MAT Inside Service Walls by the Maine Department of Corrections — An OPEN MINDS Program Profile

Program History

In early 2019, Maine Governor Janet Mills signed an executive order directing state resources to be directed at the Maine Department of Corrections (MDOC) to help justice-involved residents suffering from opioid addiction. After getting the okay from the governor, Deputy Commissioner Ryan Thornell, who oversees the program, brought together staff from all levels in the MDOC to participate in a steering committee to map out the timeline and procedures for implementing MAT treatment for residents. This committee consisted of security staff, nurses, case managers, administrators, clinicians, and community treatment professionals. One of the important pieces was listening to concerns from security officers who worried medication assisted treatment (MAT) was similar to contraband items forbidden by the MDOC.

Population Served

Maine’s pilot MAT services started at four of the state’s six adult correctional facilities focusing on caring for residents who fit medical criteria and were 90 days from their release date. This pilot was population focused on ensuring continuity of care so that as the client was released, he or she had a solid plan in place to continue treatment and engage with community programs like peer support, harm reduction, and community-based recovery groups. By November 2019, the department expanded MAT access to a fifth facility, and three months later, in February 2020 expanded MAT access to the remaining sixth facility, the Maine State Prison.

Less than a year after the pilot, MDOC expanded the MAT program again to provide different types of buprenorphine and naltrexone to residents six months from their release date and provide maintenance to those entering the system already on an MAT, including methadone. By May 2021, the eligibility criteria were further expanded to include residents who still had two years until being released. Today, MAT services are universally accessible to any resident in Maine’s state correctional system, regardless of sentence length. MDOC started with about 100 residents and now reaches about 700 adult residents a year.

Program Fees & Funders

Costs associated with the first-year pilot during fiscal year 2020 totaled $1.2 million and included $450,000 in braided funds through a partnership with the Maine Office of Behavioral Health (OBH) and the Director of Maine’s Opioid Response, Gordon Smith. With the expansion in 2021, costs increased as projected, but they were below expectations, totaling close to $930,000. Ongoing costs for the service will run close to $1.5 million, which is about $500,000 less than originally anticipated, the added costs related to universal expansion.

Program Performance & Metrics

As Maine evaluates the costs associated with this established service, the department will be able to continue using the braided funds from state and federal agencies, will tap into overall savings acquired through reduced costs from having more healthier residents, and consider the option of establishing an Opioid Treatment Program within a facility, which some addiction professionals say is the most cost-effective manner to way administer methadone to residents. In addition to treatment, MDOC staff has been focused on reducing the stigma of addiction recovery among residents. For example, staff worked to change their language in speech and in documentation to non-stigmatizing, person-first, person-centered language, using terms like “resident,” “client,” and “person with substance use disorder. MDOC has done away with stigmatizing words like “prisoners,” “probationers,” and “drug addicts.

Success

For the future, the MDOC plans to continue universal access to MAT and look to meet other cross-over needs for residents, such as treatment for Hepatitis C.

General info

Maine Department of Corrections Central Office
25 Tyson Drive, Third Floor
State House Station 111
Augusta, ME 04333
(207) 287-2711
https://www.maine.gov/corrections/home

Key Staff

Randall Liberty, Commissioner
Ryan Thornell, Ph.D., Deputy Commissioner
Gary LaPlante, Director of Operations
Susan Gagnon, Director of Adult Community Corrections
Anna Black, Director of Government Affairs

 

Four ‘Must Have’ Competencies For Post-Pandemic Competitive Advantage

By Monica E. Oss

We’ve covered the “triple whammy” of the pandemic on next normal health care—shifting competition based on changing consumer expectations, payer expectations, and price points (see Post-Pandemic, Strategy Needs Technology). I got a better sense of the market factors driving these changes—and the new competencies required for success—in a recent article, How Digital Is Changing The Pharma & Healthcare Industry, by Nikki Gilliland at Econsultancy. My takeaway is that there are four new competencies that executive teams should be thinking about to stay in the game as the effects of the pandemic digital shift become standard market factors.

To start with, the “must have” hybrid service model requires digital first consumer intake processes. For care coordination programs to be successful—and cost-effective—remote monitoring capabilities will likely be a “must have.” Another takeaway—to improve consumer engagement, social communities need to be built on and integrated into existing commercial internet platforms. And finally, without a robust web presence and expertise in search engine optimization, competing for referrals will be increasingly difficult. These are the next frontiers in organizational infrastructure for competitive advantage—and I’m adding them to my specialty provider organization competency map (see From Crisis To Growth: A New Leadership Mindset).

Digital first consumer intake/interface is critical to success with hybrid models. The pandemic has moved much of care delivery to virtual. But as we move to the post-pandemic landscape, the preferred service delivery modality is a combination of virtual and in-person care in clinics and in consumers’ homes. Recent research confirms this preference—in a national survey, more than 40% of consumers said that when it comes to mental health and routine care, they’d rather access services virtually or through a combination of virtual and in-person visits (see Post-Pandemic, Majority Of Patients Say They Prefer In-Person Care, Survey Finds). And a Healthgrades study found that when given a choice between health care providers with similar experience, proximity, availability, and patient satisfaction ratings, the vast majority of consumers—81% for primary care and 77% for specialists—choose the provider who offers online scheduling (see Specialty Care Strategy For A Tech-Enabled Future).

To make hybrid services an operational reality at scale, provider organization executive teams should develop a digital first consumer intake process with a well-designed “digital front door.” This intake process should include real-time appointment scheduling that is linked to both benefits eligibility information and the schedules of clinical team members. Many components of the digital front door, including online scheduling, can likely be built into existing EHR systems but standalone technology platforms are also available and can be integrated with current technology platforms.

Best practice care coordination will require leveraging personalized remote monitoring. Care coordination and case management services are slowly moving to risk-based and value-based reimbursement models—with reimbursement tied to outcomes. To be competitive in this market space, provider organization managers will likely need to deploy a coordinated suite of tech-enabled functionality. What does that look like? Decision support tools for care coordinators, driven by consumer data. Smartphone-based outreach to consumers for active monitoring, self-care supports, and engagement. Passive remote monitoring tools for staying on top of consumer health status over time. Market advantage will go to the organizations that can reduce costs by leveraging their clinical workforce with technology, while managing and optimizing performance and consumer outcomes.

Consumer engagement success will depend on strategies to build specialized social communities on existing platforms. Consumer engagement and participation in managing their health is key to making value-based reimbursement work. The question for clinical management teams is how to connect with those consumers. There are many standalone consumer web portals, discussion boards, blogs, and more. But getting traction with those standalone initiatives is difficult. Rather, consumers are likely to discuss issues and seek health care information, opinions, and suggestions from channels they are already active on. Provider organizations should consider facilitating social networks on existing platforms for their consumers and encouraging staff to weigh in on these online communities to share expertise when appropriate.

Social media platforms like Facebook, Twitter, Instagram, and YouTube (and to a lesser extent, LinkedIn), as well as messaging apps like What’s App and WeChat (in China) host consumer and caregiver groups with interest in specific conditions and treatments. Some of the newer apps for behavior-based chronic disease management also include a social component to let consumers engage with peers. But most consumer and professional engagement communities are web-based—they can be found through simple online searches and accessed with a web browser, while they also maintain a presence on all the major social media platforms. A Pew Research survey indicated that 26% of adult internet users had read or watched someone else’s health experience about health or medical issues in the past 12 months. And 16% of adult internet users in the U.S. go online to find others who share the same health concerns (see The Social Life Of Health Information).

There are a number of existing online communities. For example, MedHelp has communities for mental health, general health, diabetes, heart disease, pregnancy, and coronavirus. PsychU offers information, resources, and collaboration and discussion platforms on challenges and treatment approaches for mental health professionals. Verywell Mind offers consumer-friendly information, generated by clinical professionals, on a range of mental health topics. And, HealthUnlocked offers technology to build health communities and is available free to nonprofits, health advocates, and consumer organizations to start new communities.

Web presence and SEO expertise are needed to compete for customer eyeballs. As care becomes increasingly virtual, referrals will become increasingly virtual. Today, 13% to 17% of visits across all of health care are conducted via telehealth—which is 38 times higher than pre-pandemic use of virtual care (see Telehealth: A Quarter-Trillion-Dollar Post-COVID-19 Reality?). Prior to the pandemic, 67% of consumers searched for health care information online and 60% searched for provider reviews online (see Digital Health Consumer Adoption Report 2020). The pandemic has likely increased this consumer behavior and will also likely change the nature of professional referrals.

As executive teams consider whether their current website and web presence is an impediment to success or an asset, there are some basic questions to ask. Is the website content, user experience, search engine performance, and online reputation strategy meeting current consumer and referral source expectations? (For more, see our on-demand OPEN MINDS Circle Executive Roundtable Session, Designing Best In Class Websites: The OPEN MINDS Website Evaluation & Improvement Process.) The answers will drive strategies for enhancing the online brand presence, upgrading web site design and content, evaluating paid web advertising options to be “found” in web searches, and linking content to social platforms in order to increase reach to consumers and health plan partners.

The bottom line? To meet the preferences of consumers  and health plans—and succeed with new reimbursement rates and models—executive teams need to make a few additions to their “core competencies.” This will involve broader planning of infrastructure, both technology and human. The key question is not “What technology should we invest in?” but rather to define how technology can help to drive strategic objectives.

For more on the organizational competencies needed for strategic success, check out these resources: