Linda_Frazier by chenshu

VIEWS: 1 PAGES: 18

									  Expanding Access to MAT:
  The Maine Experience

        Linda J. Frazier, RN, CHES, MA
              Treatment Manager
    Maine Office of Substance Abuse, DHHS
2009 NIATx Summit & SAAS National Conference
                   Tucson, AZ
     Maine MAT Partners

 Acadia Hospital
 Addiction Resource Center at
    MidCoast Hospital
   Aroostook Mental Health Center
   Maine General Medical Center
   The City of Portland Health Care for the
    Homeless FQHC
   The Maine Alliance for Addiction
    Recovery
   The Maine Association of Substance
    Abuse Programs
   The Maine Office of Substance Abuse
Context of Maine MAT Project
 9 OTP Clinics serving 3,518 clients receiving
  Methadone, capacity is 4,810
 5 Original MAT Pilots + 5 New Pilots (6/09)
 SOTA – State Opiate Treatment Authority
 History of using Medicaid Funding for
  treatment; State Plan includes and supports
  key components
 OSA seen as authority on Treatment Issues;
  Solid Relationships across and within state
  systems and the provider community
Key Activities
 Partnership & Shared Aims – Rapid Cycle PI
 Surveys, Chart Audit, Focus Groups –
  Provider Staff & Consumers
 Implementation of Non Discrimination
  Language in July 2007 Contracts
 Implementation of Pay for Performance
  Contracts July 2007
 Changes to TDS Data System July 2007 –
  Added questions on Evidence Based
  Practices, MAT, Access/Retention
RIDER E: PROGRAM REQUIREMENTS
(SUBSTANCE ABUSE SERVICES)


NON-DISCRIMINATION
13. Providers receiving grant funds from OSA
  will not discriminate against clients who are
  using legitimate medications to assist their
  recovery and will not have policies that allow
  them to refuse admission to treatment or to
  discharge clients from treatment based on the
  use of legitimate addiction medications.
Partnership With MAT Agency Pilot Sites

 Four original AR MAT pilots, 2 added vivitrol sites, LC
    with these and five additional sites April 2009.
   ASAM LOC written into licensing regulations 2006.
   Develop treatment processes & protocols – ID need
    for medication and access to funds, patients right to
    have MAT, address internal barriers like staff
    attitudes.
   OSA sponsored training to address staff education
    and identified barriers of prejudice and mis-
    information about MAT.
   Site visits in July 2009.
Support for MAT Systems Change
 Continued support for MAT – Coaching, Learning
    Session Participation
   State General Funds for MAT
   Medicaid Reimbursement for Suboxone without Prior
    Authorization for Addiction Treatment
   Co-sponsorship & Support for Development of ROSC
   Education & Training
   Evaluation of MAT in Addiction Treatment
   Consulting Medical Director
STOP Selling What You Have
START Selling What They Need
STOP Talking, START Doing

                    IBM.com/doing/uk
             Heathrow Airport Billboard
              October/December 2008
 Primary Barrier


People don’t know what
   they don’t know
Challenges
 Addiction is a Chronic Health Condition!
 Information & technology transfer
 Policy & Regulatory Changes – connecting the dots
 Preventing Prior Authorization and benefit limitations
  specific to Medications for Addiction Treatment
 Funding, Policy, & Professional Silos
 Using data results to support the above and make the
  business case for sustaining and expanding access
  to MAT
   Results


Four original RWJF Advancing Recovery
             MAT Pilot Sites
Percent of Admissions with any MAT

                                                           Percent of admissions with any MAT

           40%


           35%


           30%


           25%


           20%


           15%


           10%


           5%


           0%
                                                 07




                                                                                                          08
                                                               07




                                                                               07




                                                                                                                       08




                                                                                                                                     08
                       )




                                    07




                                                                                             08




                                                                                                                                                   09
                     06




                                              20




                                                                                                       20




                                                                                                                     20
                                                                             20
                                                             20




                                                                                                                                   20
                                  20




                                                                                           20




                                                                                                                                                 20
                 un




                                             un




                                                                                                      un




                                                                                                                    ep
                                                            ep




                                                                         ec




                                                                                                                                ec
                                 ar




                                                                                          ar




                                                                                                                                                ar
                -J




                             -M




                                                                                      -M




                                                                                                                                            -M
                                                                        -D




                                                                                                                              -D
                                                                                                                 l-S
                                                           S
                                           -J




                                                                                                    -J
            n




                                         pr




                                                                                                  pr
                                                       l-




                                                                                                                            ct
                                                                                                               Ju
            a




                             n




                                                                                      n




                                                                                                                                            n
                                                                    ct
                                                      Ju




                                                                                                                            O
         (J




                                         A




                                                                                                  A
                           Ja




                                                                                    Ja




                                                                                                                                          Ja
                                                                    O
       e
     in
    el
as
B




                                                                 Percent of admissions with any MAT - AR agencies

                                                                 Percent of admissions with any MAT - Non AR agencies
    Percent of non-methadone admissions with
    MAT other than methadone
                                                     Percent of non-methadone admissions with MAT other than methadone

                30%



                25%



                20%



                15%



                10%



                    5%



                    0%

                                      )                  7                07                    07                         07                    8                08                08                08                  9
                                    06               200                20                    20                      20                   200                  20                20                20                200
                                n
                              Ju                  ar               un                     p                       c                     ar                 un                ep                ec                  ar
                          -                     -M              r-J                -   Se                   -   De                    -M                r-J               l-S                -D                  -M
                    Ja
                      n                     n                Ap                 ul                       ct                       n                  Ap                Ju                O ct                n
            e
                (                         Ja                                   J                     O                          Ja                                                                         Ja
       in
    el
Bas


                                                     Percent of non-methadone admissions with MAT other than methadone - AR agencies


                                                     Percent of non-methadone admissions with MAT other than methadone - Non AR agencies
    Percent of admissions with Buprenorphine

                                                     Percent of admissions with buprenorphine

          20%

          18%

          16%

          14%

          12%

          10%

          8%

          6%

          4%

          2%

          0%
                                                07




                                                                                                          08
                                                              07




                                                                              07




                                                                                                                       08
                     )




                                                                                                                                     08
                                  07




                                                                                            08




                                                                                                                                                   09
                   06




                                               20




                                                                                                         20




                                                                                                                    20
                                                                            20
                                                            20




                                                                                                                                 20
                                20




                                                                                          20




                                                                                                                                                 20
                un




                                           un




                                                                                                     un




                                                                                                                   ep
                                                           ep




                                                                        ec




                                                                                                                                ec
                               ar




                                                                                         ar




                                                                                                                                                ar
              -J




                           -M




                                                                                     -M




                                                                                                                                            -M
                                                                       -D




                                                                                                                              -D
                                                                                                                l-S
                                                          S
                                          -J




                                                                                                    -J
          n




                                        pr




                                                                                                  pr
                                                      l-




                                                                                                                            ct
                                                                                                               Ju
          a




                           n




                                                                                     n




                                                                                                                                            n
                                                                   ct
                                                     Ju
       (J




                                                                                                                            O
                                       A




                                                                                                 A
                         Ja




                                                                                   Ja




                                                                                                                                          Ja
                                                                   O
      e
    in
  el
as
B




                                                           Percent of admissions with buprenorphine - AR agencies

                                                           Percent of admissions with buprenorphine - Non AR agencies
Reduced use at discharge: AR agencies

                                                       Reduced use at discharge: AR agencies




       60.0


       50.0


       40.0


       30.0


       20.0


       10.0


           0.0




                                                                                              08
                                                  07




                                                                                                            08
                    06




                                                                   07




                                                                                                                            08
                                    07




                                                                                 8




                                                                                                                                            09
                                                                               00




                                                                                          20




                                                                                                          20
                  20




                                                                 20




                                                                                                                          20
                                20




                                                20




                                                                                                                                          20
                                                                              2




                                                                                         un




                                                                                                       ep
                 un




                               un




                                              p




                                                              ec




                                                                                                                      ec
                                                                           ar




                                                                                                                                       ar
                                            Se




                                                                          M




                                                                                                                                   -M
                                                            -D




                                                                                                                     -D
                                                                                                     -S
                                                                                       -J
            -J




                           -J




                                                                          n-




                                                                                     pr
                                           l-




                                                                                                      l
                                                                                                   Ju
           n




                           n




                                                                                                                                   n
                                                         ct




                                                                                                                 ct
                                                                        Ja
                                         Ju




                                                                                     A
      Ja




                         Ja




                                                                                                                                 Ja
                                                        O




                                                                                                                 O
      e:
    in
  el
as
B




                                                Reduced use - non-methadone MAT                    Reduced use - no MAT
     Percent Abstinent at Discharge

                                                    Percent abstinent at discharge: AR agencies

          80


          70


          60


          50


          40


          30


          20


          10


           0




                                                                                                08
                                                   07




                                                                                                               08
                                  07




                                                                  07




                                                                                                                              08
                  06




                                                                                  8




                                                                                                                                                9
                                                                               00




                                                                                                                                           00
                                                                                              20
                                               20




                                                                                                            20
                20




                              20




                                                                 20




                                                                                                                             20
                                                                               2




                                                                                                                                            2
                                                                                            un
                                               p




                                                                                                          ep
                             un




                                                             ec




                                                                                                                         ec
                                                                            ar
               un




                                                                                                                                         ar
                                            Se




                                                                           M




                                                                                                                                     -M
                                                            -D




                                                                                                                        -D
                                                                                                       l-S
                                                                                        r-J
           -J




                         -J




                                                                          n-
                                        l-




                                                                                                     Ju
                                                                                       Ap
           n




                         n




                                                                                                                                     n
                                                        ct




                                                                                                                    ct
                                                                        Ja
                                       Ju
         Ja




                       Ja




                                                                                                                                   Ja
                                                        O




                                                                                                                    O
     e:
   lin
 se
Ba




                                                                  Percent abstinent at discharge - non-methadone MAT

                                                                  Percent abstinent at discharge - no MAT
Successful Whole Systems
Change Requires ART
 Trust & Respect
 Identified Common & Shared AIMS AND
  Mutual Accountability & Transparency
 Common Shared Language – Between
  professional fields and the recovery
  community
 Cultural Competency
 Positive Role Models, Access to
  Coaching/Recovery Support

								
To top