Access to substance use treatment boosted through statewide training programs

By: Debbie Reinheimer

Despite the blizzard-like conditions, more than 60 emergency physicians and nurses from across Michigan traveled to Lansing in late February for a critical day of training. The eight-hour training session would enable them to screen patients for opioid use disorder and initiate medication assisted treatment (MAT) right in the emergency department, getting patients needed support and treatment more quickly.

MAT is an evidence-based treatment option that uses medication to block the effects of other opioids and limits potential for opioid abuse or risk of overdose. The treatment can be provided through a physician’s office. So, increasing patient access to MAT is a critical tool to address the rising number of Michiganders with opioid use disorder.

Blue Cross Blue Shield of Michigan, working in partnership with the Michigan Emergency Department Improvement Collaborative and the Michigan Opioid Prescribing Engagement Network, organized the training session specifically for emergency providers. Dr. Eric Ketcham, an ED physician, addiction specialist and MAT expert from New Mexico conducted the training with three co-trainers from Michigan emergency departments. Trainers covered issues particular to the emergency setting. Attendees represented 14 different EDs across the state.

Seth Krupp, MD, medical director and vice chair of operations for the Department of Emergency Medicine at Henry Ford Health System, says the training enables his team to be part of the solution.

“MAT gives us a key tool to set our patients up for success. First, we have peer recovery coaches here who identify patients who fit the profile for the treatment. Coaches talk with patients about their readiness to quit and provide them with resources. Now, we’ll be able to take the next step and prescribe the medication when needed, then connect patients with providers to continue their treatment,” said Dr. Krupp.

Emergency department physicians are in a unique position to address the opioid crisis by providing point-of-care treatment. Patients are often more willing to accept treatment when they’re in the emergency department, even when the opioid use disorder is not the primary reason for a patient’s ER visit.

“Last week, for example, a patient came to the ER due to injuries from a fall. But our peer recovery coaches investigated and found he fell because he overdosed on heroin,” said Dr. Krupp. “So, an important first step is to change the way we think about people with opioid use disorder. And MAT is one of the most crucial things we need to adapt.”

In addition to the special training for emergency health clinicians, Blue Cross is supporting monthly MAT training sessions throughout Michigan for primary care physicians who wish to provide MAT in their offices. Those who complete MAT training must apply for a SAMHSA waiver to prescribe the medication.

The sessions are conducted through the Michigan Opioid Collaborative, a partnership between the Michigan Medicine Department of Psychiatry, Michigan Department of Health and Human Services and Blue Cross Blue Shield of Michigan. The training sessions are certified by the American Society of Addiction Medicine, and are offered each month in a different location, to better enable physicians across Michigan to attend.

“More than 325 primary care physicians have completed or registered for the MAT training in less than a year since we began our efforts,” said Amy McKenzie, M.D., M.B.A., medical director at Blue Cross Blue Shield of Michigan. “There is great interest from primary care physicians in this program.”

To help encourage more practices to receive training and offer medication-assisted treatment to people with substance use disorder, Blue Cross offers incentives through two Value Partnerships initiatives:

• MAT Practice Transformation Incentive — This is for Blue Cross designated Patient-Centered Medical Home practices that begin providing the service in 2020 and 2021.
• Value-based reimbursement — This is for physicians who deliver MAT, if they meet specific thresholds and timelines. Physicians should contact their physician organization for details.

“If we can increase access to treatment and the capacity of participating physicians to provide MAT, we can make a tremendous difference in the lives of our patients, their families and others in the state who are suffering from substance use disorder,” said Dr. McKenzie.