Too often we hear about the ravages of substance abuse disorders, such as opioid addiction, and not enough about the innovations in health care to treat it — not as a problem but as a chronic illness that requires a thoughtful treatment strategy. Drug overdose deaths and opioid-related deaths are on the rise. On average, 115 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention. Health centers play a particularly critical role on the ground because they are treating people who would typically experience multiple barriers to getting substance abuse treatment — unaffordability, few or no options, or the stigma of addiction. Clinicians from Community Health Centers in California, New Jersey and New York were on Capitol Hill this week to brief Congressional staff and policymakers on how their model of integrated care is working to fight addiction in some of the most economically challenged and medically underserved communities.
Primary care is a key entry point for patients seeking treatment for substance abuse and many health centers (82 percent now provide behavioral health services) initially screen patients to see if they need alcohol or drug counseling. When it comes to the individual patient, “The same answer isn’t always the same answer,” said Daniel Miller, MD, Chief of Clinical Integration and Graduate Medical Education at Hudson River Healthcare, Inc. (HRHCare) based in Tarrytown, NY. Even without the barriers, substance abuse disorders are complex and the patients who suffer from it typically have comorbidities, such as mental illness or chronic pain.
HRHCare, however, is up to the task. HRHCare is comprised of 28 health centers that serve 143,000 patients. Like most health centers, HRHCare is serious about its mission to pursue evidence-based medicine — essentially seeking new and better ways to produce the best possible outcomes. They go beyond the traditional Medication Assisted Treatment for 0pioid use disorder and provide an integrated team-based, patient-centered approach that is about “meeting the patients where they are,” said Miller. Part of that approach means a focus on understanding the role of trauma or adverse childhood experiences in influencing addiction. According to a study by the Centers for Disease Control and Prevention and Kaiser, 66 percent of people in substance abuse treatment report childhood abuse or neglect.
Dr. Miller was joined by Roderick Seamster, MD, President and CEO, Watts Healthcare Corporation, Los Angeles, CA; Rachel Evans, MD, Chief Medical Officer for Henry J. Austin Health Center in Trenton, NJ and moderator Kima Taylor, MD, MPH, Managing Principal, Anka Consulting, LLC.
Each panelist gave a snapshot of the best practices for treating substance abuse disorders using technology — such as electronic health records or telehealth — care integration, counseling, pain management services and a team-based approach that also looked beyond the illness of addiction and addressed social determinants of health, rather, the environmental culprits that may cause it. The briefing also featured an issue brief which describes in more detail health center services in treating substance abuse and addiction, entitled, “Rising to the Challenge: Community Health Centers are Making Substance Use Disorder Treatment More Accessible Than Ever.”
There remains much federal and state policymakers can do to support the health center model in treating substance abuse disorders: sustained funding for health centers, a robust Medicaid program (Medicaid is 43 percent of health centers’ total revenue), same day billing in Medicaid and improved reimbursement of telehealth services. Acting on these recommendations can help ensure that health centers continue to their record of success in cutting health care costs and reducing unnecessary visits to hospital emergency rooms.
The Capitol Hill briefing comes as thousands of health center professionals convene this week for the 2018 NACHC Policy and Issues Forum.