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A Business Case for Quality: The Baltimore Experience
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  1. A Business Case for Quality: The Baltimore Experience ADAA Annual Management Conference October 2, 2008

  2. The Network for the Improvement of Addiction Treatment (NIATx) • National process improvement model founded in 2003 • Learning collaborative • University of Wisconsin • Robert Wood Johnson Foundation • SAMHSA • Resources – www.niatx.net

  3. NIATx Goals & Results ↓ Wait time for treatment – 34% reduction ↓ No shows – 33% reduction ↑ Admissions – 21% increase ↑ Treatment continuation – 22% increase

  4. 5 NIATx Principles • Understand & involve customers • Fix key problems • Pick a powerful Change Leader • Get ideas & encouragement from others inside & outside the organization & field • Use rapid-cycle testing to test effective changes

  5. Baltimore NIATx Providers • Baltimore Community Resource Center • Damascus House • Echo House • Mountain Manor Adolescent Program • Sinai Hospital Addiction Recovery Program

  6. Provider Role in NIATx • Use existing resources to improve services • Learn innovate strategies through networking • Receive tools, case studies, research information, publications and innovative ideas from NIATx

  7. Advancing Recovery • “NIATx Plus” • Focus on evidence-based methodologies • Use of medication • Continuing care • Provision of wrap-around & supportive services • Use of specific psychosocial clinical interventions • Screening & brief interventions in primary care settings • Includes payer system-level (State/City) as well as provider-level changes • Resources: www.advancingrecovery.net

  8. Baltimore AR Project - AIM • Improve the quality of buprenorphine care through increased access to buprenorphine treatment and improved long-term retention of clients. • Treatment will be improved by standardized clinical practices, streamlined admissions, integration of buprenorphine & counseling & case management, and coordinated continuing care.

  9. Baltimore’s Business Case • Baltimore’s buprenorphine treatment model saves money & maximizes existing resources by: • Using scarce resources to stabilize addicted patients, link patients with health insurance and various rehabilitation services, and transfer patients to the larger medical system • Opening more publicly-funded substance abuse treatment spaces for uninsured patients as stabilized patients are transferred to the medical care system

  10. Business Case (cont.) • Sharing the cost of treating substance abuse among the publicly-funded substance abuse treatment system, and private and public third-party health care insurers • Reducing emergency room costs and costs to treat acute and chronic diseases • Improving public safety, increasing employment of formerly addicted people, and reducing homelessness and poverty

  11. UMBC Reports on Medical Savings See: www.baltimorecity.gov > Substance abuse, mental health and violence > Heroin addiction treatment correlates in Maryland • An evaluation of whether medical savings are associated with expanding opioid maintenance therapy for heroin addiction in Baltimore City (8/28/07) • Comparing pre-treatment and post-treatment Medicaid utilization in individuals who enter methadone therapy (8/15/07) • Opioid exposure in Maryland hospitals (7/3/07) • Review of cost-benefit and cost-effectiveness literature for methadone or buprenorphine as a treatment for opiate addiction (5/9/07) • Heroin addiction treatment correlates in Maryland (3/12/07)

  12. Baltimore AR Providers • Family Health Centers of Baltimore • Total Health Care • Universal Counseling Services

  13. Change Processes - Providers • Streamline admission process • Increase # of intakes • Streamline time from intake > first buprenorphine dose • Increase 90-day retention

  14. Change Processes - System • Increase buprenorphine slots • Increase continuing care physicians • Create alternative treatments for patients who do not respond to usual treatment • Develop standardized buprenorphine clinical guidelines • Streamline approval of provider budget modification requests • Start organization-wide CQI process

  15. Next Steps • Continue work on original goals & sustain accomplishments • Client focus groups and surveys to better understand our customers • Collaborate with criminal justice & mental health • Explore non-traditional recovery-oriented models of care

  16. Contacts • Bonnie Campbell, Baltimore Substance Abuse Systems, bcampbell@bsasinc.org, 410-637-1900 ext. 252 • Wendy Merrick, Total Health Care, wmerrick@totalhealthcare.org, 410-383-7197 • Tracy Schulden, Universal Counseling Services, tschulden@universalcounseling.com, 410-752-5525 • Catrina Scott, Mountain Manor, cscott@mountainmanor.org, 410-233-1400 • Robin Woodell, Baltimore Community Resource Center, rwoodell@bcrcinc.org, 410-366-1717