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Strengthening MAT Processes and OUD Care in Emergency Departments

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’s 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 HMA 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 HMA 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.

HMA 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 HMA’s 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: www.stnicholashospital.org/opioid

Blog

CMS payment notice signals shift in COVID-19 policies for Medicare Advantage, Part D

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This week our In Focus section reviews the Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies issued by the Centers for Medicare & Medicaid Services (CMS) on February 1, 2022. The Advance Notice includes proposed updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2023. It also shows CMS’ updates to Part D benefit parameters. Comments are due by 6:00 PM EST on March 4, 2022. The final Rate Announcement will be published by April 4, 2022.

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Blog

Delaware Releases Medicaid Managed Care RFP

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This week our In Focus section reviews the Delaware request for proposals (RFP) for Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus), the state’s Medicaid managed care programs. The RFP was released by the Delaware Department of Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) on December 15, 2021.

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Brief & Report

Second behavioral health issue brief focuses on workforce crisis and call for immediate action

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The National Council for Mental Wellbeing (National Council) and HMA have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.

The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.

Recommendations include:

  • Adopting transformative clinical approaches and team-based care
  • Identifying short-term actions and developing long-term strategies for improvement
  • Expanding the workforce to build a more robust provider pipeline
  • Increase adoption of in-person/telehealth hybrid models

HMA and the National Council colleagues contributed to the briefs and surrounding research.

Webinar

Webinar Replay: Comparing Medicaid program delivery models on quality outcomes

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This webinar was held on February 15, 2022.

In 2020, state and federal government spending on Medicaid was $646 billion, with just over half going to Medicaid managed care programs and the rest to fee-for-service (FFS), primary care case management (PCCM), and other models. Despite the large investments, little evidence exists on differences in quality between the various models. Using the 2019 CMS Adult and Child Core Set Quality Measures, HMA normalized performance data across states to compare outcomes between managed care, FFS and PCCM. During this webinar, HMA consultants discussed the findings, which were published in an HMA white paper in November 2021.

Learning Objectives: 

  • Understand how the different Medicaid delivery models performed on quality measures from the 2019 Adult and Child Core Set.
  • Learn more about the Adult and Child Quality Measure Core Set and why the 2019 dataset provides one of the first opportunities to make valid comparisons between the Medicaid delivery models.
  • Find out how this research could be expanded upon in the future to assess the key factors that drive higher quality and better performance in population health for low-income individuals.
  • Explore the broader implications of this research for policymakers and state Medicaid officials.

HMA Speakers

Anthony Davis, Managing Director, Quality and Accreditation Services, Portland, OR
David Wedemeyer, Principal, Los Angeles, CA
Joe Moser, Principal, Indianapolis, IN
Beth Kidder, Managing Principal, Tallahassee, FL

Blog

Minnesota releases Medicaid RFP for 80 counties outside Twin Cities

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This week our In Focus section reviews the Minnesota request for proposals (RFP) for Families and Children Medical Assistance (MA), the state’s traditional Medicaid managed care program, and MinnesotaCare, the state’s Basic Health Program (BHP), in 80 counties outside of the Twin Cities seven-county region. The RFP was released by Minnesota Department of Human Services, Purchasing and Service Delivery Division on January 18, 2022. Contracts will begin January 1, 2023, covering approximately 470,000 members.

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Blog

CMS seeks new direction for Medicare Advantage and Part D on health equity and dual eligible integration

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This week, our In Focus section highlights the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage (MA) and Part D programs for contract year 2023 and how these changes may impact plan applications, bid submissions, and market dynamics for future years. The analysis and insight reflect the combined expertise of HMA and its companies including the Wakely Consulting Group and The Moran Company.

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