Helping healthcare providers treat a surge of opioid-addicted patients

Jonathan Hager, M.D., was practicing internal medicine in Rochester, N.Y., when he decided he wanted to do more for his community health center patients. He wanted to help people struggling with opioid addiction.

Specifically, he wanted to start prescribing a medication that curbs cravings for opioids like OxyContin or heroin and helps people who are addicted to these drugs maintain their sobriety. Hager knew the region lacked enough prescribers of this kind of treatment. So he took the required eight-hour course to get certified to prescribe the drug and let the community know he was accepting new patients. They poured in. At one point, his waiting list was 200 names long.

Seeking Help with Complex Cases

Hager soon realized treating substance use disorder is much more complicated than simply prescribing a medication. Many of his patients also had mental illnesses, like anxiety or depression. Some needed surgery–could they have opioid painkillers? And for patients who were still using other substances like cocaine, Hager worried about continuing to offer them medication-assisted treatment for opioid addiction.

Hager says the course he took to get certified to prescribe medication-assisted treatment covered the basics. But he wanted to build his confidence to tackle more complex cases. Medical school hadn’t provided much training in substance use disorder treatment in general. “My experience was extremely limited,” Hager says. “When I was training 20 years ago, there weren’t that many heroin addicts in the hospital.”

Enter ECHO: A Team of Experts

That’s why Hager says he jumped at the chance to join Project ECHO (Extension for Community Healthcare Outcomes), a year-and-a-half old doctor education initiative led by Excellus BlueCross BlueShield, to help boost healthcare providers’ capacity to treat patients with opioid use disorder. There are many ECHOs around the country, focused on different medical conditions. In a nutshell, they’re designed to help community healthcare providers offer more specialty care to patients. It’s especially helpful for rural regions or areas with provider shortages. A multidisciplinary team of experts gathers every other week on a video conference with providers interested in deepening their skills. There’s a short lecture, and then participating providers present cases, asking for the group’s input. Excellus is the first insurer to help launch an ECHO.

Ann Griepp, M.D., chief medical officer of behavioral health at Excellus, says ECHO has helped providers feel less isolated and more confident about handling complicated patients. It’s amplified the ability of community healthcare providers, like primary care doctors, to bring specialty medicine to more patients. Experts on the video conference include a physician who specializes in treating chronic pain, a toxicologist at the University of Rochester, social workers, a representative from New York State’s office of substance abuse services, a chiropractor, addiction specialists and Griepp, a psychiatrist.

ECHO’s Early Impact

Griepp says Excellus is analyzing data now about the effectiveness of the ECHO. She wants to know how doctors have improved their practice and the extent to which patients have gotten better. She says early indications point to patients sticking with treatment longer, as well as a decrease in the cost of hospital care per patient.

It may not be the kind of impact measurable in numbers, dollars or statistics, but ECHO participant Dr. Jonathan Hager says one of the main benefits of the bi-weekly sessions has been to increase his comfort level with the unknown. “The biggest thing that I’ve taken away,” says Hager, “is that there’s a lot more gray [area] in this treatment world than black and white.” When Hager presents a case to the ECHO experts, he’s come to accept the fact that there may be no right or wrong answers, but he knows he can tap into the group’s wisdom. “It’s so much more useful,” says Hager, “than reading about something or having someone lecture you.”

To learn more about the Excellus ECHO in Rochester, N.Y., visit http://echo.unm.edu/.