Bassett Earns Statewide Recognition for Opioid Addiction Treatment in Primary Care Setting A Model for NYS

Bassett Healthcare Network

In the fall of 2016, Bassett Healthcare Network, in collaboration with DSRIP's Leatherstocking Healthcare Partners Collaborative, launched an innovative program aimed at making evidence-based addiction treatment more readily accessible to people living in rural central New York by offering medication-assisted treatment (MAT) in the primary care setting. The program is now being held up as a model for other health systems around the state and has earned Bassett the Healthcare Association of New York State's 2018 Pinnacle Award for Quality and Patient Safety. The award recognizes organizations that are playing a leading role in promoting improvements in health care delivery in New York State.

Battling an Epidemic

According to the Centers for Disease Control and Prevention, on average, 115 Americans die every day from an opioid overdose.

Currently, Bassett's opioid addiction program is helping more than 200 patients from around central New York address their addiction through a combination of MAT, counseling and comprehensive primary care to address other health issues.

"Some counties in our project's service region had among the worst rates of overdose for prescription opioid and heroin use in the state in 2015," explains James Anderson, PhD, a clinical psychologist with Bassett and medical director for behavioral health and integrated services. "However, in order to receive MAT, they often had to travel over 60 miles one-way. We had to figure out a way of helping the population we serve that is struggling with addiction. By weaving treatment into our primary care services and conceptualizing it as management of a chronic health condition, it fits within the purview of whole-person primary care to which our primary care clinicians are accustomed.

"Primary care visits within Bassett Healthcare Network are also covered by private insurance and Medicaid, making addiction treatment in this setting accessible to more patients regardless of income."

The network now has 27 primary care practitioners, both physicians and advanced practice clinicians, who have obtained Drug Addiction Treatment (DATA) waivers or "x" licenses, in order to be able to prescribe buprenorphine for treatment of opioid addiction. Bassett's goal is to have 90 percent of the network's primary care clinics offering addiction treatment as part of comprehensive primary care within the next three years.

MAT in Norwich

Dr. Jennifer O'Reilly, a primary care physician and medical director in Bassett's Norwich health center, is working with family nurse practitioner Pam Gilbert to help addicted patients. They currently have 58 patients in treatment. "The work has been incredibly rewarding," says O'Reilly. "We are able to offer prenatal care in conjunction with MAT to our pregnant patients. We have a number of patients who have been able to find stable housing, successfully start a job, and regain custody of their children since starting treatment. We have been able to address multiple chronic illnesses, including hepatitis C, that otherwise would have gone untreated. We are also providing contraceptive care, preventative screenings, and mental health care for these marginalized patients. The patients have been so grateful for help, and having them receive their treatment in primary care has normalized their condition and helped them to feel less persecuted and judged for their mental health and substance use issues."

An important factor in the program's success has been a partnership with the University of Massachusetts (UMass) to provide training, consultation and support through the first year. Clinicians, nurses and office staff from health centers around Bassett's eight-county service region met weekly in a virtual video conference with two family medicine physicians from UMass who have significant experience in using buprenorphine to manage opioid addiction, as well as a clinical psychologist with experience in providing integrated behavioral health care. These sessions served to help answer specific questions about an individual patient and allowed the group to learn from each other about how to best deliver this component of care. In conjunction with DSRIP, Bassett is currently exploring a second year of collaboration with UMass.

In addition to the collaboration with UMass, the network hired an addiction medicine psychiatrist (Dr. Roxanne Lewin), who helps initiate treatment for many of the patients and then transitions them back to primary care once they are more stable. Lewin also acts as an ongoing resource to support primary care providers within their clinics, as they care for patients struggling with addiction.

MAT Piloted in Cobleskill

Dr. Joseph Sellers, regional medical director and a primary care practitioner in Bassett's Cobleskill clinic where the MAT program was first piloted, says, "We've been doing this a year and a half now; we've matured quite a bit. Initially, we worried about people's substance abuse and now that's evolved to the patient's recovery phase and helping with transportation; education and job development."

Between the Middleburgh, Schoharie and Cobleskill health centers, Bassett's Schoharie County clinics are helping 48 patients through addiction treatment and recovery. Sandra Falco is the nurse manager for the Cobleskill health center.

"This is so much better than before when we had to refer them to community resources, which were very thin and patients might not follow through," explains Falco. "In the primary care setting, there's no stigma. Our addicted patients are here for treatment of a chronic illness and they're grateful to have help managing other medical conditions as part of their overall health. It's exciting to be able to effect such positive change on our patients' lives."

Sellers agrees and notes, "We've had people who've gotten their lives back together; I've had a patient graduate from college, get a job and move on with his life. It is tremendously rewarding."

Bassett was honored with the Pinnacle Award at HANYS' 50^th annual membership conference June 28. This is the third year in a row Bassett Medical Center has earned HANYS' prestigious Pinnacle Award for Quality and Safety. The previous awards were for initiatives related to improving outcomes for diabetic patients and patients on dialysis.

HANYS encourages other hospitals to garner ideas and identify best practices for quality and safety improvement from published award submissions. More information is available at www.hanys.org.