Addressing opioid use disorder at community health centers in California
By Alexandra Staropoli and Shelly Virva
Nearly 50,000 individuals died of opioid overdoses in 2017. The Centers for Disease Control and Prevention estimates that opioid overdose deaths increased by nearly 45 percent between 2015 and 2017. As opioid overdose deaths continue to rise, policymakers across the country are working diligently to fund and implement solutions.
This week, Congress sent a package of bills to the President’s desk that, if fully funded, would invest more than $8 billion in programs across various federal agencies. Last month, the Department of Health and Human Services announced a $1 billion investment in states to fight the opioid epidemic. While the legislative package is a good step forward, there is still more to be done to fully address treatment needs across the country.
While no single policy solution will solve the opioid crisis on its own, new evidence suggests that increased access to multiple interventions, including medication assisted treatment, psychosocial treatment, naloxone, and needle exchange programs, when implemented together, would have a significant impact on the reduction of opioid overdose deaths in the next decade.
At the Camden Coalition, we’ve seen the impact of improved access to medication assisted treatment (MAT) firsthand, in both our work in Camden and around the country as technical assistance providers through our National Center for Complex Health and Social Needs.
In particular, we’ve witnessed the significant role that community health centers play in prevention and treatment of opioid use disorders. This is especially true for individuals with complex health and social needs who often live in underserved communities and rely on community health centers for their primary care. Since less than half of community health centers utilize MAT, there is an incredible opportunity to impact the opioid epidemic by expanding access to MAT in those settings.
To that end, in 2016 the Camden Coalition entered into a partnership with the California Health Care Foundation to implement a team-based, integrated MAT program in ten community and county health centers in California.
Implementing Team-Based Integrated MAT Programs in California
Over an 18-month period, the Camden Coalition’s technical assistance team worked with ten community and county health centers and their payer partners in California to develop sustainable, integrated care models for complex patients. A recent evaluation of the project by the Urban Institute demonstrated the program’s success. Some of the key accomplishments included:
- Treatment of more than 500 patients who may not have otherwise received appropriate, evidence-based care at the ten community health centers across the state that expanded MAT. This included an increase in the number of providers licensed to prescribe buprenorphine.
- Relationship development across settings, including coordination between community health, criminal justice, mental health, and emergency departments for buprenorphine inductions.
- A reported shift in culture and reduction in stigma as a result of education on addiction and trauma, and complex care more generally.
- At one site, the evidence revealed an overall reduction in emergency department and inpatient utilization.
The evaluation also highlighted several facilitators for success. A few key components included:
- Provider champions whose leadership and support for others in the organization were critical to the development and maintenance of these MAT programs.
- Technical assistance, education around opioid use disorder, and peer supports were important for providers and other team members who lacked significant (or sometimes any) experience treating people with opioid use disorder.
- The team-based care approach inclusive of behavioral health providers, and case managers, was essential to the success of these programs.
- Strong support from top leadership within the agency is necessary to MAT program success.
Reimbursement challenges for community health centers
While funding opportunities for MAT integration are growing, community health centers can face some reimbursement challenges when implementing team-based care. Medi-Cal, California’s Medicaid program, reimburses drug and alcohol counselor services through a separately funded and regulated system (Drug Medi-Cal), and community health center participation in this system is feasible, but complicated. In addition, Medi-Cal prohibits same-day billing for medical and behavioral health providers. This has been a significant barrier to integrated care delivery not only in California but several other states as well. Advocates in California are currently working on legislation to address this same-day billing issue.
A comprehensive approach to addressing the opioid epidemic must include expanding access to MAT and evidence-based behavioral health therapies. The California Health Care Foundation experience provides an instructive model for community health centers and primary care providers. They can play a significant role in expanding access to comprehensive, multi-disciplinary team based MAT programs.