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Case Study

Implementation of Medications for Opioid Use Disorder (MOUD) and Medication Assisted Treatment (MAT) Programs in County Justice Systems and State Departments of Correction

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CONTEXT: THE PROBLEM

A significant percentage of individuals in American jails and prisons have a substance use disorder (SUD), with those with opioid use disorder (OUD) at especially high risk of death due to overdose upon release from incarceration.1 At the same time, overdose deaths during incarceration continue to increase.2,3

Medications for opioid use disorder (MOUD) and medication assisted treatment (MAT) programs reduce in-jail overdose death by 50% and the risk of overdose death after release by 60%. MAT programs also redress substantial racial and ethnic health disparities4. Despite these proven benefits, most incarcerated Americans do not have access to this treatment. Barriers to MAT implementation include lack of resources such as money, trained staff, and leadership; stigma toward both SUD and MOUD; and limited system ability to support adaptive change.

KEY MODEL ELEMENTS AND PROMISING RESULTS

黑料不打烊 (黑料不打烊), a national research and consulting firm focusing on publicly funded healthcare, developed a MAT implementation support model working with dozens of jails and prisons across the United States, rapidly scaling access to MOUD/MAT during incarceration. This implementation support model fosters both technical and adaptive change using a learning collaborative structure and adult-learning theory. The model also acknowledges the unique environment of each jail and prison and the challenges of providing healthcare services for a complex condition like OUD in a correctional setting. This model program is straightforward, documented, proven, and readily replicated.

The model provides participating jail and prisons teams with access to robust individualized technical assistance and coaching; peer-to-peer support and learning; training; and collaborative educational sessions. This approach recognizes that multidisciplinary teams inclusive of custody/security staff; medical personnel; behavioral health providers; and others must be convened and supported as a cohesive unit to effectively implement MOUD and MAT programs in jails, prisons, and the justice and addiction ecosystems. This ecosystem view incorporates the critical partners and pathways outside the jail and prison to support effective re-entry to the community following incarceration to support recovery. A change management and continuous quality improvement framework is foundational to the model.

In the California, Illinois and Michigan county jail team learning collaboratives, county teams receive implementation grants or stipends. Over the course of the projects these amounts have ranged from $15,000 to over $100,000 per county, which were included in the project budget from the funding source (State Opioid Response in CA and IL; state general funds in CA). Offering this 鈥渟eed money鈥� serves as an incentive to help counties engage in the learning collaborative. 黑料不打烊 has managed all aspects of these implementation grants/stipends.

Evaluation

Collection and analysis of data informs ongoing technical assistance and demonstrates the rapid scaling and positive impact of the program. In the state learning collaborative programs, deidentified data is collected from county jail teams and analyzed and compiled to reflect trends and progress in the implementation effort. Where 黑料不打烊 supports state departments of correction with MOUD and MAT implementation, 黑料不打烊 assists the prison system with identifying and using key data points to inform a continuous quality improvement process.

Funding

The MOUD and MAT county jail implementation model was initiated in 2018 in California鈥檚 MAT in Jails and Drug Courts program with demonstrated impact for expanding access to MAT in the state鈥檚 county jails. The project was funded with federal State Opioid Response dollars administered by the California Department of Health Care Services (DHCS) through September 2022. The California legislature approved state general funds to support continuation of the program from October 2022 through June 2025.

Illinois鈥� Department of Health Services Substance Use Prevention and Recovery (SUPR) sponsored implementation of that state鈥檚 learning collaborative beginning in 2021 with federal State Opioid Response Dollars. It is currently funded through June 2024 with plans to extend the learning collaborative under a new SOR funding cycle.

Michigan Department of Health and Human Services elected to implement the county jail learning collaborative in late 2023, funding it with state opioid settlement funds for continuation through November 2026.

HealthCare Access Maryland in support of the Maryland Governor鈥檚 Office of Crime Prevention, Youth, and Victim Services deployed this model for a limited three-month period with 黑料不打烊 to increase access to MOUD for incarcerated persons. The impetus for this project was the OUD Examinations and Treatment Act, which requires local jails/jurisdictions in Maryland to offer all forms of MOUD.

Michigan Department of Corrections has engaged 黑料不打烊 for years as its contracted third-party health care evaluator. 黑料不打烊 supported the DOC鈥檚 MAT implementation across multiple sites in the Michigan prison system with state general funds from 2020-2022.

黑料不打烊 supported the Alaska Department of Corrections with widescale MAT implementation under a contract through state general funds 2022-2023.

RESULTS

黑料不打烊鈥檚 successful model incorporates strategies that overcome typical barriers to MOUD/MAT implementation in corrections settings.

  • In the California learning collaborative, 黑料不打烊 has engaged 41 county jails over four years resulting in 35,000 person-months5 of individuals on MAT with counties participating representing almost 90 percent of the state鈥檚 total population.
  • In the Illinois learning collaborative, 黑料不打烊 has engaged 28 counties over three years resulting in over 720 unique individuals receiving MAT in jails with participating counties representing 64 percent of the state鈥檚 population (Cook County is excluded because of an evolved MAT program prior to inception of Illinois鈥� county learning collaborative).

Figure 1. Running total of unique individuals who have received MAR in Jail in Illinois from inception of data collection from counties through December 2023. (MAR is medication assisted recovery 鈥� the term used for medication assisted treatment in Illinois.)

Figure 2. Running total of person-months individuals who have received MAT in jail in California participating jails from program inception through August 2022

Figure 3. Running total of person-months individuals were initiated or continued on buprenorphine in California participating jails from program inception through August 2022

STRATEGY/APPROACH/INTERVENTIONS

黑料不打烊 coaches and subject matter experts (SMEs) understand and respond to the unique regulatory oversight, policies, and procedures in jail and prison operations, requiring customized approaches to introduce and expand MOUD and MAT access. Both adaptive and technical change strategies are deployed to assist jails and prisons in changing their culture and operations to treat SUD like other chronic, treatable diseases. 黑料不打烊 coaches and SMEs stay deeply involved with implementation teams to initiate and support change over time.

County jail teams in the learning collaborative and DOC site teams are assigned an 黑料不打烊 coach who understands and supports their individualized operations, resource capacity, and goals. The coach convenes an in person-team meeting and initial facility walk-through to jump start the initiative and inform ongoing team implementation goals and activities. The coach assists the team in establishing and executing goals and action steps that align with the overarching goals of the learning collaborative or DOC system.

All county teams are regularly convened for collaborative learning sessions to support their implementation plan on an ongoing basis. These sessions include fundamental information on MAT/MOUD and related components of evidencebased SUD treatment in corrections settings. Coaches identify challenges and barriers at their sites and these themes inform sessions at additional learning collaborative convenings. These identified themes are also targeted with training and hands-on coaching support (e.g., biases against MAT among providers and custody staff; custody concerns about diversion of medications; payment mechanisms for the medications; and sufficient staff capacity to offer the treatment).

Critical elements of the change effort include:

  • Improved SUD screening, assessment, treatment options, and planning to include at least two forms of MAT are core themes and goals of the learning collaborative. This messaging and expectation accelerate implementation by 鈥渟etting a bar鈥� for teams鈥� efforts while providing them with individualized assistance to overcome challenges in meeting their goals.
  • Engagement across the treatment ecosystem including advisors from state associations of counties, sheriff departments, treatment providers, and the state prison system connects the counties with emerging policy and best practices from their professional peers.
  • Multidisciplinary teams: MAT in jails and drug courts requires an integrated approach inclusive of medical and behavioral health care staff, custody/security and other justice professionals, and county providers and leadership.

This implementation model drives rapid, systemic change that would likely not be possible with individual site efforts. Scaling is accelerated by the learning collaborative model in which barriers that are identified by multiple county or DOC site teams, such as regulations for methadone access to incarcerated individuals or practice of a healthcare vendor serving multiple sites, are addressed at the levels of state policy or corporate leadership and addressed in group learning opportunities.

Lessons Learned

  • The approach needs to be tailored to each jail and county 鈥� and for departments of correction, each DOC site – who have resources, concerns, and goals unique to them. For example, a DOC reception center will have different security and programming requirements and workflows than a general detention center. A rural county with an average daily population of 15 and intermittent nursing and provider access has different resources than a suburban jail with an average daily population of 500. The technical assistance must incorporate this understanding and meet each site where they are to be effective.
  • The aim 鈥� improved SUD treatment systemwide including transitions when individuals enter the corrections system and again at release 鈥� needs to be addressed as a countywide problem that needs a comprehensive ecosystem solution. Or, in the cases of departments of corrections, system and statewide perspective and strategies are required.
  • Implementation of MAT in jails should be sponsored by the sheriff, and key partners from probation, jail custody, jail healthcare, drug courts, local county drug treatment programs, and the county administrator鈥檚 office must be included in planning and implementation. Implementation of MAT in departments of corrections must be endorsed and actively supported by the highest levels of leadership in the system and at each prison location.
  • Do not underestimate the prevalence and impact of stigma. There is an ongoing need for broader education about substance use disorders and treatment including about MAT and MOUD. All stakeholders and those impacted by opioid use disorder need to understand that substance use disorder is a chronic brain-based disease and that MAT/MOUD is effective treatment 鈥� not use of a substance that is problematic, i.e. 鈥淢AT is just replacing a drug with another drug.鈥�
  • It is important to build supportable, sustainable implementation plans. If teams are not given sufficient support and opportunity to evolve in their understanding and development of the implementation program they may fail. At the same time a sense of urgency is important because people are dying due to lack of access to needed treatment.

ABOUT 黑料不打烊

黑料不打烊 is a leading independent research and consulting firm with more than 500 consultants with expertise across all domains of publicly funded healthcare and human services. 黑料不打烊 has distinguished itself from other consulting companies with our decades-long tradition of hiring senior-level policymakers, healthcare system leaders, and other experts with hands-on experience.

1 National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

2

3

4

5 鈥淧erson-months鈥� is defined as the number of persons receiving MAT (any of the three forms of MOUD) in the reporting month, per jail, aggregated.

Case Study

Pipeline Research and Policy Recommendations to Address New Innovative Therapies

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THE CLIENT

Large national pharmaceutical manufacturer government affairs team focused on innovative therapies, including cell and gene therapies.

BACKGROUND

The client was looking for an experienced team who could assess the current pipeline of innovative therapies, examine current reimbursement policies to assess long-term compatibility with the adoption of innovative therapies and novel delivery mechanisms, and make policy recommendations to address any challenges identified through the process. 黑料不打烊, The Moran Company, and Leavitt Partners, both 黑料不打烊 subsidiaries, were selected as the team with the needed expertise and capacity to create several deliverables. These deliverables were focused on the impact of the upcoming pipeline of certain innovative therapies on different payment systems, as well as working with the client鈥檚 team to develop and refine federal and state policy recommendations to address identified challenges.

APPROACH

Our collective team developed the following qualitative and quantitative analyses:

  • Pipeline analysis of near-term innovative therapies
  • Analysis of this pipeline鈥檚 interaction with current Medicare payment systems
  • Site of services for delivery of therapies and movement across payment systems
  • Overview of FDA oversight of cell and gene therapy
  • Medicaid reimbursement and budgetary issues resulting from pipeline of therapies
  • Payment system capacity issues analysis
  • Development and refinement of policy program recommendations

Pipeline analysis. With the pipeline analysis, the team assessed the types of products and stage of development before undertaking research on characteristics of individual therapies potentially entering the market. Data on potential new products was then stratified to allow for further analysis of key characteristics, such as patient population, type of clinical treatment, acute and chronic use, sites of service, and type of effect of the treatment.

Payment system impacts. The payment analyses included a combination of quantitative and qualitative sources to project the impacts of the pipeline on Medicare and Medicaid, as well as other impacts on payment system capacity.

Policy recommendations. After completing analyses on the different areas of payment impacts resulting from the pipeline of potential therapies, the team developed more than two dozen policy recommendations that could prepare, and further improve, existing payment systems for the pipeline of expected therapies. The team also identified potential strategies to educate policymakers and advance policies. Recommendations included policies related to Medicaid, Medicare, and value-based payments.

RESULTS

The project equipped the client with a holistic understanding of future potential impacts and actions to address challenges in a detailed pipeline analysis of innovative therapies.

Case Study

Laying the Foundation for Modernizing Indiana鈥檚 Public Health System

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THE CLIENT

The Indiana Department of Health.

BACKGROUND

Even before the COVID-19 pandemic, Indiana鈥檚 public health system, administered primarily at the local level, struggled to meet the state鈥檚 public health challenges. The pandemic further exposed the system鈥檚 deficiencies, as well as the geographic, racial, ethnic, and socio-economic disparities in health outcomes that exist across the state. Recognizing that the state can and must do better, Governor Eric Holcomb appointed a 15 member Governor鈥檚 Public Health Commission (鈥渢he Commission鈥�) charged with examining the strengths and weaknesses of Indiana鈥檚 public health system and making recommendations for improvements.

The Commission held monthly meetings from September 2021 through July 2022. Its work was driven through the following six workstreams led by designated policy advisors who conducted research, engaged experts and stakeholders, and developed draft recommendations for the Commission鈥檚 consideration: 1) governance, infrastructure, and services, 2) public health funding, 3) workforce, 4) data and information integration, 5) emergency preparedness, and 6) child and adolescent health.

APPROACH

The Indiana Department of Health (IDOH) engaged 黑料不打烊 to support the Commission鈥檚 work by providing overall project management support; facilitating the work of the IDOH鈥檚 project Steering Committee; and providing staff support for Commission meetings and for each of the six workstreams. This included meeting and agenda planning, preparation of meeting minutes and summaries, public health modernization research, and development of meeting materials. 黑料不打烊 also summarized public input received though the Commission鈥檚 website and at seven 鈥淟istening Tour鈥� meetings held across the state, prepared a draft final report that included draft findings and recommendations, and collaborated with IDOH as the report was finalized.

RESULTS

The Commission鈥檚 was released on August 4, 2022. The report鈥檚 findings and recommendations will form the basis of proposed legislation that will be offered in the 2023 session of the Indiana General Assembly, including proposals that would substantially increase public health service and funding across the state.

Case Study

Reforming Colorado鈥檚 Behavioral Health System

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THE CLIENT

Colorado Department of Human Services and Behavioral Health Administration.

BACKGROUND

Like many states Colorado has historically struggled with a mixture of challenges relating to its public behavioral health system including funding issues, duplicate processes across multiple state systems, and the absence of a cohesive statewide strategy, which has proved increasingly problematic for Coloradans, especially those with complex needs. The state set out to create a system with a coherent vision and strategy that could provide high quality, equitable and accountable care to all Coloradans.

In 2019, Colorado Governor Jared Polis created a Behavioral Health Taskforce (BHTF) charged with evaluating and setting a roadmap to improve the state鈥檚 behavioral health system. The BHTF created a set of more than 200 recommendations that were both structural and programmatic in nature. The most significant structural change was a recommendation to create the Behavioral Health Administration (BHA)鈥攁 single accountable entity that would reduce fragmentation across sectors and programs and build a more strategic approach to ultimately improve behavioral health outcomes.

APPROACH

In 2021, 黑料不打烊 began an extensive partnership with the Colorado Department of Human Services to support the planning and implementation of the BHA. The initial project approach incorporated technical research, extensive stakeholder engagement, model design, and change management.

Technical research:

黑料不打烊 conducted a technical review of over 100 behavioral health programs across 14 state agencies and branches of government including each program鈥檚 funding source, program details, population served, eligibility, relevant past and current legislation, administrative rule, waiver authority, contracts, data reporting, and data infrastructure. 黑料不打烊 also conducted research into other state models of reform and conducted interviews with six states on detailed lessons learned from reform efforts.

Stakeholder engagement:

黑料不打烊 conducted three rounds of extensive statewide stakeholder engagement with more than 700 representatives across all Colorado counties. Stakeholders represented various sectors and feedback focused on: 1) understanding what stakeholders wanted from a BHA which turned into a detailed list of BHA functions; 2) gaining feedback on draft models of the BHA structure and 3) providing an update and response to the final BHA model chosen.

Model design:

黑料不打烊 drafted multiple models for the BHA and facilitated a detailed evaluation process with the Behavioral Health Reform Executive Committee comprised of the Lieutenant Governor, Executive Directors of the Colorado Departments of Health Care Policy and Financing, Human Services, and Public Health and Environment, the Commissioner of Insurance, and a Deputy County Manager. The process was designed to help the committee consider multiple design elements, weigh pros and cons, and ultimately provide a BHA design recommendation to Governor Polis.

Change management:

黑料不打烊 employed an extensive change management approach centered on communication and transparency, partnering with communications vendor Merritt+Grace to create a website, a weekly Frequently Asked Questions update, a communication ambassador program across 14 agencies, and a formal change management plan for the BHA process.

RESULTS

The Executive Committee and Governor Polis ultimately chose a model that gives the state the ability to streamline strategy, regulation, funding for high quality and equitable care, and serves as an innovative approach for the nation. Rather than consolidating or moving all behavioral health into one department, the design provides a networked approach to behavioral health and allows for the recognition of expertise in context. The model also positions the state for an expanding impact of behavioral health with future funding on climate change, economics and other factors.

Specific design elements include:

  • A cabinet-level position that elevates the criticality of behavioral health
  • A single cross-payer and cross-sector behavioral health entity tasked with collaborating across agencies and sectors to drive a comprehensive and coordinated strategic approach to behavioral health
  • Better strategy and planning to leverage all funding streams including non-Medicaid, Medicaid and commercial, education, criminal justice, etc., payments for behavioral health, and ensure the state maximizes federal dollars to support the system
  • System and services that reflect the 鈥渧oice鈥� of individuals and families

The governance for the BHA is a cabinet-level commissioner, an interagency council of cabinet members, and an advisory council with diverse representation of individuals and family members with lived experience, local government officials, providers, tribal governments, and others.

ONGOING SUPPORT

黑料不打烊 created a detailed implementation plan as a final deliverable for the project and has been subsequently providing ongoing support with implementation. 黑料不打烊 has also provided support in the drafting of authorizing legislation, hiring and onboarding of new staff, support in drafting a report for the legislature, additional stakeholder engagement, creation of an innovative access -to-care methodology, and development of interagency agreements to support collaboration with the BHA across all departments. 黑料不打烊 has also continued change management support for the BHA including multiple aspects of the daily operation of the new Administration, which necessitated changes and adjustments to previously existing state offices. It has been our privilege to support Commissioner Dr. Morgan Medlock and her leadership team as they work tirelessly to bring the vision of the BHA to Colorado.

Case Study

Multiple Clients Accepted into ACO REACH Model

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THE CLIENT

Multiple healthcare provider organizations.

BACKGROUND

In early 2022 黑料不打烊 and Wakely Consulting Group, an 黑料不打烊 Company, assisted multiple clients with their applications to participate in the new Centers for Medicare and Medicaid Services (CMS) Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model program. The purpose of this model is to improve quality of care for Medicare beneficiaries through better care coordination and increased engagement between providers and patients including those who are underserved. ACOs and participating providers are held responsible for patients鈥� total cost of care and must meet certain quality metrics. In return, they have more flexible payment arrangements, can achieve shared savings, and can provide additional services such as telehealth, home-based care, and more options for post-acute care.

APPROACH

The 黑料不打烊 and Wakely team tailored their approach based on each client鈥檚 needs. Support included helping clients determine whether to apply; the most appropriate levels of risk and capitation to take on; clinical design, governance structure, and provider recruitment; and how to approach the model鈥檚 health equity requirements. The team also provided estimates of the total number of aligned beneficiaries based on client participant provider lists along with financial projections of performance in the program. Finally, the team drafted responses to application questions and provided some clients with a mock score to help them understand strengths and weaknesses of their application.

RESULTS

The application selection process was highly competitive. Of the 271 applications received, CMS accepted just under 50 percent. Notably, nine out of the 10 organizations 黑料不打烊 and Wakely supported were accepted into the model. Since their acceptances, the team has helped many of those clients prepare for implementation on January 1, 2023.

Case Study

Texas Health Action: Strategic Plan Development

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THE CLIENT

Texas Health Action

BACKGROUND

Texas Health Action (THA) is a community informed, non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment. THA provides sexual health and behavioral health programs and services with an expertise in serving LGBTQIA+ people and those impacted by, or at risk of, HIV in Texas.

THE CHALLENGE

In 2021, THA underwent a merger that created a need for the development of a unified vision, direction, and business model to align and expand sexual health and behavioral health services. When THA began the process of creating a new strategic direction and priorities, 黑料不打烊 was engaged to support the development of a three-year strategic plan reflecting changes present in a post-COVID-19 pandemic world. The objective of the strategic planning process was to create a dynamic and actionable plan, while refining and reestablishing the organization鈥檚 Mission, Vision, Values and Beliefs.

APPROACH

Utilizing a collaborative and transparent process, 黑料不打烊 and THA used a four-component, collaborative, strategic planning approach with the following goals:

  • Project initiation to confirm shared expectations for managing the project.
  • Building a shared understanding to gain insight and develop meaningful strategic options including stakeholder input, strategic research, and data analysis, to be community and data-informed.
  • Completing an environmental scan to gain a comprehensive external context for THA鈥檚 work, including conducting an internal analysis of existing resources, strengths, and challenges.
  • Socialization by creating and communicating a shared vision of the future with all stakeholders.

THA developed a to inform staff and the public about the strategic planning process and project as well as solicit feedback from stakeholders.

RESULTS

The final report was completed and presented in November 2021, carrying the organization from 20222027. The 黑料不打烊 team worked with THA to examine and update their Beliefs, Why, and Strategic Direction while aligning them with the existing Mission and Values. Most notably, the strategic plan and direction introduced and focused on the concept of health justice and centering health equity. The full plan will be released in the early fall of 2022.

Highlights of the plan include the following:

Our Why

Healthcare must be equitable and just to work for all people. For decades, achieving positive health outcomes has been a struggle among people of color and sexual minorities. Efforts to improve health are impeded by inequitable social structures, stereotypes, and systems that are not designed to consider racial and sexual minorities, queer culture, and the social determinants of health. We acknowledge that health justice is the attainment of health equity, actualized when structural factors no longer determine health outcomes. Thus, THA exists so people can access and receive the care they deserve.

Strategic Direction

A new component included in the strategic plan was to develop a Strategic Direction. For the organization, it was established to be 鈥減ursue health justice鈥�, defined by the organization as the attainment of health equity, actualized when structural factors no longer determine health outcomes.

Our Mission

Texas Health Action is a community informed non-profit dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment with an expertise in serving LGBTQIA+ people and people impacted by HIV.

Our Values

  • Accountability for self and others
  • Cultivate Trust in all our relationships
  • Total Inclusion
  • Drive Innovation
  • Respect all
  • Pursue Excellence

Our Beliefs

  • Person-centered care integrates sexual, emotional, behavioral, and physical health
  • Access to culturally competent, patient-centered, trauma informed, quality healthcare services is a human right
  • Health justice emanates from being stigma free, having no-barriers, being inclusive, and engaging in intentional outreach & engagement
  • Health equity requires outreach and services that are inclusive of orientation, identity, sero-status, race, ethnicity, location, or situation
  • Client needs are met through innovation in care delivery and holding ourselves responsible to use resources and systems to meet client needs
  • Health education and patient empowerment is fundamental to achieving wellness
  • Treat patients and each other with respect and radical kindness
Case Study

Expanding Access to CenteringPregnancy Group Care Through Telehealth

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BACKGROUND

Poor birth outcomes, especially for communities of color, are a persistent health issue for our country. While there is no 鈥渃ure鈥� for preterm birth, the leading contributor to poor birth outcomes, group prenatal care is an evidence-based practice to reduce pre-term birth, especially for urban African American communities.

Group prenatal care provides a host of other benefits including improved breastfeeding rates, enhanced parental knowledge, and better pregnancy spacing. In addition, decreasing preterm birth provides tremendous cost savings.

The Centering Health Institute (CHI) has developed a successful model of group prenatal care called CenteringPregnancy™. CenteringPregnancy empowers patients, strengthens patientprovider relationships, and builds communities through three main components of health assessment, community building, and interactive learning delivered as a series of group visits with pregnant individuals at similar gestational age.

While more prenatal providers are offering Centering as a model of care, not every pregnant individual has access to this model. Maternity care in rural America is facing a crisis in access, and the COVID-19 pandemic required organizations to shift to care delivered through telehealth.

APPROACH

CHI engaged 黑料不打烊 to assist in responding to acute operational concerns for practices forced to abruptly implement telehealth during the onset of the COVID-19 pandemic. Dr. Margaret Kirkegaard, a family physician who provides prenatal care in clinical practice and is experienced in telehealth implementation projects, helped the CHI team respond to the needs of communities and families by expanding access to CenteringPregnancy group prenatal care through telehealth.

Based on that experience, CHI and 黑料不打烊 worked to develop a virtual model for CenteringPregnancy group prenatal care based on the existing evidence for telehealth prenatal care and the experience of current Centering providers.

RESULTS

The team developed a CenteringPregnancy Virtual Playbook with multiple provider and patient tools that help Centering sites establish a clinically appropriate cadence of telehealth and in-person visits, perform self-assessment via telehealth (e.g. home blood pressure monitoring), and manage group interactions through a telehealth platform. This work has the power to support families and providers and expand access to this critically necessary model of care.

Case Study

Strengthening MAT Processes and OUD Care in Emergency Departments

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THE CLIENT

Hospital Sisters Health System (HSHS), St. Nicholas Hospital, Sheboygan, Wisconsin

BACKGROUND

The prevalence of opioid use disorder (OUD) and the resultant harms from this disorder continue to escalate in the United States. The CDC鈥檚 National Center for Health Statistics released a report noting that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 100,000. The majority of these deaths are attributable to opioids.

THE CHALLENGE

Many individuals with OUD are seen in the emergency department (ED) due to overdose attempts, OUD related conditions like skin infections, or other medical issues where they acknowledge opioid use. However, most EDs are not prepared to initiate lifesaving, evidence-based treatment for OUD in the form of Medication Assisted Treatment (MAT).

HSHS, St. Nicholas Hospital, honoring their Franciscan tradition to provide holistic care with special attention to the most vulnerable individuals, committed to tackling the OUD issue head on.

APPROACH

With help from a team of 黑料不打烊 clinicians including a primary care physician, an addictionologist, emergency medicine clinicians, and a social worker, HSHS St. Nicholas Hospital applied for a grant from the Wisconsin Department of Health Services. The grant funds were used to strengthen their processes to initiate MAT in the ED, connect individuals with OUD with peer recovery specialists directly in the ED, and develop timely referrals for outpatient continuation of MAT.

The 黑料不打烊 team of Margaret Kirkegaard, MD, Shannon Robinson, MD, Scott Haga, PAC, Shelly Virva, LCSW, and Corey Waller, MD performed an initial assessment of ED processes for HSHS St. Nicholas Hospital, facilitated development of electronic medical record (EMR) tools for OUD order sets and referrals, and helped the hospital identify and tackle barriers to more robust MAT prescribing.

黑料不打烊 also prepared and delivered a series of OUD educational modules that were tailored to individual clinical disciplines including didactic webinars and short, educational videos designed to fit the reality of a busy ED during a global pandemic.

RESULTS

HSHS St. Nicholas Hospital, with 黑料不打烊鈥檚 continued assistance, is currently working on strengthening their OUD clinical processes and expanding MAT initiation in the ED to other HSHS hospitals and neighboring hospital systems.

LEARN MORE ABOUT THE PROJECT:

Case Study

Midwest Health Plan Earns NCQA Accreditation

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THE CLIENT

A managed care health system serving the comprehensive needs of communities and offering care delivery sites across the Midwest.

THE CHALLENGE

The client wanted to expand its reach by offering its Marketplace product in in a nearby state. T he state requires either National Committee for Quality Assurance (NCQA) accreditation or Centers for Medicare and Medicaid Services (CMS) approval to determine network adequacy and allow plans to operate in the state. The client, already established with 黑料不打烊 in other states, reached out to secure our services to help them with the accreditation process.

While NCQA accreditation is never easy, this process was complicated by several factors including a six-month timeline in order to start processing requests during the open enrollment period, as well as a complex company structure.

APPROACH

Working on-site, 黑料不打烊鈥檚 experts assembled a team from the client鈥檚 staff to assist with the accreditation process and completed a second-level review of every document as they readied the accreditation submission. After submission, 黑料不打烊 consultants helped the team answer two rounds of complex questions in response to requests from NCQA.

The biggest challenges were questions regarding the company鈥檚 organizational structure because the plan operates under different names in different states. Multiple-state accreditation is a challenge to explain to NCQA, but 黑料不打烊鈥檚 seasoned experts were able to create a very clear document and explanation that showed the organizational structure and sole ownership of the health plan. This was crucial because it was a non-typical issue and questions needed to be answered in a satisfactory manner in order to ensure accreditation and the ability to sell the plan鈥檚 product during open enrollment for 2020.

In addition, in order to ensure the accreditation was secured in time, our team was able to obtain an expedited decision from NCQA. Preparing for accreditation is usually a year-long process, but the team was able to complete the process and secure accreditation in less than six months.

RESULTS

The client was granted interim accreditation status on November 15, 2019, in time for the plan to enter the marketplace for open enrollment. Coming up just two points short of a perfect score, the plan reached its goal of opening services in the state.

In addition to helping the client reach its goal, 黑料不打烊 experts continue to work with the company to tailor and implement a Survey Ready Model to ensure they are prepared for the next accreditation cycle. 黑料不打烊 also is providing accreditation services to the client in two additional states.

The company president and chief executive officer said accreditation would not have been possible without 黑料不打烊鈥檚 expertise and guidance.

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