Aftershocks: Addressing the rise of substance use disorder and COVID-19 - HIMSS
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Aftershocks: Addressing the
rise of substance use disorder
and COVID-19
Se s s ion # 95, Augus t 11, 20 21
Rut h Zimme rma n, RN, MSN
Director of Informatics & Clinical Product Strategy, PointClickCare
DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.
1
Welcome
Rut h Zimme rma n, RN, MSN
Director of Informatics & Clinical Product Strategy, PointClickCare
#HIMSS21 2
Conflict of Interest
#HIMSS21 3
Agenda
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#HIMSS21 4
Learning Objectives
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#HIMSS21 5
Before the COVID
Pandemic
There was already a crisis of SUD in the US
6
A Growing
Epidemic
Overdose deaths exploded to more than
90,000 in 2020, and synthetic opioids were
involved in more than 60 percent of all
overdose deaths
Note: Synthetic opioid deaths exclude those from methadone. Specific
drug-class deaths are not mutually exclusive as some deaths are attributed to
multiple drug types. 2020 - National Vital Statistics System Provincial Drug
Overdose Death Counts, Dec. 2020 predicted totals (not final data, subject to
change).
Source: Jesse C. Baumgartner and David C. Radley, ‘The Drug Overdose
Mortality Toll in 2020 and Near-term Actions for Addressing it,” To the Point
(blog), Commonwealth Fund, July 15, 2021.
https://infogram.com/the-drug-overdose-mortality-toll-in-2020-and-near-term-actions-for-addressing-it-exhibit-1-1h8n6m3050y8z4x #HIMSS21 7
A Growing Epidemic
164.8
Million
60.2%
https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf #HIMSS21 8
A Growing Epidemic
•
93,000
In 2020
https://www.statnews.com/2021/02/16/as-pandemic-ushered-in-isolation-financial-hardship-overdose-deaths-reached-new-heights/ #HIMSS21 9
The Tip of
the Iceberg
Estimated Percentage Increase
in Overdose Deaths
Jan-Aug 2020 compared to Jan-Aug 2019
Note: District of Columbia had an estimated increase of 72%; South Dakota
had an estimated decrease of -4%.
Data: Jan.-Aug. 2019 final totals: CDC WONDER; Estimated Jan.-Aug.2020
totals: Calculations based on National Vital Statistics System Provincial Drug
Overdose Death Counts, CDC WONDER.
Source: Jesse C. Baumgartner and David C. Radley, ‘The Spike in Drug
Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move
Forward,” To the Point (blog), Mar. 25, 2021. http://doi.org/10.26099/gyf5-3z49
https://infogram.com/https://infogram.com/the-spike-in-drug-overdose-deaths-during-the-covid-19-pandemic-and-policy-options-to-move-forward-exhibit-2-1h8n6m3g1r71z4x #HIMSS21 10COVID-19 Disruptions to Health Care and the
Impact on the Opioid Epidemic
New virtual health
Pre-existing
treatment options;
challenges are
changes in health
compounded and
policy to support
impact access to
access to virtual
SUD care
health care
Data informs
and enhances
Stressors population health
exacerbate Exponential management and
OUD New access growth in virtual personal health
to care health care delivery
obstacles for OUD
Increase patients
demand for The rise of
mental health data-informed
Overlap of and SUD health care
Innovative
vulnerable treatments
applications of
populations new technologies
increasing for OUD
negative OUD Disproportionate
Accelerated prevention and
outcomes impact on
adoption of new treatment
vulnerable
populations COVID-19 technologies
Disruptions to
IMPACT ON IMPACT TO
Public Health and
PEOPLE WITH HEALTH Health Care
OUD SYSTEM
Source: Deloitte analysis. Deloitte Insights. I deloitte.com/insights #HIMSS21 11According to the Center for Disease Control
and Prevention, prescription opioid use alone
accounts for $78.5 billion a year in costs for
health care, lost productivity, addiction
treatment, and criminal justice involvement.
#HIMSS21 12Taking Action
Increased Naloxone Access Changes in Opioid Prescribing Patterns
1 co-prescribing naloxone
3 Reductions prescription opioids
Harm Reduction Medication Assisted Treatment (MAT)
2 4 patient-tailored protocols
changing stigmas
#HIMSS21 13The Perfect Storm
Conditions leading to the worsening SUD crisis
14“
We consider addiction a ‘disease of
isolation’ …now we’re isolating all these people
and expecting them to pick up the phone, get
online, that sort of thing — and it may not work
out as well.
Dr. Marvin Seppala,
Chief Medical Officer at the Hazelden Betty Ford Foundation.
#HIMSS21 15A Disease of
Isolation
Monthly Drug Overdose Deaths
Note: Synthetic opioid deaths exclude those from methadone. Specific
drug-class deaths are not mutually exclusive.
Data: Final 2016-2019 monthly totals: CDC WONDER; Estimated 2020 monthly
totals: Calculations based on national Vital Statistics System Provisional Drug
Overdose Death Counts, CDC Wonder
Source: Jesse C. Baumgartner and David C. Radley, ‘The Spike in drug
Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move
Forward,” To the Point (blog), Mar. 25, 2021. http://doi.org/10.26099/gyf5-3z49
https://infogram.com/the-spike-in-drug-overdose-deaths-during-the-covid-19-pandemic-and-policy-options-to-move-forward-exhibit-1-1h7k230l515jg2x #HIMSS21 16The Impact of Social Distancing on
Mental and Behavioral Health
The Facts:
• mental health of 45 percent of US
adults
negatively impacted
•
1 in 4 of those with a serious mental illness also have SUD
#HIMSS21 17The Impact of Unemployment, Homelessness, and
other Social Determinants of Health
The Facts:
• 14.8% in April 2020
• opioid-related ED visits and
deaths increase by 7 and 3.6 percent
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• 35 percent of homeless individuals are affected by substance abuse, and
#HIMSS21 18A National Relapse
#HIMSS21 19Addressing COVID-era Needs
Providing relief, empowering patients
and providers
20Breaking Down Barriers
National State/Regional Local
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#HIMSS21 21A Well-rounded Approach to Improvement
Telehealth Medication Assisted Appropriate Settings
1 2 Treatment (MAT)
3 for Appropriate Care
#HIMSS21 22Care Coordination Challenges
and Opportunities
Stories of success
23Care Coordination and 42 Code of Federal
Regulations (CFR) Part 2
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#HIMSS21 24Added Level of Privacy for Patients with SUD
Clinic Relationships
Entire Cross Continuum
Trading of information between SUD clinics SUD clinic
#HIMSS21 25Case Study
Options Counseling
and Family Services
(Oregon)
26Case Study
Options Counseling and Family Services
90 % follow-up rate for behavioral health
clients post-ED visit.
27“
We’re able to reach out to their other providers to coordinate
care. For example, we’ve had primary care doctors call us if
they’re seeing a spike in concerning behaviors or mental health
symptoms. This ongoing communication enables us to problem
solve with each of those safety -net providers in our clients’ lives.
Lara Barnes, M.Ed., LMFT
Behavioral Health Director, Options Counseling & Family Services
#HIMSS21 28Case Study
Aspire Health
Alliance
(Massachusetts)
29Case Study
Aspire Health Alliance
30“
The event notifications are a way to find people and engage
them while they’re in the ED. In this acute state —this crisis
state —we find a higher rate of engagement. If we send our
people to the hospital, we can coordinate with a social worker to
say, ‘look, this is a free service from Mass Health for you. I’m here
to help you get what you need; how can I help?’
Deborah Jean Parsons
Director of Integrated Care, Aspire Health Alliance
#HIMSS21 31Aspire Health Alliance
Step One Step Two
How it
Works
Step Four Step Three
#HIMSS21 3250% of patients who are
contacted by an Aspire
case manager during their
hospital stay engage in the
BHCP program
#HIMSS21 33Case Study
Bartlett Regional
Hospital (Alaska)
34Case Study
Bartlett Regional Hospital
• 63.6% retention rate
15% higher than national average
• SUD-related
staph infections and endocarditis
35“
The Collective platform has helped us maintain a continuity of
care—within the hospital and the community. And now that it’s
been married in to the PDMP, it has been an invaluable resource
to our ED as patients travel through the community, state, and,
in some places, nationwide.
Claire Geldhof, ED RN
Case Manager, Bartlett Regional Hospital
#HIMSS21 36Using Care Coordination to Address SUD
Mat-Su Regional Medical Center Bartlett Regional Hospital
Alaska Alaska
80 %
Opioid prescribing
63%
Retention Rate
in ED (2015-2018)
Through adoption of
prescribing guidelines and Bartlett patients enrolled in a
integration of PDPM data buprenorphine MAT programs
into Collective platform and a reduction in drug-related
staph infections and endocarditis
cases entering the ED
#HIMSS21 37Case Study
Pierce County
Emergency Medical
Services
(Washington)
38Case Study
Pierce County Emergency Medical Services (EMS)
39Pierce County Emergency Medical Services (EMS)
Step One Step Two
How it
Works
Step Four Step Three
#HIMSS21 40Using Care Coordination to Address SUD
Tri-cities area hospitals Washington State
Washington after implementing Collective platform
Randomized
34 %
Opioid related
Controlled Trial (RCT)
comparing care
coordination with and
without the Collective
80 %
Odds of receiving
27%
Opioid related
platform opioid prescription deaths
ED visits
from ED (2008-2011)
• 24% reduction in ED encounters
with opiate prescriptions,
• 10% drop in total Medicaid ED
encounters year-over-year, and
• $34 million in savings
#HIMSS21 41Since implementation in 2015,
Northwest Physician Network
has seen a reduction in ED use
of nearly 50%
#HIMSS21 42Needs Identification and Support Through
Effective Care Coordination
Behavioral Health Community
SUD clinic providers Resources
The Facts:
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#HIMSS21 43Questions?
Thank You! Rut h Zimme rma n, RN, MSN Ruth.Zimmerman@PointClickCare.com www.linkedin.com/in/ruthzimmerman
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