Transcript Medication Assisted Treatment in Maine

Addiction Resource Center’s
Experience 2005-2010
Marketing and
Finding/Maximizing Revenue
Sources for your Evidence Based
Practices
November 2005
NIATx
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ARC receives a PI Grant from the Maine Office
of Substance Abuse (OSA)
Objectives:
Learn Rapid Cycle Process Improvement.
 Use these tools to decrease client wait times and
increase client retention in treatment.
 Report your data and share your experiences.
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Pt. Access is a Program’s Best
Marketing Tool
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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.
Social Marketing: What We Did
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Product = MAT
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).
Indicators of Successful Social
Marketing
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“I always get my clients in at ARC.”
“You guys don’t believe in impossible clients”
“I knew you’d know what to do.”
“I just texted 40 of my friends.”
“We need more chairs, parking spaces, staff…”
What Happened with Pt. Access?
ARC Business Case
Wait Times Are Down 77% From Baseline
14
12
10
Wait Time OP
8
Wait Time IOP
6
Monthly Average
4
2
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What happened to pt. volumes? ARC Business Case
IOP Volume Is Up 205% Over Baseline
ARC IOP Volumes 2006-2008
512
452
427 435
427
402 398
372
384
297 305
269 250
256
128
305 297
257
275
199
128
325
391
382 388
367 367
334
443 452
287
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120
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ARC Business Case
Medicaid Net is up 53% Over Baseline 3’rd Party and Private
Net Is Up 50% Over Baseline
Net Revenue
100000
80000
Medicaid
60000
3'rd Party and
Private
40000
20000
0
Q1
2006
Q2
2006
Q3
Q4
Q1
2006 2006 2007
Q2
2007
Q3
2007
A Model for Change
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The NIATx Way: Performance/Process
Improvement has provided ARC three key
assets which enable larger systems change:
1.
2.
Tools to manage change.
Experience being successful. (Access and
Retention)
3. Institutional Credibility (budget neutrality or better)
November 2006
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We still had an opiate problem!
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Needed to make a big change!
November 2006
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Implement Medication Assisted Treatment
(MAT) for opiate addiction. (Service Gap)
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Not with 20 consumers, but 200. (Economies
of Scale—Delivery Model)
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We needed a PLAN!
Key Activities
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Analyze relevance of current services and what gaps
exist. Pt. Need, Payor Need.
Analyze community demand for service. Volumes.
Analyze Payer Mix for new and existing services.
Complete draft of “Mission Fit” and “Business
Case.”
Present business plan to Hospital
Administration/Board.
Demand Analysis-Mission Fit
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ARC took a 4 month snap shot to trend volumes of
clients seeking treatment for opiate dependence.
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Of 15 assessments Dx. with opioid dependence in Jan.
and Feb. 2007
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On average 15-20 callers per month request Suboxone
assisted treatment.
Five have admitted to treatment programs and are involved
in MAT.
Those not admitted did not access MAT
Anticipated volume of new ARC clients per year is 100150 clients
Pt. Volumes Analysis
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Obtained report from Maine Hospital
Association looking at DRG’s of opiate
dependence/detoxification.
Sorted data by zip code, then payer source.
Pt. Volumes Analysis-Mission Fit
Opioid Admits outside ARC Service Area from
w/in ARC Service Area- 2005
115
120
100
80
60
40
20
0
42
47
26
Lincoln
Sagadahoc
N.
Cumberland
Total
Community Response-Business Case
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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.
The funding mix from this population is:
34% private insurance
28% Medicaid
17% Medicare
16% Unfunded
Payer Priorities
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Cigna endorses Medication Assisted Treatment.
Anthem puts out report on improved outcomes with
MAT.
Cigna is largest payer in our service area. Bath Iron
Works. “The Shipyard”.
Anthem is largest 3’rd party payer in Maine.
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.
Capacity Planning
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20% attrition rate is factored for each change in level of
care. Induction to Med. Management, during IOP
treatment, and from IOP to Aftercare.
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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.
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.
Community Response-Business Case
(Cost)
FTE’s
Salary
1.75
$72,800.00
MD Contracts
8 hrs/wk@
$100/hr.
$41,600.00
Equipment
Auto BP Cuff
2 Couches
Exam Table
Fringe
$24,024.00
G&A
Total Cost
$18,493.38
$115,317.38
$7,945.00
$49,545.60
$2,420.00
$1644.00
$804.00
$4868.00
Total Cost
$169,730.98
Community Response-Business Case
(Revenue) CPT Codes?
Service
Code
Deliverable
Volume Charge
Gross
Net
Induction 1
99205
Office Visit-New 60 min.
120
230
27,600
12,420
Induction 2
99204
Office Visit-New 45-60 min
120
210
25,200
11,340
Subsequent Visits
90862
Med Management
532
76
40,852
18,218
99213
Office Visit 15 min
67
95
6,365
2,864
99214
Office Visit 25 min
67
124
8,375
3,768
IOP
90853
3 hrs/day 2-5 days/wk.
1536
225
345,600
155,520
OP Group
90853
90 min. 1x/wk.
924
60
55,440
24,948
Assessment
90801
60 min. multi-axial
120
100
12000
5,400
521,065
234,479
ARC Treatment
Totals gross * .45
MeCare Contracts
MAT Pts. as % of total new Pts 20062010 (20% sustained growth)
Percentage of New Clients Receiving Bup. - by Month-Bruns and Dama (# inductions and
Month
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30%
25%
20%
15%
10%
5%
0%
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Ave. Per Cent
transfers/total # admissions for the mo.)
Post Implementation
Access/Engagement
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Admission Conversion rates for opioid addicted
clients are up 60% over baseline.
Retaining clients maximizes revenue
Number attending 1'st treatent session following Opioid
MAT Implementation
40
30
34
29
20
20
5
10
0
# admitted
# attending 1'st tx.
session
Baseline
Post Implementation
Actual Volumes 2007-2010
Number of Clients
Number of Clients Prescribed Buprenorphine - by Month Bruns. And Dama Group (last mo.
census + current mo. inductions+ current mo. transfers - current mo. discharges)
150
100
50
0
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Post Implementation
Pit Falls (Keep workin’ it)
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Access for new bup. pts. is decreasing
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Bottlenecks in maintenance apt. schedule begin
drive access for new patients.
Deviation from practice standards to
accommodate rapid pace
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Work-arounds that compromise pt. and public
safety.
Business Case
MAT Groups
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Increase induction access through use of MAT
management groups
OV New OV New OV Est. Med Psych O/P Med Psych Psych Psych OV Est O/P
Pt. 60" Pt. 45" Pt. 15" Assess. 60" Mngmt 15" 15" 30" Intrvw MD Pt. 25" Med
Jan
3
8
33
0
0
0
0
2
2 40
Feb
10
10
35
0
0
0
0
2
2 40
March
8
10
56
0
0
0
0
5
0 40
April
2
5
43
0
1
0
0
3
0 15
May
1
10 102
0
0
0
2
3
5 25
June
4
8
72
0
1
0
0
6
5 20
July
3
8 101
0
0
35
0
1
0 22
Aug
Sept
Totals 31
59 442
0
2
35
2 22
14 202
Monthly
Totals
0
88
3 102
4 123
2
71
2 150
0 116
8 178
19
820
Pt. Flow Analysis: Business Case
for MAT Groups
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Used PDCA cycles to pilot one group for 8 wks.
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Better use of multidisciplinary team approach
Consistent application of standard of care
Replicate intervention with two 1.5 hour groups per
week.
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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.
Increase monthly average from 8 to 16 inductions.
Increase monthly average from 2 to 7 psychiatric evaluations.
Will result in increase revenues in the amount of $41,000.00
per year-NET.
Business Case-Room to Breathe
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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.
Increased volumes, retention and diverse payer mix has dropped our
cost 30%
ARC Revenue
$1,075,211
$1,200,000
$785,579
$786,386
$953,959
$1,000,000
$800,000
$600,000
$400,000
$200,000
$0
SFY2006
(Baseline)
SFY 2007
SFY 2008
SFY 2009
Marketing Through Leadership: Community
and Professional Education
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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.
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Published Guide for the Implementation of
Medication Assisted Treatment. 2011
University of Wisconsin–Madison, Center for
Health Enhancement System Studies.
Marketing Through Leadership: Community
and Professional Education
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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.
CIT training annually. 40 hrs. training to local
law enforcement.
 Payer/Provider Partnerships
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Support for rapid cycle change approach.
State and other payers want to know barriers to
MAT implementation.
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Access
Flexibility
Advocacy and Credibility
Operational relief
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Licensing regulations
Incentives in Contracting are congruent with 4 AIMS
Gold Status with Anthem, Diverse Payer Mix