3CCORP_UW_MacColl 6-BBs Agenda August 16, 2017

Olympic Community of Health Agenda Three County Coordinated Opioid Response Project U of WA WWAMI Region Research and Network MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute

August 16, 2017, 11:00 am to 12:00 pm Six Building Blocks to Safer Opioid Prescribing Wed, Aug 16, 2017 10:30 AM - 12:30 PM PDT

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Attachments:

• Agenda

• 6-BBs to Safer Prescribing Poster

• Clinician Confidence in Prescribing Poster

• UW – MacColl roles in Medicaid Transformation 3.a._draft

• Laura-Mae bio

• Mark Parchman bio

• Mark Stephens bio

AGENDA

1. Welcome and Introductions Chris Frank and Susan Turner

2. Presentation – Six Building Blocks Laura-Mae Baldwin Michael Parchman Mark Stephens

3. Questions and Discussion Chris Frank and Susan Turner

4. Next Steps Chris Frank and Susan Turner

5. Closing Chris Frank and Susan Turner

Medicaid Transformation Opioid Project Goals and Strategies: Roles that the UW Team Based Opioid Management Group Can Play

UW Team Based Opioid Management Team

Center for Opioid Safety Education

Goal 1: Prevent opioid misuse and abuse

Strategy 1: Promote use of best practices among health care providers

Facilitated implementation of 6-BBs in primary care practices, including TelePain

Strategy 2: Raise awareness and knowledge of the possible adverse effects of opioid use, including overdose, among opioid users

Facilitated implementation of 6-BBs included risk communication tools for patients

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Strategy 3: Prevent opioid misuse in communities, particularly among youth

Strategy 4: Promote safe home storage and appropriate disposal of prescription pain medication to prevent misuse

Strategy 5: Decrease the supply of illegal opioids

GOAL 2: Link individuals with opioid use disorder to treatment support services

Strategy 1: Build capacity of health care providers to recognize signs of possible opioid misuse, effectively screen for opioid use disorder (OUD), and link patients to appropriate treatment resources

Facilitated implementation of 6-BBs, including opioid misuse tools

Strategy 2: Expand access to, and utilization of, opioid use disorder medications in communities

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Strategy 3: Expand access to, and utilization of, opioid use disorder medications in the criminal justice system

Strategy 4: Increase capacity of syringe exchange programs to effectively provide overdose prevention and engage beneficiaries in support services, including housing

Strategy 5: Identify and treat opioid use disorder among pregnant and parenting women (PPW) and Neonatal Abstinence Syndrome (NAS) among newborns

Strategy 6: Support whole person in recovery

GOAL 3: Intervene in opioid overdoses to prevent death

Strategy 1: Educate individuals who use heroin and/or prescription opioids, and those who may witness an overdose, on how to recognize and appropriately respond to an overdose

Strategy 2: Make system-level improvements to increase availability and use of naloxone

Facilitated implementation of 6-BBs, including naloxone co-prescribing

Strategy 3: Together with the Center for Opioid Safety Education, promote awareness and understanding of WA State’s Good Samaritan law

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GOAL 4: Use data to detect opioid misuse/abuse, monitor morbidity and mortality, and evaluate interventions

Strategy 1: Improve PMP functionality to document and summarize patient and prescriber patterns to inform clinical decision making

Facilitated implementation of 6-BBs, including PMP use

Strategy 2: Utilize the PMP for public health surveillance and evaluation

Strategy 3: Continue and enhance efforts to monitor opioid use and opioid-related morbidity and mortality

Facilitated implementation of 6-BBs included pro-active monitoring of patients

Strategy 4: Monitor progress toward goals and strategies and evaluate the effectiveness of interventions

prescribed opioids, goal setting for improvements, and measuring success.

Laura-Mae Baldwin, MD, MPH is a practicing family physician who cares for patients with chronic pain, a

Professor of Family Medicine at the University of Washington, and a researcher whose career has

focused on access to and quality of health care in diverse underserved and rural areas. Laura-Mae

currently directs the WWAMI region Practice and Research Network, a network of 60 primary

care clinics in the five state WWAMI region committed to participating in research. Laura-Mae has

established many active research and practice improvement partnerships with clinicians and clinical

practices and organizations, including with 20 rural practices across Eastern Washington and Central

Idaho participating in a study to address safer opioid prescribing, led by Michael Parchman.

Michael Parchman, MD, MPH, is Director of the MacColl Center for Healthcare

Innovation within the Kaiser Permanente Washington Health Research Institute. For

over 25 years his work has focused on practice redesign to improve chronic illness care

in primary care settings. He currently leads a project to build Quality Improvement

capacity in over 200 smaller primary care practices in the Pacific Northwest with a goal

of improving cardiovascular risk factors. He also leads a study team to address safer

opioid prescribing in rural health clinics across Eastern Washington and Central Idaho.

Prior to joining MacColl Dr. Parchman served as a project officer at the Agency for

Healthcare Research and Quality where he was Director of the Practice-Based Research

Network program and senior advisor on Patient-Centered Medical Homes. He has over

thirty years of primary care practice experience.

1

Mark R. Stephens

Change Management Consulting

14300 23rd Ave SW

Seattle, WA 98166

Direct: 425-970-3170

Mark.R.Stephens@comcast.net

Mr. Stephens is the president of a healthcare consulting company specializing organizational change, process improvement, education and technology support for large healthcare organizations. The

majority of his client engagements have involved dealing with chronic pain and opioids. Mr. Stephens areas of expertise include:

• Advising healthcare organizations on strategies for addressing the opioid epidemic

• Helping formulate state and regional approaches to engaging the healthcare community to coordinate efforts to address the opioid epidemic

• Creating guidelines and policies for treating pain, both acute and chronic

• Promoting non-pharmacological approaches to treating pain

• Implementing strategies for tapering and dealing with substance use disorders

• Team based approaches to treating chronic pain

• Provider and patient educational programs, including websites, online training, professional

conferences, community engagement, public awareness campaigns

• Identifying and assisting implementation of opioid metrics to monitor progress on reducing pills in circulation

• Creating implementation “Toolkits” that regions and individual clinics can employ to rapidly

focus efforts using a common framework

• Development and maintenance of regional and state websites to provide resources for professionals and education for the public

• Development of metric tracking “dashboards” for regions and clinics

• Strategies for leveraging the state prescription drug monitoring programs (PDMP) to inform clinicians and monitor regional statistics

• On planning committees for professional conferences and community forums, including

conference website development, online registration, and marketing support.

Mr. Stephens has worked with the following healthcare organizations:

Oregon

• Oregon State Health Authority

• Portland Tri-County Health Departments

• Southern Oregon Pain Guidance Group

• AllCare CCO of Southern Oregon

Washington

• Group Health Cooperative of Washington

• Group Health Research Institute

• University of Washington

• Washington State Bree Collaborative

California

• California State Compensation Insurance Fund

• California State Division of Workers’ Compensation

• California Healthcare Foundation

• San Francisco Healthcare Plan

Centers for Disease Control and Prevention

Veterans Health Administration

Selected Client Engagements

Oregon Health Authorities Prescription Drug Overdose Project – This is a four year, CDC funded project to address the opioid use and abuse problems in 10 critical need regions in the state of Oregon. The project tasks include:

• Developing a state wide regional approach with a common implementation “toolkit” for 10 regions

• Developing a statewide website to provide educational resources, policies, metrics, and

• Engaging each region’s healthcare organizations and the public in a coordinated approach to change the approach to treating pain,

• Reduce the use of opioids for both new and existing patients, employ team based approaches to treatment, integrate behavioral health,

• Provide metrics to measure progress and implement a “dashboard”

• Develop a state sponsored online training for all disciplines treating chronic pain (physicians, nurses, psychologists, social workers, physical therapists, etc.)

• Provide regional practice coaches and consultants to support implementation efforts in 10 regions.

Mr. Stephens is a key contributor on most of the project tasks and deliverables.

Oregon State Pain Guidance Website – Working with the Southern Oregon region, the Portland Tri-County Health Departments, the Oregon Coalition for Responsible Use of Meds on a state wide website portal for public and healthcare professionals on pain management, opioids, substance abuse, safe disposal. www.OregonPainGuidance.org

Southern Oregon Pain Guidance Group – Designed, developed and maintain a website for a collaboration of healthcare providers in Southern Oregon. Helped develop the OPG Pain Management Guidelines, on planning and marketing committees for the 2017 Pain Conference.

Washington State Bree Collaborative – Member of the Bree Collaborative working group to implement chronic pain and opioid treatment guidelines for Washington state, using the Washington State Agency Medical Directors Group (AMDG) Guideline on Prescribing Opioids for Pain

Team Based Opioid Management (AHRQ Research Study) – Three year research study to work with rural clinics in Eastern Washington and Idaho to implement policies, standard work, patient tracking for chronic pain patients on long term opioid therapy. This is a joint research project between Kaiser Permanente Research and the University of Washington. Mr. Stephens helped develop the “Six Building Blocks” framework for the rural clinics and developed the website that supports the research project. http://www.ImprovingOpioidCare.org

Centers for Disease Control and Prevention – The CDC has a three year contract with Abt Consulting for the development of an “Implementation Package” for the CDC’s Opioid Guidelines. This consists of implementation guidelines and policies based on the CDC’s 12 opioid prescribing recommendations, a set of proposed national metrics, and web based implementation toolkit. The project will select 6 – 9 large healthcare systems to use this implementation package and track their progress using the proposed national metrics. Mr. Stephens is a consultant on the project consulting on the implementation package, advising on the metrics and developing the website for the CDC implementation package and toolkit. http://www.breecollaborative.org/topic-areas/opioid/

California State Division of Workers’ Compensation – Currently developing three CME modules on the Medical Treatment Utilization Schedule, Qualified Medical Evaluators, and chronic pain and opioid treatment. http://www.dir.ca.gov/dwc/CaliforniaDWCCME.htm

California Healthcare Foundation – Currently developing one hour continuing education for all pharmacists in California to address “corresponding responsibility”, illicit prescription requests, identifying patients with substance abuse or addiction and referring to treatment options.

California State Compensation Insurance Fund – Developed two online training systems for their 2,500 physician network on the use of opioids for acute pain injuries and managing chronic pain patients on opioid therapy. http://www.healthcare-courses.com/statefund/regApp/default.asp

North Shore LIJ Health System of New York – Developed an online training program in Health Literacy, to train the 9,000 Nurses and 10,000 physicians of a 15 hospital system. Objectives was to improve health outcomes by improving the effectiveness of patient-provider communication.

Group Health Cooperative – Developed an online training system to support a comprehensive practice improvement initiative to standardize the prescribing, monitoring and treatment of patients on opioids for chronic pain. Trained over 800 clinical staff including 450 prescribers.

EMR and Clinical Process Redesign – Working with the VHA Puget Sound Health Care System, developed business case for re-engineering clinical processes and customizing medical records system for 1800 clinical staff. Coordinated work of several project teams developing standardized clinical processes. Reported to senior executive team and worked with heads of service lines.

Physician Documentation and Coding – Developed an online training with interactive simulation to teach physicians, nurse practitioners and residents to document patient encounters accurately.

Oregon Health Authority Patient Centered Primary Care Home online training – Developed an online training for the Oregon state Patient Centered Primary Care Home certification for primary care providers throughout the state. Over 400 providers have completed the training.

Veterans Health Administration Chronic Pain Education for Providers and Patients – Developed two complementary training modules for providers and Veterans to change the treatment approach to reduce the use of high dose pain medication, promote functional rehabilitation and encourage patient self-management. Over 10,000 VHA providers have completed this training.

Veterans Health Administration websites – Developed and maintained three national websites for Multiple Sclerosis (www.va.gov/ms ), Geriatrics (www.va.gov/geriatrics ), Amputation & Prosthetics Engineering Research (www.amputation.research.va.gov )

Previous Experience

TransactIQ.com Founder and CEO – Seattle, WA 1999 - 2000 Founded company to develop and market a new product in the real estate industry to automate the

residential sales transaction. The system is an Internet platform to manage workflow, track status, exchange information and distribute documents for all parties involved in the transaction.

Terradatum Founder and COO – Seattle, WA 1997 –1999 Co-founded company that developed high performance, multiple listing database systems for the real

estate industry. Developed and installed systems in metropolitan regions including San Francisco, San

Jose, Portland, Kansas City, Chicago and Philadelphia.

Alpenglow Founder and President – Seattle, WA 1993 – 1997 Founded company to produce multimedia CD-ROM’s with adventure, travel and wildlife themes. Produced two award-winning multimedia products that sold over 400,000 copies and were translated

into three languages.

Deloitte & Touche – Partner for Audit Technology, London, UK 1986 - 1992 Prior to moving to Seattle in 1992, Mr. Stephens was a partner with Deloitte & Touche based in London, UK where he was the partner responsible for Technology for Audit and Accounting. He was also responsible for coordinating technology for the European firms and one of three partners responsible

for developing the Deloitte and Touche global audit technology system.

Education Bachelor of Science: Mathematics & Computer Science – University of California, San Diego

Medical Management Certificate Program – University of Washington – courses include Quality

Management, Strategy Management, Leadership & Change Management, Financial Management

Non-Profit Associations The Executive Network of Seattle (TENS), a professional organization of executives in the greater Seattle area. Chairman 2002 – 2004.

The Exchange Club of Highline – A charitable organization that raises funds for local schools and other organizations serving the disadvantaged, elderly and low income families of south Seattle communities.

Community Health Centers of King County - Board Member 2003 – 2006, Treasurer 2004 – 2005.