Integration of Recovery Support and Healthcare – A Case Study

Integration of Recovery Support and Healthcare – A Case Study

According the DHEC there were 550 deaths in South Carolina from a drug overdose with prescription opioid drugs listed on the death certificate in 2016, up 7% from 512 in 2015 and up 18% from 464 in 2014. In 2016, Greenville County had the largest number of drug-related deaths (53) in South Carolina outside of Horry County. Pickens, Oconee and Laurens counties ranked in the next tier of counties with the most drug-related deaths (45 total). The healthcare system bears a great deal of the burden in responding to the growing opioid epidemic. This issue adds to an already overwhelmed system where SUD is concerned. For example, at Greenville Memorial Hospital (GMH) from July 2015 – June 2017, there were 3,628 inpatient admissions due to substance use disorder (SUD) related diagnoses codes and direct average cost for these hospitalizations was comparable to patients admitted for congestive heart failure or pneumonia (~$4,500 per hospital stay). Analysis of utilization at just one catchment area ED (GMH) for behavioral and substance use disorders over a one-year period (2016-2017) revealed alcohol misuse as one of the 3 most common primary diagnoses along with anxiety and depression, with approximately 2000 patients with 2 or more visits to ED, and total cost of $4,007,569; 70.1 % of this payor mix was self-pay (41.2%) or Medicaid (28.9%). SUD is wreaking havoc on the healthcare system and opioid use disorder is set to make this situation even more unmanageable as we look to the future. Despite the widespread negative impact of SUDs, only 10% of people in the U.S. with SUD receive treatment leaving 90% unengaged in any type of recovery process. A major service gap nationwide and in the project catchment area is lack of follow up on referrals. When people leave the hospital or their primary care setting they simple do not adhere to the discharge recommendations. This is to be expected and is a reality that must be confronted. We also know that 15% of individuals who present with an overdose in the emergency department will die from another overdose within the year raising the urgency around healthcare and recovery integration. Engagement of patients with an opioid use disorder is an area that needs to be refined along with ongoing retention in recovery support. Our current system is relatively fragmented with many opportunities for the patient to “drop off” and disconnect with services. The traditional routes of referral from healthcare to acute care treatment settings have proven insufficient. Therefore, we believe that the integration between healthcare and recovery support services is an essential piece of the puzzle as we move forward in this battle to arrest the opioid epidemic. This training will focus on the unique relationship between Faces and Voices of Recovery (FAVOR) Greenville and the Greenville health system. Over the past 5 years these two organizations have forged a working relationship that is setting the standard in terms of recovery and healthcare integration. FAVOR Greenville is an independent recovery community organization. Named one of 4 model programs nationwide by the Substance Abuse Mental Health Services Administration (SAMHSA) FAVOR Greenville is the premier provider of recovery coaching services in the nation. Recovery coaching represents a new, continual model of care tailored to a patient’s specific needs, recovery stage, and personal challenges in maintaining recovery. It is based on a partnership between the certified coach and the patient and consists of a long-term recovery plan that encompasses physical, social, psychological, and familial goals towards success. Recovery coaching uses a patient-centered approach to formulate a peer-guided customized plan for recovery success and enhanced quality of life. Coaches develop an individualized recovery plan and serve as liaisons for patients to gain access to specialty and community services. Peer-based recovery services are associated with improved relationships with providers, increased satisfaction with the treatment experience, reduced rates of relapse and increased retention in treatment programs. In addition to coaching services, FAVOR Greenville provides family support programs, group coaching services, educational activities, intervention services, and community-based socialization activities for individuals and families in need. FAVOR Greenville has 28 satellite locations/partnerships across the Upstate of South Carolina and serves over 5,000 new participants each year. Greenville Health System (GHS) first opened its doors as City Hospital back in 1912. Over the last 100 years, the organization has evolved from a single free-standing hospital to a highly integrated delivery system and now an academic medical center. In that time, GHS has become the state’s largest not-for-profit healthcare system and an advocate for healthy living initiatives, such as LiveWell Greenville, the GHS Swamp Rabbit Trail and Greenville B-cycle, the city’s new bike share program GHS’ commitment to medical education has also advanced over the years, most notably with the recent opening of the University of South Carolina School of Medicine Greenville on GHS’ Greenville Memorial Medical Campus. This new medical school is focused on transforming healthcare delivery by training physicians to connect with communities, patients, colleagues and technology in a new, more progressive way. This training will focus on the integration of these 2 organizations toward the goal of more effectively addressing the opioid epidemic in the Upstate. We will explore the history and evolution of the relationship, the status of current projects, and potential future projects. Richard Jones CEO FAVOR Greenville will moderate and participate in a panel discussion with key leaders from GHS to illustrate the specific programs and landmark projects that have been initiated over the past 4 years. Specifically, we will explore the following topics: Alain Litwin, MD, MPH, MS, Chair of Academics and Research, Department of Medicine will discuss the overall vision of addiction medicine and recovery integration within the GHS programs with special emphasis on the role of recovery coaching in implementation of a chronic disease management approach. Karen Lommell, DO, MHA, MS; Behavioral Health Chief Medical Officer Division Chief of Emergency Psychiatry Department of Emergency Medicine & Academic Department of Psychiatry and Behavioral Medicine will discuss the evolution and implementation of the FORCE (FAVOR Overdose Recovery Coaching Evaluation) program which launched in January 2018. Recovery Coaches provide 24 hour on-call response to overdoses in the GHS Memorial Campus Emergency Department. Results have been stunning: FAVOR Greenville recovery coaches have successfully engaged 97% enrolling 92 patients in the program. 73% remain active cases with FAVOR Greenville and 62% have been linked to other treatment/recovery services. Lauren Demosthenes MD, Medical Director of High Value Care and Innovation, Department of Ob/Gyn will discuss the evolution of the FAVOR Greenville and University of South Carolina School Of Medicine at Greenville (USCOMG) partnership. Since 2016 FAVOR Greenville has been involved in training 3rd year medical students in the Recovery Coaching discipline. These students then act as liaisons and recovery advocates within various settings at GHS. In addition, several of the students serve as volunteer coaches at FAVOR Greenville. This partnership is unprecedent and has been featured at the Association of American Medical Colleges annual conference in 2017. Participants in this training will: Gain an understanding of the process of recovery integration into a healthcare setting. Be able to identify potential opportunities and challenges associated with recovery integration in various healthcare settings Identify potential plan of action for increasing recovery and healthcare integration in local communities