Toolkit Released for Employers to Address Opioid Misuse and Opioid Use Disorder in the Workplace

Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery

Employers play an important role in influencing the health and safety of their employees, their families, and the communities they live in. Taking strides to support employees and their families can have a measurable positive impact not only in their lives, but in the success of a business. With the nation in the midst of an opioid crisis, the employer’s role as an agent of change is more important than ever. In the workplace, opioid-related issues are impacting businesses and the safety and well-being of their employees.

Outdated workplace policies and culture can be contributing to stigma and leave current and potential employees fearful of repercussions associated with seeking help. Addressing opioid-related issues in the workplace is new to many employers and finding solutions can be confusing and complex as most employers do not have expertise in this domain. Adding to employer challenges, a behavioral health care system that does not consistently provide high-quality, evidence-based care can exacerbate, rather than alleviate, the problems. In some cases, poor quality addiction treatment can lead to worse outcomes for patients.

As part of the Kentuckiana Health Collaborative’s (KHC) ongoing focus on high value behavioral healthcare and second year of partnership with the Kentucky Opioid Response Effort (KORE), the KHC has developed a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD). Using this toolkit, employers can expect to learn:

  • What the basics of opioid use and addiction are and how it affects the workplace
  • How to use data to understand the status of opioid use, misuse, and OUD among employees and dependents with healthcare coverage
  • What benefit strategies direct employees to evidence-based care for prevention, treatment, and recovery from opioid misuse and OUD
  • How to design workplace policies that protect and support employees and employers and improve workplace culture
  • What legal issues may pertain to addressing substance use in the workplace

The toolkit can be viewed here. Today, approximately 80 employers and other healthcare stakeholders convened to mark the release on this toolkit and discuss the recommendations made and existing goals and challenges that remain. For employers who were unable to join us at this event, the KHC will be offering a complementary webinar on May 15, 2019 from 12 pm to 1 pm. Stay in touch with the KHC for reflections and updates this ongoing initiative.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

We packed a ton of great content into a small amount of time, so we didn’t get to all of the questions submitted by participants on our web application.

Let’s remedy that.

The KHC has spent the last couple of weeks following up with speakers on these questions, and we’ve compiled them below. Note that some answers have been edited for space.


“For Mental Health, Let’s Act Before Stage 4”

Paul Gionfriddo | President and CEO | Mental Health America

In other countries they have programs to integrate mental health treatment and the community. What do you think the barriers are to doing that in the US?

We tend to favor the system with which we have the most experience. In the United States, that has been characterized by separate and unequal care, first in state hospitals, now in jails and prisons, for people with mental illnesses. Our challenge is to change the way we think about mental health conditions, because thinking about them as public safety concerns (i.e. dangerous to self or others) makes it hard to fully integrate the services and treatment for them into the community.

How do we get people to seek treatment without the fear of retribution or ostracization?

First, we should screen everyone for mental health conditions as ubiquitously as we screen for blood pressure in adults, and hearing and vision in children. That’s what’s recommended for everyone over the age of 11 by the U.S. Preventive Services Task Force, but it’s just not done. By screening, we normalize mental health and mental health care and make this a part of overall health and health care. And then we can treat right away when it’s warranted, instead of letting up to ten years pass between the emergence of symptoms and getting the right diagnosis and treatment.


“Roadmap for Employers to Achieve High Value Behavioral Healthcare”

Mike Thompson | President and CEO | National Alliance of Healthcare Purchaser Coalitions

The National Alliance recommends ensuring health plans have network adequacy for behavioral health services. How is this best measured?

Most health plans have directory of network psychiatrists. However, few know whether those psychiatrists are taking new patients – ask them, by specialty if possible (eg child psychiatrists), what percentage of network behavioral health specialists are taking new patients.

Most health plans measure access to network providers by driving distance but few know or monitor how long it takes to schedule an appointment – ask them, by specialty if possible, what is the average wait time for an appointment for a new patient?

Most health plans will indicate that it is difficult to get behavioral health specialists to join networks but few have taken a positive step toward change this trend – ask them, by specialty if possible, how do network reimbursement rates for behavioral health specialists compare to non-behavioral health specialists? How do network reimbursement rates compare to out-of-network charges for behavioral health specialists? What is you plan to improve network participation rates of behavioral health specialist?

What do you think has shifted within our world society to now have this be recognized as a top 5 issues when it’s always been perceived as a personal and economic issue?

Three things that have contributed to Mental Health rising to be among the top issues facing companies and organizations globally:

1) growing recognition of the huge and disproportionate economic impact of the issue to companies and societies, well beyond the costs of treatment (e.g. impact on co-morbidity, impact on productivity. Impact on caregivers).

2) growing understanding of the physical and environment underpinning of behavioral health issues (genetics, social determinants and trauma, brain science) as well as how to prevent and treat it.

3) cultural change giving a growing voice to its wide prevalence and new acceptance as a human condition rather than a character flaw. This has been led by advocates, celebrities, businesses and policy makers.


“Unaddressed Drivers of Poor Mental Health (PANEL)”

Aja Barber | Community Health Administrator, Center for Health Equity | Louisville Metro Dept of Public Health

When is the next Health Equity Report slated to be released?

In keeping with the timeline so far, we’re anticipating releasing a 2020 or 2021 Health Equity Report.

From the CHE perspective, what can be done on a policy level to help close mental health disparities throughout our community?

We’re currently in process of building the legislative agenda for Public Health & Wellness so I don’t have a specific answer to this yet. But I do believe policies ensuring physical and mental healthcare as a guaranteed right for every individual are critical first steps.

Danesh Mazloomdoost, MD | Founder | Wellward Regenerative Medicine

What can we do as community members, professionals, and advocates for change to get the appropriate word out about the model that Wellward works off of?

Wellward looks for opportunities to work with the community and educating both patients and clinicians on this paradigm shift in addressing painful conditions. Any opportunity to speak or inform the public about Fifty Shades of Pain would be welcomed. While the book became an international bestseller, any purchase or review helps boost its visibility to the public, even a $0.99 Kindle purchase does a lot. Our goal is to simply create greater awareness about sustainable ways to think about pain in improved the health of our community such that pain problems become less prevalent. Your assistance in spreading that message in any capacity is helpful.


“Incenting Recovery Rather than Relapse through Bundled Payments (PANEL)”

Kelly Clark, MD | Founder, Addiction Crisis Solutions | President, American Society of Addiction Medicine

David Smith | Founder| Third Horizon Strategies

In a bundled payment model for medications treatment for Opioid Use Disorder, what non medicine therapies should be included?

Clark: In the PCOAT payment model, medications themselves are not core services/products being delivered.  The core elements to be covered are those consistent with the ASAM Guidelines for Use of Medications in the Treatment of Addiction Involving Opioids: Medical services for diagnosis, treatment planning and medication management; core psychosocial interventions including the levels of counselling which can be done by the prescriber with sufficient time and expertise; and care coordination activities.  There are different approaches in this bundle, depending on the capacity and capabilities of the provider/provider group.  More information can be found here.

Smith: We would be deferential to the professionals empaneled to provide care for the patient. The entire ARMH-APM turns on the axis of a treatment and recovery plan that addresses a range of mental and social considerations (in addition to clinical) that support a patient’s recovery. The clinical professionals and support teams that work with the patients are required to work with the patient in identifying specific therapies, in addition to addressing exogenous determinants that would interfere with the recovery plan and facilitate resources accordingly. The concept APM does set general guidelines regarding the need for evidence-based approaches to therapies holistically, but we also believe that the payment mechanism and the associated risk will play a role in motivating the underlying delivery system to provide non-medical services and therapies in a way that will sustain impact.

How do we move to a model that values quality care and implements metrics around performance?

Clark: We start by defining quality and performance. We can use the Triple Aim concept of Value = Quality/Cost, but quality of care in medical systems is an ever-expanding construct…Beginning by ensuring baseline process measures are used to ensure standards of care are being met – we don’t want to incent performance of cost savings by allowing care considered not to meet baseline standard of care quality metrics…Next, we need to consider the goals of managing chronic diseases: Decreased disease related morbidity, early mortality, total cost of care, and increased functioning/quality of life…To be operationalized, “Quality” is a very granular concept, and we must move boldly ahead to save lives.

Smith: It’s a collaborative enterprise and requires a payer to lean into a payment model that provides adequate resources for care that has a long-term orientation and supports the delivery system in its integration for the purpose of a more seamless patient experience. Our approach is to facilitate this through a risk-bearing provider entity capable of centrally managing a care team and the associated care transitions through a network of providers that engage the patient based on need and subsequently (or initially, depending on the patient) supports the patient’s assimilation back into their environment (or a new environment depending on the underlying circumstances).

Why don’t all clinics require counseling along with the administration of these medications? How is a patient supposed to differentiate between these clinics?

Clark: In an ideal world, people with any disease would have access to whatever interventions they need to help them manage their chronic disease at the time they need it, and also have access to things which would possibly benefit them. In the case of addiction, an individual at one point in time may require 24-hour care in addition to ongoing medication management, or require intensive outpatient care at another point in time, or require no further outpatient services than meetings with their prescriber. There is no one size fits all… 

We do not expect people with brain or other diseases to “talk their way out of their illness.” The currently available data we have for opioid addiction does not show improved outcomes by adding 60-minute formal counselling sessions to the regular physician medication management visits (which include supportive counselling and other techniques)…And forcing people into higher than needed levels of care does not improve outcomes – I have seen it simply discourage them from receiving the care they do need. Finally, there are structural and payment barriers to providing psychotherapy (done by licensed masters level professionals) in the same offices as prescribers which include licensing and payment issues as well as a shortage of either psychotherapists or counselors of lower educational requirements.

Patients and their families currently have few ways to determine the quality of care being provided by any provider or program. The ASAM/CARF certification, as well as the proposed Shatterproof rating system, are looking to make information about programs more transparent by means of independent site surveys (ASAM/CARF) or provider/patient/payer data collection (Shatterproof).

Patients with opioid addiction and their families can look here for information:

http://eguideline.guidelinecentral.com/i/706017-asam-opioid-patient-piece/0?

https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Where are these programs being piloted?

Clark: The P-COAT model does not currently have formal piloting occurring, but it does delineate the types of bundled payment approaches which are already being provided in some communities by forward thinking health plans working with engaged providers. 

Smith: Like everything in health care, we are living under our potential. We don’t get the results we pay for and have developed a delivery system that receives enormous financial benefit when patients have a recovery disruption or cycle through recovery. Our perverse incentives prevent us from driving the type of alignment across this diffuse ecosystem of resources that does a tremendous disservice to patients and their families.

Are recovery models serving people equally across socio-economic levels, including the homeless?

Smith: Today, no, not generally (in my opinion). This is where we need to go. Most Americans can access some form of coverage (non-expansion states notwithstanding). Even for those Americans unable to access coverage, the financial burden of addiction on our entire emergency infrastructure creates an economic rationale for society to provide these services. If we build a delivery model that supports this and link patients under the auspices of their coverage/non-coverage considerations, an underlying economic calculus that isolates value for parties (government, society, payer, etc.) should be a catalyst for establishing the right access to services for patients.

KHC Continues Conversation Around Behavioral Health with Successful Annual Conference

At the KHC 2018 Annual Conference, “Connecting Mental and Physical Health,” our organization pledged to continue to focus on the what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. In addition to the many projects and grants related to behavioral health that we’ve had in the last year, our KHC 2019 Annual Conference continued the conversation started in 2018, titled “High Value Behavioral Healthcare.”

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Details about the conference agenda and speakers can be found here, but some of the highlights included:

  • A motivating opening speech by Mental Health America President and CEO Paul Gionfriddo, which got a standing ovation – a first ever for the KHC Annual Conference. If you are unfamiliar with Gionfriddo’s story or work, take few minutes to read his essay for “Health Affairs.”
  • An employer roadmap for achieving high value behavioral healthcare, developed by the National Alliance of Healthcare Purchaser Coalitions, to ensure that organizations’ health plans drive high value care.
  • Panels on the unaddressed drivers and contributors of behavioral health and new bundled payments to incent addiction recovery. Stay tuned for follow-ups with more discussion from these panelists on our blog!
  • A story of successful implementation of behavioral telehealth medical services by the Kentucky Employees’ Health Plan, presented by Commissioner Jenny Goins.

New Strategies Improve Interaction, Engagement

A record 212 individuals attended this year’s conference, and 75 of those individuals attended the pre-conference reception the evening before the conference, where they were able to meet with other attendees, conference speakers, sponsors, and exhibitors. Although always a challenging endeavor because of people’s demanding schedules, there was an increase of more the 40% in attendance and more food had to be ordered to accommodate. A fantastic problem to have!

KHC 2019 Annual Conference attendees listen to a panel.

The KHC also implemented a new system of commenting and asking questions, through Slido.com, which allowed more questions to be asked more efficiently. Compared to the previous app that we had used, this got a lot more engagement. We were able to archive additional questions that weren’t addressed and followed up with our speakers on them – stay tuned for those answers, coming soon!

The comments received from participants were overall very positive and educational. We are reviewing the feedback now and will use it to guide our future conference planning.

KHC conference achieved directive and financial objectives

The KHC staff, Executive Committee, and members appreciate our community coming together for another outstanding conference examining how to create a high value behavioral healthcare system. The conference met attendee’s expectations and provided finances to further the work of the KHC. The success of the conference would not have been possible without the support of our sponsors and exhibitors. A huge thank you to our Gold sponsors Pacira Pharmaceutical and Artemis Health, who each presented a showcase. An immense thank you to our partner Norton Healthcare, who has been a Silver sponsor for the fifth year. We also want to thank our partners Kentucky Primary Care Association and LG&E-KU for being Bronze sponsors. This year many of our partners and community organizations sponsored tables, allowing many of their employees and associates to attend the conference. A big thank you to table sponsors Norton Healthcare, Baptist Health, CHI Saint Joseph Health Partners/Our Lady of Peace, Anthem, Novo Nordisk, Department of Behavioral Health, Developmental, and Intellectual Disabilities, Trager Institute, Blue and Co. CPA, Commonwealth of Kentucky Personnel Cabinet, and Louisville Society of Human Resource Management. A pre-conference reception allowed attendees, exhibitors, and speakers to network. Thank you to Humana for sponsoring the reception. Finally, we want to say thank you to all of the exhibitors and attendees who participated in this year’s conference.

There is no rest when it comes to the KHC Annual Conference, so we’ve already begun planning the KHC 2020 Annual Conference, our sixth. Save the date for March 11, 2020, and stay tuned for the conference title!

KHC Fifth Annual Conference to Focus on High Value Behavioral Healthcare

On March 5, the KHC’s annual conference will move from a broad based view of value-based healthcare innovation to a deep dive into what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. This conference will examine how employers, payers, and providers can ensure individuals have access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Mental health and substance use disorder continues to rise to the top of many healthcare purchasers’ costliest and most prevalent conditions. Yet, these conditions are not treated by plans and providers the same way as physical health conditions. In fact, mental health is the only chronic disease in America that is not treated until Stage IV. And individuals facing substance use disorder continue to receive treatment that does not comply with current medical recommendations. Research consistently demonstrates smaller payments to behavioral health providers and higher out-of-network use for patients with mental health and substance use disorders, despite parity being law. All of these barriers create a system that often does not meet individuals’ behavioral healthcare needs.

The night before the conference a networking reception will be held, during which a short role-playing exercise by local high school students and a psychologist will demonstrate to attendees how adults and students can have positive mental health dialogue. Appetizers and drinks will be served, and exhibitors will be available.

The morning of the annual conference will kick off with Paul Gionfriddo, President and CEO of Mental Health America. Gionfriddo will provide an overview of mental health status and access in the United States, with a personal reflection on how, through policy decisions, he helped create a flawed mental health system that has failed millions, including his son.

Dr. Stephen O’Connor, University of Louisville Department of Psychiatry and Behavioral Sciences, will moderate four panelists, who will discuss several drivers and contributors to poor mental health often overlooked:

  • Dr. Joseph Bargione, a school psychologist, will discuss how healthcare networks can address adverse childhood experiences (ACEs) in patients
  • Dr. Danesh Mazloomost, anesthesiologist and pain management specialist, will discuss a new framework for treating pain that avoids addiction and has better outcomes
  • Aja Barber from Louisville Metro’s Center for Health Equity will explain how the relationship between mental health, social determinants of health, and institutionalized systems of power/oppression keep us from experiencing the kind of world we all deserve
  • Allison Tu, StAMINA and student at duPont Manual High School, will share youth insights into the factors influencing mental health from a series of focus groups conducted with high schoolers across Kentucky

Mike Thompson, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, will discuss the roadmap and checklist his organization developed for employers to use in designing high value behavioral healthcare. All attendees will receive a copy of the roadmap, which includes an assessment of current performance of health plans and behavioral health organizations across key areas. The KHC is a member of the National Alliance, which represents more than 50 business coalitions in the U.S., supporting more than 12,000 healthcare purchasers and 45 million Americans.

A light continues to shine on the fact that many patients do not get appropriate treatment for substance use disorder. As a result, two new payment models have been designed to help incent effective treatment and recovery. Dr. Kelly Clark, an addiction psychiatrist and the President of the American Society of Addiction Medicine, will present the new Patient-Centered Opioid Addiction Treatment (P-COAT). The model is designed to increase the utilization of office-based treatment of opioid use disorder by providing adequate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services. David Smith from Third Horizon Strategies will then discuss the new Addiction Recovery Medical Home (ARMH) receiving significant national attention. The model establishes a continuum of care from the time a patient enters an acute-care setting and is diagnosed with a substance use disorder through their recovery process. ARMH incorporates quality payments and bonuses for achieving certain outcomes and cost savings.

Telehealth has quickly gained the attention of employers and payers working to increase network adequacy of medical and behavioral health providers. Commissioner Jenny Goins will present examples of how Kentucky’s Department of Employee Insurance has implemented telehealth behavioral health along with the data related to utilization and financial savings.

Dr. Diana Han, Global Medical Director for Louisville-based GE Appliances, a Haier company will explore the reactions of local health plans to the day’s presentations. She will discuss with plans how their organizations are innovating to help individuals gain access to timely, effective, and affordable behavioral healthcare. Eric Bailly from Anthem and Dr. Stephen Houghland from Passport Health Plan will discuss their latest strategies to address network adequacy of high quality behavioral health services to their members.

Several other behavioral health innovations will be highlighted at the conference as well. Attendees will learn about a new non-opioid alternative for reducing opioid exposure post-surgery. A new MOMS Partnership that makes mental health within reach of over-burdened, under-resourced mothers will be presented. The KHC will will share the six priority behavioral healthcare measures selected to align Kentucky’s primary care providers and will provide a sneak peek into the soon-to-be released toolkit for employers on benefit design and workplace policies for supporting prevention, treatment, and recovery.

The conference will provide excellent networking opportunities for all types of healthcare stakeholders. Over 20 exhibitors will be available to discuss their latest products and services. If you have any questions about the conference, be sure to call the KHC office at 502-238-3603 or email info@khcollaborative.org. We hope to see you there next month!

Changing the Narrative One Day at a Time

Dr. Ken Wilson, KHC Co-Chair, Retires After Fourteen Years of Esteemed Service and Leadership

KHC Releases 2018 Annual Report

Last year was a big one for the KHC, and it marked the beginning of many changes for our organization…

2018 Round-up: Top Stories from the KHC

Two years ago, the KHC launched a blog with the goal of improving communication with our members and the community about KHC activities, partner work, local and national news, and industry updates. In what has become an annual tradition, we are ending 2018 with a “Best of” for our blog, looking at posts that have had the heaviest readership and those that our staff deemed its favorites.

Most Read Posts

  1. Kentucky Core Healthcare Measures Set Finalized. Leading the development of a core set of primary care measures for Kentucky was one of the greatest accomplishments in the KHC’s 15-year history, and readership of the blog post that announced its completion reflected that, making it the highest read post of the year.
  2. High School Students Found Action Group to Improve KY Youth Mental Health. With mental health as a top priority, the KHC began a new collaboration with the Student Alliance for Mental Health Innovation and Action, a network of passionate students driving the movement to improve youth mental health through research and action.
  3. SBIRT: Why Should I Care? This guest post, written by Mallori De-Salle, highlights the need for a fundamental change of thinking around how we view substance use disorders.
  4. SBIRT Toolkit Released for Healthcare Providers to Address Opioid Crisis. In 2018, the KHC developed through a Kentucky Opioid Response Effort grant a guide for primary care providers on Screening, Brief Intervention, and Referral to Treatment (SBIRT), which identifies individuals with risky and unhealthy substance use behaviors.
  5. KY Core Measures Set Now Available for Public Comment. Again reflecting the magnitude of the development of a core set of healthcare measures, a second post on the subject showed up on the most read blog post lists. This piece announced the beginning of a public comment period. The KHC received many thoughtful responses from healthcare stakeholders across the Commonwealth.

KHC Staff Favorites

 

Kentucky Core Healthcare Measures Set Announced and Action items identified on healthcare affordability in the region at the KHC Community Health Forum

Selected by: Randa Deaton

It is always hard to pick a favorite blog post of the year, so this year I’ve decided not to pick just one but rather two of my favorites about the power of collaboration by Stephanie Clouser. The first one is Kentucky Core Healthcare Measures Set Announced, because it is one of the KHC’s greatest accomplishments over its 15 year history. This blog post summarizes the power of collaboration, when many minds and stakeholders come together. My second favorite blog post is her most recent post titled, Action items identified on healthcare affordability in the region at the KHC Community Health Forum. This post describes the KHC’s first candid discussion with multiple healthcare stakeholders about the drivers of healthcare affordability and its impact on our community. The event was comprised of many thought leaders representing payers, purchasers, providers, policymakers, and consumers, and the convergence of ideas indicated a readiness by many of the stakeholders to move toward action. As we look forward to 2019, the KHC will continue to use its platform to promote collaboration to advance the healthcare of our community.

High School Students Found Action Group to Improve KY Youth Mental Health

Selected by: Teresa Couts

My favorite blog came from Allison Tu, a student at duPont Manuel High School. She founded an action group called the Student Alliance for Mental Health Innovation and Action, or StAMINA. StAMINA is a student-driven group on a mission to change the state of student mental health in Kentucky. I find it refreshing that teenagers are focused on serious health challenges that affect their peers. Students are experiencing stress, anxiety, and depression that may go unchecked by parents, family members, and teachers resulting sometimes in suicide. StaMINA’s mission to decrease stigma surrounding mental illness and increase effective mental health prevention and treatment services for Kentucky youth is commendable. I dislike the stereotypes that we put on teenagers, such as, they are on social media all day, only care about themselves, are irresponsible, lazy, up to no good, and too young to understand anything about life. The youth are our future and with groups like StaMINA we are in good hands.

National Alliance Annual Forum Identifies Priority Issues and Key Actions for Employers

Selected by: Michele Ganote

This year was my first to attend the annual National Alliance Forum. It was exciting to be present as KHC was awarded the 2018 Membership Leadership Award for this year’s work on healthcare measurement alignment, youth mental health and opioid use disorder. The conference consisted of some great topics with very knowledgeable speakers. It’s interesting that so many speakers are passionate about what they do because of their own experiences with health and/or healthcare. It’s comforting to know that none of us are alone with what we have experienced in the healthcare world. We can always find someone who can relate. Marc Brackett, PhD, Yale Center for Emotional Intelligence, was one of my favorite speakers. The approach at Yale Center is to focus on the role of emotions and emotional intelligence in learning, decision making, relationship quality, and mental health. His talk was interesting and he presented the information in a way that was fun and relatable.

SBIRT: Why Should I Care?

Selected by: Natalie Middaugh

One of my favorite blog posts of 2018 was from Mallori DeSalle, Outreach Coordinator and Lead SBIRT Trainer at the Indiana Prevention Resource Center, and guest panelist on our October SBIRT webinar. SBIRT calls for a fundamental change of thinking around how we view substance use disorders, and this post highlights the ease and benefits of making this change. Mallori raises the question, “What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts?” This comparison emulates the “common sense” nature of SBIRT and helps us envision how an upstream approach to addressing risky substance use behaviors can be critical in avoiding the associated negative outcomes. I have heard resounding enthusiasm around SBIRT implementation, both locally and nationally, and I am hopeful that the KHC can continue serve as catalyst and supporter of its adoption.

QPR Reflections: Suicide Prevention Training Hits Home

Selected by: Stephanie Clouser

This piece was a personal one to me, starting out as a journal entry that morphed into something more. In September, as part of the KHC hosted a Question, Persuade, Refer (QPR) suicide prevention training session as part of a community goal to set a record for people trained in one week. It hit home for me, being in the position myself just last year. The KHC has spent the last year and a half focusing on better integration of mental and physical health, recognizing that not being afraid to have conversations around mental health is a big part of reducing stigma and better addressing the issue in our community. I was grateful for the opportunity to share some of my story and grateful that the work the KHC has done around mental health has made a personal impact on me.

Action items to address healthcare affordability in the region identified at Community Health Forum

It’s no secret that we have a problem with healthcare affordability in this country. Each day, there are new headlines that highlight this problem. We are all familiar with these headlines. But what do we do about it?

That’s exactly what we addressed in last week’s Community Health Forum, “The Path to Affordable Healthcare.” In a different format from our typical Community Health Forum, which lasts a couple of hours, “The Path to Affordable Healthcare” was extended to a half-day event and included an interactive portion, where participants worked in groups to create action items to tackle healthcare affordability in the region.

FORUM INVOLVED LEARNING AND TAKING ACTION

In the first half of the day, participants listened to several speakers and panelists discuss the lack of agreement on an affordability definition, the current state of healthcare affordability in the nation and region, the drivers of healthcare affordability, the role of regional collaboration, and the barriers that keep us from achieving affordable healthcare.

There was much interesting information given and discussion had in first half of the day, including three speaker presentations and a panel loaded with healthcare experts from across the Commonwealth (see agenda here). But the highlight of the day was the creation of action items by event participants designed to help develop a community action plan to address healthcare affordability in our community.

“For me the event just reconfirmed how pivotal the KHC is to the region. Having healthcare stakeholders (purchasers, payers, hospitals, and so on) all working to together to understand each other’s needs is the only way we are going to get true change to a fragmented system. Everyone will win when our healthcare systems provide quality care, access to care at an affordable cost. Alone we can accomplish nothing. Working together we can gain everything.” -DeAnna Hall, Manager Corporate Health & Wellness, LG&E KU

Working in groups, participants brainstormed and defined goals to prioritize and improve healthcare affordability as it relates to health, price, and waste – the drivers of healthcare affordability. The action items were not limited to what the KHC could accomplish, but for the community as a whole. Given the range of viewpoints in the room, the task became an energetic exercise. Ten ideas were identified and discussed with the larger group, and participants then identified and voted on their top three selections.

The action items were outlined, in descending order of votes:

1. Create a state-wide data warehouse with claims, electronic health records, and public health data to map price and quality variation. The warehouse will be led by the state and the KHC and the data will be used to partner with the next iteration of the RAND hospital price transparency study.

2. Create a statewide collaboration to identify the top three costly chronic conditions that have a gap in care and work to close gaps through payment innovation, patient education, aligned cost and quality measures, and care coordination.

3. Participate in a self-insured transparency study for Kentucky with the current iteration of the RAND hospital price transparency study and use the results of the study in next year’s contract negotiations.

4. Conduct a three-year pilot to create a workflow redesign to integrate social determinants of health, physical health, and mental health into a quality patient care management plan in Louisville Metro.

5. Create a knowledge transfer center for employers and health plans to define health transparency and value-based purchasing, to be operated by the KHC.

6. Promote competition and consumerism to drive affordability through legislation. Educate legislators on price transparency.

7. Promote healthcare transparency and affordability across all parties by removing data barriers.

8. Improve patient engagement with health coaches or community health workers, with a focus on preventive screening in rural areas of Kentucky.

9. Create a defined pathway for musculoskeletal outcomes pricing with reduction in imaging for low back pain. Each year, focus on specific employers.

10. Educate consumers, employers, students, etc., on healthcare benefit literacy.

“Active engagement, interaction, and partnership among government, payors, employers, and providers is essential to solving the dilemma of healthcare affordability in Kentucky. While we all share a common objective to provide high quality care to the citizens of the Commonwealth, we need to start four-way conversations to listen and understand perspectives and challenges and then use this information to create productive solutions. In our workgroup I believe each member learned something new about another’s perspective. As a first-time participant I look forward to opportunities for further engagement to offer a providers perspective and contribute to real problem solving.” -David Zimba, Managing Director, Kentucky Health Collaborative, and event panelist

NEXT STEPS

There is a clear want and need for better data around cost and quality in the Commonwealth. As the KHC data scientist, this is what I like to hear! It is impossible for any stakeholder – consumer, provider, plan, or other – to make informed and appropriate choices with large gaps in information. Transparency is key to healthcare affordability, as it provides insights and identifies problems. There was also a lot of talk around minimizing wasteful treatments and procedures that provide little or no benefit.

Many potential ideas were created at “The Path to Affordable Healthcare,” and the next step is to identify which can be and should be acted upon in the community. This event was held in partnership with the Network for Regional Healthcare Improvement (NRHI) to bring healthcare affordability to the forefront of healthcare transformation efforts through a campaign called Affordable Care Together. As part of that campaign, the KHC is required to create an action plan by January 15.

The KHC will take these action items back to its leadership team to determine which are appropriate for our organization to pursue. Look for more updates in the near future.