The Greater Portland Addiction Collaborative, led by Mercy Hospital and several nonprofit and public sector partners, commits to saving and improving lives through a newly launched collaboration. Through their efforts, its members aim to contribute to the long-term health and wellbeing of the Greater Portland community, and hope that this collaborative approach can serve as a replicable treatment model that other communities can adapt or draw from, in Maine and beyond. The goal is to create a successful integrated and comprehensive treatment model for the Greater Portland community through the systemic accountability and optimization of existing assets. Under this new approach, the potential improvement in clinical outcomes, financial and operational performance of several organizations will drive resource allocation, continuous improvement, and delivery redesign that will result in fewer overdoses and untimely deaths.
The collaborative will implement a Coordination Team (CT) that meets weekly to review the identified cohort of persons seeking addiction services. The CT will consist of police liaison, crisis provider, street outreach, case management, 12-step volunteer coordinator, and peer support worker. This group will have a shared release and document all contact in a web-based community care plan. CT will be trained in Motivational Interviewing, an evidenced-based tactic that promotes behavioral change.
Currently, there is little access to detoxification for persons seeking to withdraw from heroin or opioids. The collaborative will address this need by adding four beds, 3.1 FTE (Full Time Equivalent) nurses, and 1.0 FTE counselor at the Milestone Foundation, which currently turns away 100 distinct individuals each month. The intent will be to optimize this organization through focused work flow and nurse protocol redesign for reduced length of stay.
The collaborative will expand treatment at Catholic Charities for intensive outpatient services. This will eliminate wait times and allow for smooth transition from detoxification services to continued treatment, shifting a high cost service from the acute care setting to a lower cost model of community organization.
The collaborative will also open four structured sober living environments to create 48 new beds and allow for the reduction to length of stay. This partnership between Community Housing of Maine and Amistad includes random drug testing, evidence-based recovery-oriented and skill-building groups, employment services, and daily contact with peer support workers will occur.
Through this coordinate effort, the collaborative will continuously measure progress and recalibrate its model, ensuring that its resources are distributed in the most effective way during each phase of implementation to eliminate waste and duplication of services. As it pursues funding, GPAC highlights its commitment to effective, low-cost treatment using existing community assets and eliminating waste and duplicative services. A key advantage of this collaboration is to shift services from the high-cost acute hospital setting to a more cost-effective community setting that will provide accountable, comprehensive care with authentic, personal commitment to the patient population. The state of Maine spent more than $76 million on substance abuse services in 2015, a number that GPAC and similar collaborative efforts can significantly reduce.
GPAC participants agreed upon an emerging collaborative model for addiction services, subject to regular review and revision. Areas of focus include the refinement of the emerging business model, effective engagement, expanded treatment, retention, and sustained recovery. The target population is uninsured persons, battling heroin or opioid addiction.
Regular Collaboration, Data Sharing and Evaluation:
In year one, critical focus will be on the development of the 3-year proforma, data sharing and evaluation plan, and performance optimization across and within the partner organizations. A shared release of information, data sharing agreement, and legal structure will be executed between all parties. Work flows within and across the partner organizations will be adjusted to ensure seamless access to treatment and concrete supports.
The GPAC infrastructure includes a steering committee of the senior executives of all partner organizations that will meet quarterly to review performance, resource allocation, and strategy. In year two, data will be used to demonstrate cost savings and improved treatment outcomes. A strategic plan will be developed by the steering committee to guide the creation of a new non-profit organization in year three to act as the backbone organization.
In year one, the new Coordination Team (CT) will meet weekly, facilitated by Mercy Hospital, to hone referral process, communication, warm hand offs, and data requirements. In year two, the CT will have mature operational systems and measure their efficacy around engagement and retention. Beyond individuals seeking assistance, areas in Greater Portland known for drug activity will be targeted for outreach and engagement. A new affiliation with drug court, re-entry, and county jails will be launched and associated cost and quality outcomes developed by the steering committee. In year three, data sharing and seamless referrals from community, criminal justice, judicial, peers, and provider community will shape the care delivery system. The external evaluator will provide evidence of GPAC impact.
Expanding Treatment Services:
Currently, the Milestone Foundation receives 300 or more calls per day from individuals seeking treatment. GPAC will add bed capacity (20 beds) for detoxification, add nursing staff (3.1 FTEs) for improved nurse to patient ratio, and reduce length of stay to address this unmet need. Catholic Charities will add staff to expand intensive outpatient treatment and all providers will integrate addiction services including medication-assisted treatment in primary care.
In year one, new clinical staff will be hired for Milestone Foundation to reduce the nurse patient ratio from 16:1 to 8:1 and evidence-based symptom based protocols will be introduced, driving a reduction in length of stay, increased productivity, and cost savings. Similarly, Catholic Charities will add a clinician to eliminate wait for intensive outpatient program and medication assistance treatment for uninsured persons. Newly launched primary care with integrated mental health and addiction services at all partners will provide the necessary ongoing treatment for participants. A case management function will be added to facilitate effective navigation across the shared delivery system.
In year two, productivity, cost, and recidivism will be areas of focus and drive resource allocation and staffing models. The program manager will be responsible for meeting productivity benchmarks, performance measures such as length of stay, reducing cost while ensuring quality outcomes. A dashboard will be shared electronically with the steering committee monthly. In year three, GPAC will be a highly integrated system of care with system accountability that is responsive to evolving business and public health needs and consumer input.
Retention:
All members of the collaborative will play a role in retention. Daily involvement of the recovery community volunteers and peer support workers from Amistad will promote optimism and help participants build skills through groups and individual support.
In year one, four new properties will be purchased by Community Housing of Maine to add 48 new beds. The intake protocol and policy for the structured sober environment will be developed with consumer input. Programming to include recovery-oriented skill building groups, employment services, and intentional peer support will be implemented. In year one, motivational interviewing training will occur for all police officers, EMS, and providers. In years two and three, vacancy, abstinence, and length of stay will be tracked to determine impact of the structured sober living environments.
