Expanding Access to MAT: The Maine Experience Linda J. Frazier, RN, CHES, MA Treatment Manager Maine Office of Substance Abuse, DHHS 2009 NIATx Summit & SAAS National Conference Tucson, AZ
May 25, 2015
Expanding Access to MAT: The Maine Experience
Linda J. Frazier, RN, CHES, MATreatment Manager
Maine Office of Substance Abuse, DHHS2009 NIATx Summit & SAAS National Conference
Tucson, AZ
Maine MAT Partners
Acadia Hospital Addiction Resource Center at
MidCoast Hospital Aroostook Mental Health Center Maine General Medical Center The City of Portland Health Care for the
Homeless FQHC The Maine Alliance for Addiction Recovery The Maine Association of Substance Abuse
Programs The Maine Office of Substance Abuse
Context of Maine MAT Project
9 OTP Clinics serving 3,518 clients receiving Methadone, capacity is 4,810
5 Original MAT Pilots + 5 New Pilots (6/09) SOTA – State Opiate Treatment Authority History of using Medicaid Funding for
treatment; State Plan includes and supports key components
OSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community
Key Activities
Partnership & Shared Aims – Rapid Cycle PI Surveys, Chart Audit, Focus Groups –
Provider Staff & Consumers Implementation of Non Discrimination
Language in July 2007 Contracts Implementation of Pay for Performance
Contracts July 2007 Changes to TDS Data System July 2007 –
Added questions on Evidence Based Practices, MAT, Access/Retention
RIDER E: PROGRAM REQUIREMENTS(SUBSTANCE ABUSE SERVICES)
NON-DISCRIMINATION
13. Providers receiving grant funds from OSA will not discriminate against clients who are using legitimate medications to assist their recovery and will not have policies that allow them to refuse admission to treatment or to discharge clients from treatment based on the use of legitimate addiction medications.
Partnership With MAT Agency Pilot Sites
Four original AR MAT pilots, 2 added vivitrol sites, LC with these and five additional sites April 2009.
ASAM LOC written into licensing regulations 2006. Develop treatment processes & protocols – ID need
for medication and access to funds, patients right to have MAT, address internal barriers like staff attitudes.
OSA sponsored training to address staff education and identified barriers of prejudice and mis-information about MAT.
Site visits in July 2009.
Support for MAT Systems Change
Continued support for MAT – Coaching, Learning Session Participation
State General Funds for MAT Medicaid Reimbursement for Suboxone without Prior
Authorization for Addiction Treatment Co-sponsorship & Support for Development of ROSC Education & Training Evaluation of MAT in Addiction Treatment Consulting Medical Director
STOP Selling What You Have
START Selling What They Need
STOP Talking, START Doing
IBM.com/doing/uk
Heathrow Airport Billboard
October/December 2008
Primary Barrier
People don’t know what they don’t know
Challenges
Addiction is a Chronic Health Condition! Information & technology transfer Policy & Regulatory Changes – connecting the dots Preventing Prior Authorization and benefit limitations
specific to Medications for Addiction Treatment Funding, Policy, & Professional Silos Using data results to support the above and make the
business case for sustaining and expanding access to MAT
Results
Four original RWJF Advancing Recovery MAT Pilot Sites
Percent of Admissions with any MAT
Percent of admissions with any MAT
0%
5%
10%
15%
20%
25%
30%
35%
40%
Percent of admissions with any MAT - AR agencies
Percent of admissions with any MAT - Non AR agencies
Percent of non-methadone admissions with MAT other than methadone
Percent of non-methadone admissions with MAT other than methadone
0%
5%
10%
15%
20%
25%
30%
Percent of non-methadone admissions with MAT other than methadone - AR agencies
Percent of non-methadone admissions with MAT other than methadone - Non AR agencies
Percent of admissions with Buprenorphine
Percent of admissions with buprenorphine
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Percent of admissions with buprenorphine - AR agencies
Percent of admissions with buprenorphine - Non AR agencies
Reduced use at discharge: AR agencies
Reduced use at discharge: AR agencies
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Reduced use - non-methadone MAT Reduced use - no MAT
Percent Abstinent at Discharge
Percent abstinent at discharge: AR agencies
0
10
20
30
40
50
60
70
80
Percent abstinent at discharge - non-methadone MAT
Percent abstinent at discharge - no MAT
Successful Whole Systems Change Requires ART Trust & Respect Identified Common & Shared AIMS AND
Mutual Accountability & Transparency Common Shared Language – Between
professional fields and the recovery community
Cultural Competency Positive Role Models, Access to
Coaching/Recovery Support