Addiction Resource Center’s Experience 2005-2010

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

2. November 2005NIATx • 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.

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. • 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 • Behavior Change=ReferentsExpect immediate access and relevant treatment services. • 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.” • “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…”

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

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

8. ARC Business CaseMedicaid 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: 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! • Needed to make a big change!

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

12. Key Activities • 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.

13. Demand Analysis-Mission Fit • 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. • Of 15 assessments Dx. with opioid dependence in Jan. and Feb. 2007 • 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 100-150 clients

14. Pt. Volumes Analysis • Obtained report from Maine Hospital Association looking at DRG’s of opiate dependence/detoxification. • 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). • 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

17. Payer Priorities • 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.

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. • 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.

19. Community Response-Business Case (Cost)

20. Community Response-Business Case (Revenue) CPT Codes?

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

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

23. Actual Volumes 2007-2010

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

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

26. Pt. Flow Analysis: Business Casefor MAT Groups • Used PDCA cycles to pilot one group for 8 wks. • Better use of multidisciplinary team approach • Consistent application of standard of care • 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 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.

27. Business Case-Room to Breathe • 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%

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. 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 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.

30.  Payer/Provider Partnerships • Support for rapid cycle change approach. • State and other payers want to know barriers to MAT implementation. • Access • Flexibility • Advocacy and Credibility • Operational relief • Licensing regulations • Incentives in Contracting are congruent with 4 AIMS • Gold Status with Anthem, Diverse Payer Mix