( Rockland, Machias, Portland, Lewiston) 8 hour training sponsored by ATTC, Brown University and CCSME. Published Guide for the Implementation of Medication Assisted Treatment. 2011 University of Wisconsin–Madison, Center for Health Enhancement System Studies. Published Guide for the Implementation of Medication Assisted Treatment. 2011 University of Wisconsin–Madison, Center for Health Enhancement System Studies.

29. Marketing Through Leadership: Community and Professional Education Provided training for USM school of Nursing students. 2009, 2010, 2011 Provided training for USM school of Nursing students. 2009, 2010, 2011 Working actively with Maine DOC to examine barriers to inmates’ access to FDA approved medications for withdrawal and craving. Working actively with Maine DOC to examine barriers to inmates’ access to FDA approved medications for withdrawal and craving. CIT training annually. 40 hrs. training to local law enforcement. CIT training annually. 40 hrs. training to local law enforcement.

30.  Payer/Provider Partnerships Support for rapid cycle change approach. Support for rapid cycle change approach. State and other payers want to know barriers to MAT implementation. State and other payers want 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 Gold Status with Anthem, Diverse Payer Mix Gold Status with Anthem, Diverse Payer Mix