Healthcare Solutions Subcommittee Meeting

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1 Healthcare Solutions Subcommittee Meeting Friday, March 25, 10-12:00 at Olver Transit Center Regrets: Drs. Higgins and Talati, BFMC Present: Pam Jobst, Athol Heywood Aaron Blanchette, Walgreen s Marina Goldman, Clean Slate Tess Jurgenson, OTF Deb Neubauer, OTF Candy Darcy, BHN Justin McNary, Recover Project Michael Lewis, Recover Project Julie Thompson, BFMC OBGYN Julie Payne Britton, BFMC Partial Hospitalization Flora Sadri, Clean Slate Jen Desjardins, Heywood Health Tim Purington, Tapestry Stefan Topolski, Trailside Health Julie Schwager, CHD Mary Burleigh-Howes Phoebe Walker, FRCOG Tim Purington, Tapestry Tammy Cagle, FCSO intern Kevin Weir, Mass Behavioral Health P ship Christine Holmes, CHD Deb Lincoln, CSO peer to peer counselor at Athol Hospital Liz Whynott, Tapestry Cheryl Dukes, UMass College of Nursing Dan Sontag, CSO Crisis Alane LePage, CSAC 1. Trauma Informed Practices Training Jen Audley and Ruth Potee invited all in attendance to an upcoming training on 4/8. Ruth asked others to report on their progress in developing capacity in this area: a. Justin McNary recommended the Salasin Center s Journey Dance as something that has worked really well for a lot of women. b. Dan mentioned that CSO has had an agency-wide trauma informed practices work group. They are trying to think about how all staff, not just clinicians, can learn from the ACE study. c. Julie S said that at Watershed they do Trauma Empowerment Programs, and there is work going on with all outpatient clients as well. There are some clinicians trained in EMDR as well. Julie PB reported that ServiceNet has a number of practices in place. d. Need: EMDR to be more accessible. Julie S. mentioned that she could help get a training in Franklin County. 2. Understanding the Insurance landscape for people seeking treatment We were joined by Jonna Hopwood, Director of Substance Use Disorders, Mass Behavioral Health Partnership (MBHP)/MassHealth, and Kevin Weir, Regional Network Manager Western MA MBHP. They manage behavioral health contracts for everyone covered by the Mass Health PCC plan only a small subgroup

2 3. of all MH clients. This includes Be Healthy, a Health New England plan that is part of Mass Health as well. Kevin explained that Mass Health has 3 categories of populations that they are set up to serve: (1) People who do not use much mental health services -- private insurance carriers (MCOs) had to provide all the services, behavioral health too. (2) A pool of people on Mass Health Standard (also known as FFS) -- people with a lot of really intense needs whose use are assumed to be not able to be managed. In FFS Medicaid, members can get detox, CSS, methadone, counseling, but NOT Structured Outpatient Addiction Programs (SOAP) = IOP or other day treatment, or TSS. However, this version of insurance covers Partial Hospitalization for longer than people on MBHP (8 days vs ). (3) (MBHP) People who have their BH services managed by a managed care organization for people who use a lot of it. The plan was designed to give people as much services as possible, improve outcomes and reduce cost. Anyone covered by Mass Health can change to this. There is also a Children s Behavioral Health Initiative came out of a Mass Health loss in a law suit. Serves all kids 0-18 with a lot of services, but there are not enough staff. Questions: Aaron asked how people can change coverage to get these services Answer: providers can call and change them, or they can call themselves and switch, and it takes effect immediately. Julie S and Dan S said for some people there are barriers to joining this plan because then they have to lose their PCP or OBGYN. It is important for advocates to carefully understand all the medical needs the person and their family have before choosing a plan. Kevin reported that in January of next year the choice for members will stop being as open. Marina asked a question about the requirement for a doctor referral for Suboxone. Kevin replied that Mass Health requires Suboxone to have a PCP referral, possibly partially in order to encourage doctors to provide itself. This is not an MBHP rule, as Suboxone is considered medicine, not behavioral health. If prescriber is a psychiatrist, MBHP will pay for their time. They agree that Suboxone is entirely too complicated to access. Candy offered to bring the issue to the Massachusetts Behavioral Health Assn. to advocate for cleaning up the regulations. Initial Authorization 4 days alcohol, 6 for opiates are their default detox (ATS) authorizations. Providers should call and talk if they want more. Candy reported that these short timelines contribute to the high rates of AMA. Jonna clarified that the new Chapter 258 law will allow for people to stay 7 days if they have commercial insurance. However, Mass Health says for all their managed care programs, provider should determine the length, as long as needed. Huge change! Need to know more about how this applies to Fee For Service Mass Health patients. Discussion of change needed in MBHP IT system because BHN reports that they are still being asked for the 4 and 6 day conversations. Answer: It will not be changed until the end of the year. They have a

3 workaround -- developed an expedited authorization that should sail through the system. BHN encouraged to be in touch if that system is not working. Discussion of ATS/detox to methadone transition. People are allowed to have methadone prescribed by MD at the detox, and carry that with them until they can be seen by the methadone clinic. They then have 14 days to see a PCP. Group discussion of changing purpose of detox model for opiates vs. alcohol. It is really about getting them onto MAT. Michael asked how this information trickles down to the street. Candy mentioned that she is getting card printed and will pass it out. Opportunities for services MBHP covers, but we don t have local providers: Acupuncture they have one contracted acupuncture provider. Ruth suggested that Community Acupuncture and People s Acupuncture in Amherst should both sign up. Deb Neubauer, Jen Audley have acupuncture contacts they will talk too. Ambulatory Detox woefully underutilized they have two contracted providers. They would be happy to contract with other entities if they want to propose a model. Other creative possibilities: They are also interested in pursuing bundled payment strategies with institutions. They have money for pilot projects. Question: will they cover Recovery Coaches? Discussion of CSP and Recovery Coaches what is the difference? Candy said in real life, RC is a person who is in recovery themselves, can speak from that perspective. They can provide transportation. CSP is much more case management. Governor has confused the two, which has been challenging for BSAS. Christine Holmes of CHD (a recovery coach and formerly in the Moms Together program) reported that they are working with five coaches right now with folks in the Watershed and the Birthplace. BSAS is paying CHD to support this program. Justin is switching jobs to work there as of April 1. Pam raised questions about whether transportation will really be able to be provided, even though it supposedly is. Julie S reminded us that BSAS has an RFR out for Recovery Coaches in ER and is making decisions now. Linda Sarage just was hired to coordinate that work for BSAS. Deb explained the differences between Recovery Coaches and Recovery Interventionists, according to Linda Sarage. Cheryl Dukes asked about workforce development. Mt. Wachusett and GCC have programs for certifications in mental health, human services, and addiction services. CHD is partnering with Springfield College. Michael reminded us that not everyone can afford to go to school. Lengthy discussion of the barrier that low pay presents to having a committed, competent workforce. People shared their stories of pay cuts taken to get into this work.

4 Mary Burleigh-Howes asked that future pilot programs be informed by the opinions and experiences of people in recovery, whose input is often neglected in the creation of programs to serve them. 4. Updates -- All a. CSAC Methadone -- is expanding. Alene reports that they are looking for new space. Candy reported that BHN tried to get them on the campus, but the city s mayor was not in favor. So they are now looking at places outside of Greenfield. Discussion of transportation issues 150 current patients, only a third use the PT1 transportation service. Kevin reported that he opened a methadone clinic once and it took contracting for a police detail to overcome the political opposition. b. Firebird Five K. Donations this year will support the purchase of women s long term sober housing purchase in Greenfield. Gold Sponsor: $1500, Silver $1,000, $500 name on the shirt. It also funds Rides to Recovery. Race is June 4. c. Active user engagement project for Greenfield. Lawsuit in Holyoke is slowing it down. The BOH is continuing slowly to consider it. d. PMP -- Phoebe reminded people that June will be a new software rollout, and Erin Herzig will be helping providers with the new system as soon as it is up and running. Ruth mentioned that the new opioid law requires that all scripts, every time they are written, have to check the PMP every time. This was a surprise to most providers, and is a huge time commitment for people on monthly prescriptions. e. Do we need a delegate training here? Baystate Franklin update on delegates: Julie T reported that for OB GYN 2 delegates got trained this month and are in process of being approved. Julie PB reported that Dr. Rourke is working with all the practices to get delegates appointed, and the Hospitalists are in the process of doing so as well. ER is fully functional with delegates for the PMP. f. Candy mentioned that BHN is looking into starting a 30 bed men s residential program at some point. Great interest from the group. g. Todd Mandell reported that people are coming in with terrible withdrawal to pure fentanyl. Ruth reported that there have lately been a few ODs that do not respond to Narcan. Justin reported that you can now get it as a tablet. There is an instant read urine dip, but it is more expensive than just ordering a test that includes Fentanyl for each person, which is what CSAC is now doing for everyone. Levamisole is a worming agent that is sometimes used to cut the fentanyl or heroin (and sometimes cocaine), which causes horrific necrosis. 5. Set Next Meeting Date: May AM-12 noon, Transit Center Outpatient Services will be invited to talk about their trauma-informed practices. Action Items: Workforce questions: GCC and Mt. Wachusett programs bring information to upcoming meeting. Invite outpatient programs to present on trauma-informed practices Tess

5 Jen Audley, Deb Neubauer put acupuncturists they know in touch with MBHP to explore the possibility of becoming certified as providers through the program. Also, someone should get in touch with Community Acupuncture and People s Acupuncture to encourage them to register with MBHP. Candy will bring to the Massachusetts Behavioral Health Assn the request to advocate for cleaning up the Suboxone regulations.

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