For some patients who survive an opioid overdose, the very next step to wellness might involve not a medical intervention, but the act of getting enough food on the table, or averting an eviction from housing. Leaders of UPMC Health Plan in Allegheny County, Pa., say a holistic approach to care has proven critical to the successes of the Rapid Emergency Department Outreach (REDO) program in engaging high-risk individuals in ongoing treatment.
“A lot of aspects of their lives are in chaos,” Ann Giazzoni, program manager at the integrated delivery system, said in a breakout session held today at the virtual Rx Drug Abuse & Heroin Summit. Giazzoni added, “We have to stay with them...A lot of it is relationship building.”
Giazzoni and Nicholas DeGregorio, MD, senior medical director for UPMC For You, co-presented a session focusing on REDO, an effort launched at one hospital emergency department in 2017 and recently expanded to a second site. The initiative was implemented in response to a spate of street drug overdoses following the introduction of a prescription drug monitoring program (PDMP) to stem the flow of misused prescription opioids.
Outreach to an individual who has been discharged from the emergency department is triggered not by an insurance claim, but by the chief complaint for the case, Giazzoni explained. Under the rapid approach, a case manager attempts to reach the discharged patient by phone within 24 hours. If that fails, a community paramedic is enlisted to attempt a home visit.
The paramedic's conversation might begin with, “We're just concerned about you,” as opposed to “I hear you overdosed this morning,” Giazzoni said.
“It starts with meeting people's needs,” DeGregorio added. “You build the trust.”
Out of 357 referrals to paramedics from May 2018 to September 2019 under REDO, 101 resulted in successful contact with the plan member, the speakers reported. It is a high-need population, with 69% of REDO participants receiving Medicaid.
DeGregorio explained that UPMC Health Plan has prioritized giving providers tools for rapid screening and referral to specialty treatment. “Our providers are paid for screening,” he said. They generally employ a Screening, Brief Intervention and Referral to Treatment (SBIRT) approach.
Before the PDMP was implemented in Pennsylvania, the health plan had created a system of electronic alerts that could give providers key information on a patient's risk for overdose, based on factors such as concurrent prescribing of opioids and benzodiazepines and/or gabapentin, DeGregorio said.
Priority at-risk populations have included pregnant women, individuals with a recent history of overdose (“the greatest predictor of a future overdose,” DeGregorio said) and those who have not been able to adhere to medication-assisted treatment.
Programming in Allegheny County is placing a strong emphasis on rapid induction to buprenorphine for overdose survivors. Initial dosing directly in the ER “might clear someone's mind so they can begin considering other options,” DeGregorio said.