Center of Excellence
Kate Henry LCSW, CCDPD
Stacey Burroughs, LPC, CAADC
Behavioral Health Service Line
May 15th 2017
LG COE Program
•DHS implemented 45 OUD Centers of Excellence (COE)
•LGH’s COE Care Management team will help individuals with OUD navigate the
health care system by:
• Integrated Counselors representing our 7 geographic regions of care
• Facilitating initiation into OUD treatment from emergency departments & primary
care physicians
• Helping individuals transition from inpatient levels of care as well as correctional
facilities to ongoing engagement in outpatient treatment
• Motivating & encouraging individuals with OUD to stay engaged in both physical
health and behavioral health treatments
Why Medication Assisted Recovery?
•Medication Assisted Treatment (MAT) is clinically and cost effective
•Saves lives, saves money (healthcare and societal)
•Only 30% of treatment programs offer MAT
•3% of US physicians have DEA waiver-1% active
•Less than half of eligible patients have access to MAT
•MISSED OPPORTUNITY to use most effective medications we have to treat OUD
amidst a crisis
Lancaster County COE
• LGH/ Penn Medicine receive the Lancaster County Primary
Health COE award.
• Buprenorphine and naltrexone treatment
• Through the HealthChoices physical health network
• T.W. Ponessa & Associates receive the Lancaster County
Community COE award.
• Licensed drug and alcohol provider that provides
counselling, methadone, buprenorphine, or naltrexone
assisted treatment
COE Team
MAT provider
within region
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PCP office
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Identifies patient
Prescribes medications
Continuity of Care
MAT prescribing
Collaboration with Care Managers
+/- Direct evaluation
COE Integrated
Therapist
Patient
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Discloses symptoms
Attends appointments
Fills out screens
Engages in partnerships for
treatment
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Community
Partners
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Engages patients
Treatment
Regular follow up
Communication with
COE Care Manager
Engages patients
Brief crisis management
Regular follow up
Tracks patients in registry
Brief intervention
Collaborates with natural and community
supports
Referrals out for assistance: housing, food,
rehab, detox, on-going tx
SUSQUEHANNA
COE
RCM COE
THE BUCK COE
LGH COE Regional Approach
•DOWNTOWN-Recovery Care Medicine operating out of Comprehensive Care Medicine
COE start date 1/1/17
• 4 physicians rotating 1/week
• 1 LCC
• 1 LPN
•SOUTHERN- The Buck Family Practice COE start date 2/8/17
• 1 physician 1/week
• 1 LCC
• 1 CMA
•COLUMBIA/YORK- COE at Susquehanna Family Practice April ‘17
• 2 physicians rotating 1/week
• 1 LCC
• 1 LPN
COE LCC
Patient 1
1300
Patient 2
1315
Patient 3
1330
COE
PHYSICIAN
Patient 1
1315
Patient 2
1330
Patient 3
1345
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COE LCC will need
additional intake time with
patients (1 hour time slot)
Need to be seen every 30
days
Intake template
Progress note template
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Patient agreement
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Inpatient Referral Process
Outpatient Referral “AMB REF 385”
Patient Story
• 36 year old female 23 weeks pregnant arrives to Women's and Babies Hospital in opiate withdrawal
• Struggling with using opiates and cocaine throughout pregnancy
• SW at WBH initiated D&A consult on 2/17/17
• COE LCSW met with patient at WBH completed level of care assessment for office based MAT 2/17/17
• Coordination between COE physician and COE LCSW able to provide script for Subutex to patient 2/17/17
• COE LCSW referred to Blueprints for D&A counseling on 2/17/17
• Intake completed at Blueprints on Monday 2/20/17
• Patient arrived for follow up at COE clinic on Tuesday 2/21/17
• Provided UDS-negative for illicit substances, positive for Subutex
• Referral for prenatal care and social worker initiated to Healthy Beginnings Plus
TIMELINE
• Referral initiated to COE 2/17
• LOC assessment completed 2/17
• MAT started 2/17
• Treatment intake 2/20
• MAT follow up appointment 2/21
• HBP referral 2/21