Becker's Clinical Quality & Infection Control

56 OPIOIDS CMS targets children affected by opioid epidemic in new care model By Harrison Cook C MS created a new payment and service delivery model to improve care quality for children under age 21 affected by the opioid epidemic, the agency announced Aug 23. The Integrated Care for Kids Model will focus on the pre- vention, early identification and treatment of behavioral and physical health needs among kids covered by Medic- aid and the Children's Health Insurance Program. This new model aims to empower states and local healthcare provid- ers to better address these needs through increased care integration to lower expenditures and boost care quality. "The interventions outlined in the InCK Model are designed to respond to this crisis by supporting state Medicaid agencies and local health and community-based partners to increase access to behavioral health for vulnerable children and build capacity in communities to provide more effective, efficient, and affordable care through home- and communi- ty-based services," CMS said in a press release. The CMS Innovation Center will release a Notice of Funding Opportunity this fall with more information on how state Medicaid agencies and other local health organizations can apply to participate in the seven-year model. The agency intends to fund eight states, where each state would receive a maximum of $16 million by spring 2019. n What hospitals can learn from California EDs treating addiction on demand By Megan Knowles O akland, Calif.-based Highland Hospital is among a small number of U.S. emergency departments that give patients withdrawal medicine, an effort to change a healthcare system that often fails to give on-de- mand addiction treatment, The New York Times reported. Here are seven things to know: 1. Highland Hospital is Oakland-based Alameda Health Sys- tem's flagship facility, with 236 beds. The hospital offers bu- prenorphine as immediate treatment to patients experienc- ing withdrawal. Buprenorphine works by easing withdrawal symptoms and cravings and is one of three medications approved in the U.S. to treat opioid addiction. 2. In giving buprenorphine around the clock to people in crisis who may never seek medical care, Highland, along with other institutions starting opioid addiction treatment in the ER, is ensuring it doesn't lose a rare treatment opportunity. "With a single ER visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of crav- ings," said Andrew Herring, MD, emergency medicine spe- cialist at Highland leading the buprenorphine program. "It can be this revelatory moment for people — even in the depth of crisis, in the middle of the night. It shows them there's a pathway back to feeling normal." 3. For patients beginning addiction medicine, finding a physician who prescribes buprenorphine and takes insurance can be challenging, and long waits for an initial appointment can lead to relapses and overdoses. 4. A 2015 study from Yale-New Haven (Conn.) Hospital found addicted patients who were given buprenorphine in the emergency room were twice as likely to be in treat- ment a month later as those patients who received an informational pamphlet with phone numbers. When Dr. Herring read the Yale study, he persuaded the California Health Care Foundation to give a small grant to Highland and seven other Northern California hospitals in 2017 to test dispensing buprenorphine in their ERs. 5. California is spending about $700,000 more to extend the concept as part of a $78 million effort to create a sys- tem that provides more access to addiction medications. In this system, ERs would start people on buprenorphine and refer them to a large-scale addiction treatment clinic to adjust to the medication, and then to a primary care practice for continuous care. Dr. Herring is the principal investigator for the project, called ED Bridge. 6. Highland's ER has offered buprenorphine to over 375 patients since February 2017. Two-thirds of the patients accepted it, along with an initial appointment for treat- ment at the hospital's addiction clinic. Even if patients are reluctant to begin treatment, those who try buprenor- phine in the ER may be more likely to do so later, Dr. Herring said. 7. Gail D'Onofrio, MD, lead author of the Yale study, said she's been receiving calls weekly from ER physicians in- terested in her hospital's model. Since the study's publi- cation, several dozen EDs, including in Boston, New York, Philadelphia, Maine, New Jersey and New York, are now offering buprenorphine. n

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