In 2014, opioid addiction was just beginning to surface nationally as an epidemic, but it was already overwhelming CHI St. Gabriel’s Health in Little Falls, Minn.
The No. 1 reason patients visited the rural hospital's emergency department was to obtain narcotics for chronic pain, and in the clinic next door, family practice providers were inundated with refill requests for prescribed pain medications.
“We also started to see in our community a lot more overdoses related to opioids, and those overdoses were hitting our [ED] as well,” says Lee Boyles, president and CEO of CHI St. Gabriel’s, a recipient of this year’s American Hospital Association NOVA Award.
What’s more, about 60 percent of the narcotic medications prescribed by the health system's clinic were diverted by patients for illegal sales, Boyles says.
“We felt, talking with law enforcement and other agencies, that we really needed to do something about this,” he says.
The next year, CHI St. Gabriel’s obtained a $368,112 grant, part of a $45 million State Innovation Model cooperative agreement awarded to the Minnesota Department of Health and Human Services by the Center for Medicare and Medicaid Innovation to help implement the Minnesota Accountable Health Model. The grant required a community-integrated care model, and CHI St. Gabriel’s focused on prescription drug abuse.
The grant enabled CHI St. Gabriel’s to launch Morrison County Community-Based Care Coordination. The health system’s partners in the venture are South Country Health Alliance, the Morrison County Public Health and Social Services departments, and several other representatives from the Morrison County Prescription Drug Task Force.
Boyles notes that rural providers face particular challenges when dealing with drug addiction. “Physicians in a rural setting can grow to trust their patients so much they don’t want to believe their patients could be diverting the drugs they’re supposed to be taking,” he says.
The program includes three key components: a multidisciplinary, care-centered team; a leadership team that oversees the care team; and a communitywide prescription drug task force.
The care team was designed to serve patient needs beyond the boundaries of the traditional care delivery model. The program’s “physician champions,” Kurt DeVine, M.D., and Heather Bell, M.D., led the effort to change prescribing practices of providers at the clinic and emergency department. Prescription orders were expanded to include start dates, a maximum number of pills per day and a “must last 30 days before refills” provision. “Even when a patient’s medication was being tapered, our goal was to provide optimum treatment. We did not want our program to be punitive,” says DeVine.
In addition to prescribing, treatment is a high priority for the program. Bell recalls losing a patient to a heroin overdose one day before she received notice of her DEA certification for suboxone administration. “Losing patients to this addiction is what motivates me to do this work,” she says.
Other members of the team contribute their expertise. The team’s pharmacist reviews prescription histories recorded in the electronic health records, with an eye toward safely tapering patients from high narcotics doses, while the social worker considers how to address a patient’s other issues, such as behavioral health history, addiction, homelessness, insurance needs and transportation.
In one instance, for example, the team helped a homeless patient with no family support system achieve full recovery from knee surgery through physical therapy and compliance with his medication therapy. The patient also moved into a suitable apartment and returned to a quality of life that improved his relationships with his adult children.
During the first year of the program, the drug-seeking diagnosis fell off the top 20 list at the CHI St. Gabriel's ED. One local pharmacy saw a 20 percent drop in narcotics prescriptions. In a four-month period, South Country Health Alliance tabulated a $439,674 reduction in pharmacy claims compared with the same period the year before.
“We know from our own internal tracking that, as a clinic, currently we are taking over 16,000 pills off the street every single month,” Boyles says. “We’re making a significant difference in the amount of prescription narcotics that were being diverted and hitting the street.”
Boyles says the program can be replicated wherever the need exists. “What we're doing in a rural community could be done in the inner city. You need a physician champion. It has to start with a physician who is willing to change the culture. And you need a team approach. You need to be partnering with stakeholders in your community. With the right team and the right resources, our program can be done anywhere.”
Each year, the American Hospital Association honors up to five programs led by AHA member hospitals as “bright stars of the health care field” with the AHA NOVA Award. Winners are recognized for improving community health by looking beyond patients’ physical ailments, rooting out the economic and social barriers to care and collaborating with other community stakeholders. The AHA NOVA Award is directed and staffed by the AHA's Office of the Secretary. Visit www.aha.org/nova for more information.