1007 – Creating a New Case Management Team for Addiction and Recovery Treatment Services
Implementation of an expanded “Addiction Recovery Treatment and Services” program for a Medicaid population.
•How to Identify Populations at Risk for Addiction in need of recovery, treatment and services.
•Identify Unique Approaches to implementing and working with an ARTS Program.
•Lessons learned from an Implementation of an Addiction Recovery Treatment and Services Program.
Optima Health works with a challenging Medicaid Population of 175,000 members. Medicaid members are prescribed opioids at twice the rate of non-Medicaid members and are at three-to-six times the risk of prescription opioid overdose (Virginia Medicaid, 2017).
Controlled Substance Over-Utilization: We created and implement a Safety Initiative Program five years ago. This program identifies high risk members with over utilization of Controlled Substances. We then have a workflow for contacting, reviewing, and restricting to one Pharmacy and/or Provider. The Program has achieved an initial 50% reduction in ED Utilization within the first 6 months of Pharmacy Lock-in for program participants.
The Addiction Recovery Treatment and Services (ARTS) Program expanded from the Safety Initiative Program and added 6 unique population subsets. Each population requires a different approach and tailored solution. The ARTS Program includes the Safety Initiative and adds a comprehensive interdisciplinary Case Management approach to engage members in treatment and recovery, including the use of ASAM criteria, for placement in the correct level of care.
ED Diversion: We created a program to identify over utilization of the ED. Case Management partnered with our Outreach Team to make home visits and educate members on appropriate ED utilization.
The ultimate goal of an ARTS program is to provide easy access to life-saving addiction treatment in order to decrease the opioid epidemic that is spreading across our country.
1. How to Identify Populations at Risk for Addiction in need of recovery, treatment and services.
2. Identify Unique Approaches to implementing and working with an ARTS Program.
3. Lessons learned from an Implementation of an Addiction Recovery Treatment and Services Program.