The Department of Health and Human Services would like to clarify why our opioid health home model is an important step in addressing the opioid epidemic in response to the BDN’s April 11 editorial, “Maine’s ‘opioid health homes’ are so intricate there will probably be only a few.”
The BDN “review” of the opioid health home model failed to fully understand this model of care in its entirety. While I appreciate that this editorial board frequently issues commentary in opposition to this administration, this model deserves a deeper understanding that should transcend the editorial board’s philosophical opposition to our administration.
The department continues to invest in evidence-based treatment options to address the opioid epidemic. The most recent initiative — the opioid health home model — received bipartisan support, allowing us to allocate $4.8 million targeting care for MaineCare recipients and the uninsured.
At the core of this effort is a focus on expanding access to treatment in an integrated care setting. Through that access point we can engage more clinicians in prescribing medication-assisted treatment and behavioral therapy along with addressing other physical and mental health needs. This model will improve access to evidence-based treatment throughout the state — especially in rural areas — and provide a more integrated approach to treatment to support recovery.
There are many licensed providers in Maine who are unwilling to prescribe buprenorphine because of concerns their opioid-dependent patients require a level of service too cumbersome for a typical primary care provider to offer.
The opioid health home model is designed to provide a wraparound support system in the community that can provide services to support the individual and the prescriber. Its integrated approach focuses on treating the “whole person” through substance abuse counseling, care coordination, medication-assisted treatment, peer support and medical consultation.
Similar models have seen great success. For example, since the introduction of the Vermont opioid health home model in 2013, there has been a 69 percent increase in access to medication-assisted treatment. There also has been a dramatic drop in waitlists for services — from 379 in May 2016 to only 162 in February 2017.
In order to ensure maximal flexibility, this initiative has two options for which applicants can choose to apply. In the first, providers are reimbursed $1,000 per member per month, with Suboxone (buprenorphine) or Vivitrol (naltrexone) being provided directly by the opioid health home, rather than having the member obtain their medication from an outside pharmacy. Under this option, providers can determine the dosing frequency based on the individual’s need. Daily observed dosing is not required — despite what the BDN says in its editorial. Providers will work with the client to determine dosing needs and schedules. For some members, daily dosing is most appropriate, while others can receive a 30-day supply at a time. In this option, a co-located pharmacist is required to ensure the buprenorphine being dispensed is recorded in the Prescription Monitoring Program, in order to avoid duplicate prescriptions.
In the second model, providers will be reimbursed $496 per member per month, and the medication must be provided by a community-based pharmacy via a monthly prescription. This option provides expanded access to members who may not be in close proximity to a medication-assisted treatment provider with a pharmacist on site.
The editorial suggests this program has so many requirements and “intricate” details it would dissuade practices from becoming an opioid health home. In actuality, it follows a model analogous to those already used at Maine health homes and behavioral health homes. Today, there are 36 organizations enrolled in our current model with 107 sites serving more than 9,000 Mainers.
In the week since the opioid health home program has been announced, we have already received seven applicants.
The BDN editorial incorrectly states that the full staff complement must be housed at a primary care provider’s office. The model is extremely flexible and allows any entity that meets the core standards, as defined in the rule, and has a substance abuse license to participate. This means that providers could be but are not limited to mental health and substance abuse agencies, including methadone clinics, federally qualified health centers or practices that are part of a larger health system.
If we are going to successfully address the opioid crisis — we need to invest in innovative programs that provide a comprehensive and integrated approach to helping Mainers with opioid addictions.
Too many lives are being lost and families are being torn apart by this epidemic. I am confident this model will help Mainers who need and want to get better.
Mary Mayhew is the commissioner of the Maine Department of Health and Human Services.