New Initiatives to Combat Substance Use Disorders
In the ongoing battle against substance use disorders, innovative initiatives have been implemented to address the rising mortality rates associated with opiate use. These initiatives focus on increasing Narcan availability, educating providers on best practices, promoting Medication Assisted Treatment, and proactive outreach to at-risk individuals. Efforts include removing copays for Narcan, educational bulletins for healthcare providers, and organizing conferences for substance abuse professionals. Through collaborative efforts, these initiatives aim to improve the response to substance use disorders and enhance clinical care coordination.
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Combating Substance Use Disorders Jordan Weisman, Psy.D Behavioral Health Chief Medical Officer
New Initiatives to Combat Substance Use Disorders The Narcan Initiative The ACDE Marigold Health Partnership Intensive Clinical Care Coordination AmeriHealth Caritas Delaware 2
New Initiatives to Combat Substance Use Disorders The Narcan Initiative In April 2018, the medical management team of ACDE designed initiatives to combat the rising mortality rate associated with illicit opiate use and accidental overdose from prescribed opiates for pain management. To that end, a multipronged approach focusing on increasing the availability of Narcan to those with an opiate use disorder or prescribed opiates for pain, education for providers regarding the ASAM Clinical Practice Guidelines for Opiate Use Disorder, increasing the availability of Medication Assisted Treatment (MAT), and aggressive outreach to those at risk of overdose was enacted. AmeriHealth Caritas Delaware 3
New Initiatives to Combat Substance Use Disorders The Narcan Initiative This initiative includes: In June 2018, ACDE successfully petitioned the State of Delaware to remove the $3 copay for Narcan; In January 2019, a Provider Bulletin was sent to all BH / SUD providers encouraging the prescription for Narcan to all members with an Opiate Use Disorder diagnosis, or those prescribed an opiate for pain management. This bulletin described the process for obtaining Narcan, as well as education for family members; In April 2019, ACDE presented the 2019 Assessment and Treatment of Substance Abuse Disorders Conference which provided free Continuing Education Units for physicians, nurses, psychologists, social workers, and addictions professionals. This conference was attended by over 300 professionals and government associates; All pharmacy profiles for members with two Narcan fills or greater, or administration of Narcan are reviewed by the Pharmacy Director for clinical concerns. This is approximately 20-30 members per month. The Pharmacy Director completes a brief synopsis of the medication profile for those identified members. The Pharmacy Director forwards the information to the Behavioral Health CMO for review. After any additional input, the Behavioral Health CMO sends the profiles and recommendations for follow up to Rapid Response and Clinical Care Coordination for the necessary outreach calls. AmeriHealth Caritas Delaware 4
New Initiatives to Combat Substance Use Disorders Narcan RX 350 17 300 250 200 18 14 20 310 2 150 6 5 3 5 30 100 5 5 6 180 33 21 14 21 10 162 19 20 7 153 148 16 25 18 15 124 11 121114 118 24 18 50 92 92 90 89 79 77 76 74 73 73 70 69 29 4 61 12 58 57 4 56 55 48 5 46 8 8 7 3 7 30 26 24 21 19 19 18 18 18 17 7.6 0 0 RX Via Dr. Rattay AmeriHealth Caritas Delaware 5
New Initiatives to Combat Substance Use Disorders The ACDE Marigold Health Partnership In April 2021, AmeriHealth Caritas Delaware entered into an agreement with Marigold Health to provide additional outreach and support to our members battling substance use disorders (SUD). Marigold Health is a live and virtual peer support program that empowers members to progress in recovery at any time, from anywhere. Services are delivered in person, over phone, video, and text (app/SMS). Members can engage in a modality most convenient to them. The core components of the ACDE Marigold Health program include: 1-1 coaching & holistic wellness planning from a Delaware Certified Peer Specialist (CPS); Four Delaware CPS are full time employees of Marigold Health, allowing contact in New Castle, Kent, and Sussex counties 24/7 access to anonymous support groups in a larger recovery community that includes patients and peers across all Marigold sites nationally with over 2000 members; and Natural Language Processing (NLP) technology flags needs as they are expressed in messages, generating alerts to facilitate care coordination. AmeriHealth Caritas Delaware 6
New Initiatives to Combat Substance Use Disorders The ACDE Marigold Health Partnership The Marigold Health online application can be downloaded in the Apple App Store and Android Play Store. Users are asked to create an account and anonymous user name, which allows for candid discussion but prevents the establishment of relationships outside the application. Furthermore, in addition to the Natural Language Processing technology used to flag statements of concern, online exchanges are monitored by supervised Certified Peer Specialists who receive regular supervision from a licensed clinician. The Marigold Health application has been thoroughly reviewed for HIPAA compliance. In addition to the benefits of participating in readily available peer support, Marigold Health has regular meetings with AmeriHealth Caritas Clinical Care Coordinators and LTSS Case Managers to discuss issues of concern, assist with outreach and contact, and encourage treatment compliance. Furthermore, Marigold Health offers behavioral health / substance abuse providers the ability to receive data on their referred members, to include email alerts pertaining to flagged statements (ex: My medication makes me sleepy, I am going to stop it or I need help with housing ). [Applicable release forms must be signed by the member.] AmeriHealth Caritas Delaware 7
New Initiatives to Combat Substance Use Disorders The ACDE Marigold Health Partnership As of Sept, 2021, over 300 ACDE members have interacted with a Marigold Certified Peer Specialist via the app or SMS. Over 3000 messages were sent in the past 60 days from the ACDE members. Marigold Health has completed over 690 calls with ACDE members. Demand has necessitated the creation of nine dedicated specialty groups for: Parents in Recovery, Keeping Freedom (for members in recovery with experience in the justice system), Mental Health and Addiction (focusing on co-occurring support); and MAT Chat (hosted and monitored by a Board Certified Physician and Certified Peer Specialist that steer participants back to their treating provider). Healthy Relationships Women s Group Loss and Addiction Resources Group Marigold Shares On September 23, 2021, ACDE and Marigold Health presented our collaboration and initial findings at the Medicaid Health Plans of America Conference in Washington, D.C. AmeriHealth Caritas Delaware 8
New Initiatives to Combat Substance Use Disorders The ACDE Marigold Health Partnership AmeriHealth Caritas Delaware 9
New Initiatives to Combat Substance Use Disorders Intensive Clinical Care Coordination Embedded staff at Rockford Center, Dover Behavioral Health, Meadow Wood Hospital, and Sun Behavioral; Virtual and Face to Face visits by Resource Coordinators and Clinical Care Coordinators; Specialized teams for members battling SUD, pregnant women, those involved with the justice system, and those with chronic medical conditions; and Ongoing care coordination that spans levels of care, and collaborates with physical and behavioral health / SUD providers. AmeriHealth Caritas Delaware 10
