The Florida Alliance for Healthcare Value held the third and final session of its virtual Summer Education Series on July 30. This two-hour session opened with Seminole County Sheriff Dennis Lemma speaking about the magnitude of the opioid crisis and the expansion of a statewide initiative called “Project Opioid.” His presentation was followed by a panel discussion on comprehensive and effective addiction recovery moderated by Francois de Brantes, Senior Vice President at Signify Health. Panelists included Eric Bailly, Business Solutions Director at Anthem, and Brad Rex, President & CEO of eHome Counseling Group, and Greg Williams, MA, Managing Director at Third Horizon Strategies.
The Rise of the Opioid Epidemic
Sheriff Lemma began by providing a history of drug abuse in the state of Florida and how it grew to be the current opioid crisis. He discussed the key factors that cultivated this epidemic,
including the deceptive sales tactics of Purdue Pharma, the creator of Oxycontin, which led providers to think the drug was not addictive, and the evolution of a “pain-centric” society where patients desired zero pain and great emphasis was placed on satisfying this need with opioids, no questions asked.
“Unlike other drugs, more than 80% of abusers became addicted following the direction of someone they trusted — a physician,” said Sheriff Lemma.
He also explained how the prolonged and sustained use of opioids changes the brain over time, impairing its function. Rather than the prefrontal cortex — which is responsible for thinking, reasoning and learning — controlling decisions, the amygdala — known for stress response and “fight or flight” — takes over. In addition, opioids attach to the mu receptors in the brain, sending a signal to the body to “relax” even to the point of stopping primary organ function such as breathing.
NARCAN®, an opioid antagonist, has emerged as a highly effective emergency treatment to reduce deaths from opioid addiction. Provided as a nasal injection, it attaches to those same mu receptors and tells the brain not to shut down and to keep breathing. This can bring patients back to life and buy time — providing 90 minutes to get a patient proper medical attention.
Despite this life-saving treatment, challenges remain. There was a 42% increase in drug overdoses nationwide this past May. “Unfortunately, COVID-19 is making the opioid crisis even worse due to the combination of isolation and unavailable support mechanisms,” explained Sheriff Lemma.
The Need for Comprehensive Opioid Addiction Treatment
Sheriff Lemma shared that addiction is a complex brain disease and should be treated as an illness. Best practice for treatment combines the use of medications, counseling and community support.
“Our old anti-drug campaigns would say, ‘Just Say No,’ but it isn’t that easy,” he explained. “Treating opioid addiction is not about making bad people good but about making sick people well.”
Sheriff Lemma also shared that a study by Kaiser found that patients receiving addiction treatment that combined medications with counseling had lower total healthcare costs, compared to those with little or no addiction treatment. In fact, every dollar invested in substance abuse treatment provided a $4-$7 return on investment.
In addition, he talked about achieving addiction independence and how it is important to understand that relapse is part of the process.
“The recovery period can be twice as long as the time of drug dependency,” he said.
Project Opioid and Recommendations for Employers
Project Opioid aims to connect all the dots. It is a coalition of business, faith and community leaders working together to solve the opioid, addiction and mental health crisis in communities
across Florida. The goal is to reduce opioid overdoses and deaths in Florida by a minimum of 50% over the next 36 months. Sheriff Lemma encouraged employers to join a local Project Opioid coalition. More information is available at https://www.projectopioid.org.
Additional recommendations for employers included:
- Have NARCAN® available in your business to save lives.
- Start a conversation within your company and community about opioid abuse.
- Increase awareness of who is affected by opioid addiction and decrease the stigma. One in three people have someone close tothem who is navigating recovery. It is very prevalent in 20 to 40-year-olds, and white females are the fastest growing group.
“Join our effort and help us build momentum,” said Sheriff Lemma in closing out his presentation. “Employers absolutely can make a difference. We want Florida to be the example for the country.”
A Comprehensive Alternative Treatment Approach for Substance Use Disorder
Sheriff Lemma’s presentation was followed by a panel discussion on comprehensive and effective addiction recovery. Brad Rex opened by sharing some recent data collected by his firm on the impact of COVID-19 on mental health. They compared their March-June 2019
patient assessments to those from the same period in 2020 and found:
- Depression was up 33%
- Anxiety was up 27%
- PTSD was up 88%
- Drug use was up 39%
- Alcohol use was up 16%
- Suicidality was up 15%
Francois de Brantes commented about the hidden pandemic of substance abuse and behavioral health conditions. “It started long before COVID, was made worse by COVID and will continue well after it is gone,” he said.
He shared the impact of substance abuse on employers:
- Seventy percent of people with direct or indirect substance abuse disorders are employed
- They have 40% more missed days from work than other employees
- They are 50% more likely to change jobs every year
- They cost an employer close to $10,000 a year
He also referenced an important effort in Florida, the Maternal Opioid Recovery Effort (MORE), which aims to screen all pregnant women for opioid abuse and addiction and connects them to needed care. Florida Alliance CEO Karen van Caulil mentioned that drug related deaths are the leading cause of death to Florida mothers during pregnancy or within one year post-partum. She also mentioned that the MORE assesses the pregnant woman for medication assisted treatment, links them to appropriate treatment and develops a safe plan of care for the baby.
Francois de Brantes also shared the findings from an Anthem study that found plan members with a substance abuse disorder consume three times as much health care. Most of it is in medical costs because of spillover co-morbid conditions such as gastroenterological issues and cardio-metabolic conditions.
However, when employees are in stable recovery, they are even more productive and less costly than other employees.
“Investment in getting to lasting recovery has a huge payoff at every level,” said de Brantes. “It is a literal 180° for the employee.”
The Emergence and Benefits of Telehealth Counseling
Rex went on to explain the benefits of telehealth, which has become the primary counseling delivery method since COVID-19. He referenced studies supporting telebehavioral health that
- 20% faster appointments than in-person sessions
- 25% reduction in hospitalization rate, lengths of stay and services
- 60% decrease in missed appointments
- 80% completion rate for addiction treatment vs. 41% for traditional delivery
The Need to Re-Engineer Substance Abuse and Behavioral Health Care
Greg Williams talked about how recovery disruptions and repeat acute treatment episodes are an issue in Florida and why re-engineering care is important to address the highly fragmented system.
“A 30-day inpatient treatment is not all people need,” he said. “Addiction is a chronic illness and requires longitudinal care. We need ongoing chronic disease management and care coordination to help patients navigate care and keep them connected and engaged.”
He shared a holistic model for an Addiction Recovery Medical Home published by the Alliance for Addiction Payment Reform that encompasses primary care providers, licensed counselors, behavioral health specialists, clinical pharmacists, social services and community support among others.
“To quote former congressman and the original sponsor of the Mental Health Parity and Addiction Equity Act, Patrick J. Kennedy, ‘It’s time to reconnect the head to the body in our health care systems,’ Substance use disorders and behavioral health drive a substantial amount other physical health problems and costs,” said Williams. “Integration and payment reform can be driven by the employer community. There is a real opportunity to transition to a model that carves substance use disorders and behavioral health back into overall health.”
Eric Bailly concurred. Bailly indicated that health plans are looking for ways to improve the quality of substance use disorder treatment that members are receiving, to include identifying the potential for payer-provider innovation such as the Addiction Recovery Medical Home model. “There is one common thread. Quality of care needs to improve, and we need to hold each other accountable for downstream impact.” Anthem is starting several pilot programs ofthe Addiction Recovery Medical Home Alternative Payment Model.
Recommended Employer Actions
Specific recommendations the panel had for employers included the following:
- Demand metrics-based care — hold your payer accountable for providing information on mental health and substance abuse.
- Address the fractured treatment ecosystem between physical and mental health. Break the silos and move toward integrated health.
- Pursue payment innovation.
The Path Forward for Mental Health and Substance Use
In addition to the insight provided from the speakers at this session, Karen van Caulil shared that the organization has been selected through a competitive process to lead efforts in Florida to improve mental health and substance use treatment. This initiative is part of a national transformative initiative called The Path Forward for Mental Health and Substance Use led by the National Alliance of Healthcare Purchaser Coalitions, the American Psychiatric Association (APA), the American Psychiatric Association Foundation (APAF) Center for Workplace Mental Health and Meadows Mental Health Policy Institute. The Florida Alliance’s efforts are
focused on achieving measurable improvements in five priority areas:
- Increasing capacity and improving access to “in-network” behavioral health specialists
- Expanding use of the collaborative care model to integrate behavioral health into primary care
- Implementing measurement-based care in both primary care and behavioral specialty care to improve quality and outcomes
- Expanding tele-behavioral health
- Ensuring mental health parity compliance
She indicated that “We are leveraging the influence of our employer and healthcare purchaser members to work with Florida’s health plans, medical and behavioral groups, consultants and brokers to transform the current system and achieve meaningful outcomes.”
Thank you again to our Summer Education Series sponsors: Amgen, Centivo, Genentech, Heron Therapeutics and Signify Healt