Addressing addiction in Camden

Care team member meets with patient in Camden

By Amy Yuen, Camden Coalition of Healthcare Providers

How Camden Coalition interventions address opioid and other substance use disorders

With the rise in public awareness around opioid use disorder affecting over 2 million Americans annually, many people have asked us if the Camden Coalition has a specific intervention that addresses opioid usage in Camden. Our answer is: “All our interventions address opioid use.” Here at the Camden Coalition, we have been providing intensive, community-based care management for more than a decade to residents with multiple chronic illnesses, many of whom have struggled with addiction. Our work is part of a broader movement of partners, including Project H.O.P.E. and the Addiction Medicine Program at Cooper, who are leaders in improving the wellbeing of individuals experiencing addiction in Camden.

“A significant portion of our participants struggle with opioid use disorder along with other complex challenges,” said our CEO Kathleen Noonan. “Because all our programs are rooted in whole-person care, we address our patients’ health and social barriers to wellness through coordinated care and support. It’s about putting the person first, not only about addressing their disorder.”

To ensure that Camden residents with complex challenges get the quality, trauma-informed care that they need, the Coalition innovates and customizes our interventions to meet people where they are. Here’s a roundup of the ways we address the needs of our patients struggling with addiction to help make a difference in their recovery and wellbeing:

Addressing addiction through our core model

In our care management model, a team of nurses, social workers, and community health workers help patients gain the skills and support they need to avoid preventable hospital readmissions and improve their wellbeing. Of those residents who participated in our care management program from September 2014 to January 2017, 50% had an active substance use disorder, and 63% were actively using or had a history of substance use disorder.

One current participant, 58-year old Charlie Vazquez, had been struggling with a substance use disorder since he was 13. For the past several months, he has been working hard to stabilize his health and improve his wellbeing, and successfully had a five-year prison sentence for a probation violation dismissed with the support of our medical-legal partnership program, our care team, and his primary care provider, Project H.O.P.E. Now, he’s a candidate for a Housing First voucher for permanent affordable housing, which should become available in a few months.

“Before the Camden Coalition came in, I didn’t care if I’d see one doctor because I was using,” he said. “Now that I’m not using, it’s not only helping me with my medical issues. It’s got to do with how I feel about myself today. Having somebody in my corner, it’s led me to want the help that nobody has given me before.”

Helping new moms on the path to recovery

Through programs like Camden Delivers, women in Camden with complex health and social needs are getting the support they urgently need to improve their maternal health. To date, the program has served 135 women. The Camden Delivers addiction pilot served 18 women. Of the nine participants currently enrolled in the pilot program within Camden Delivers, seven have clinical documentation of substance use.

One of our graduates, Christine Keck, was an expectant mother who was homeless and struggling with opioid addiction. The Addiction Medicine Program at Cooper Hospital collaborated with our care team and Christine’s other providers to link her to the services she needed to meet her medical and social needs, and better manage her health long-term. Today, she is thriving with her boyfriend and their baby. She spoke candidly with New Jersey First Lady Tammy Murphy in February about her journey toward recovery.

“I had someone in my corner to help navigate the things that are ignored and forgotten during active addiction,” said Christine. “If programs like Camden Delivers were expanded and given funding, we would see the rates of homelessness, addicted newborns, and overdoses decrease; ERs not being misused; and employment increase.”

Recovery and wellness for Camden residents re-entering society

To better understand the challenges faced by residents with recurring histories of hospitalization and incarceration and to expand care management services to inmates at the Camden County Jail, we recently initiated Camden RESET in collaboration with the Camden County Re-Entry Committee. Our research has shown that many people struggling with opioid addiction have frequent contact with both the healthcare system and the criminal justice system. All 16 patients who are enrolled in Camden RESET have a documented history of substance use. And of the 16, ten have documented history of opioid use.

“Our participants are excited to be working with us to make the changes they want in their lives,” said Bill Nice, Program Manager of Innovation Operations at the Camden Coalition. “As we build on our relationships with patients and community partners, we’ll continue to focus on how we can address the challenges faced by our participants, including opioid use disorder, with the most impact.”

Housing patients first, addressing addiction second

Our Housing First pilot program follows an evidence-based housing model that ends homelessness for individuals facing long-term housing challenges, and our research has shown that the program dramatically reduces the patterns of high hospitalization and emergency room use among patients with chronic illnesses. Out of the patients who have been approved for housing vouchers from the Department of Community Affairs, at least 66% have a substance use diagnosis. And of the 66%, at least 31% have an opioid-related diagnosis.

Once patients are housed, they are in a safe, stable environment and are better able to make the changes in their lives that lead to better health. Jamal Brown, who had been in and out of the hospital over 30 times in eight months, was living with an addiction when he moved into supportive housing. Today, Jamal’s medical issues are under control and he plays an active role in the Camden Coalition Housing First support group, a space for anyone in the Housing First program to come and talk with other individuals who have recently been housed.

“For our patients struggling with serious health issues and substance use disorder, it feels intuitive to try and tackle the health condition or the addiction first,” said LaTonya Oliver, Clinical Manager of Social Work for Innovation Operations at the Camden Coalition. “In actual practice, what’s best is to have their basic needs addressed first, which is what we do with Housing First. After they are stably housed, patients are able to focus more on their health and address issues like addiction.”

The Camden Coalition has always focused on addressing medical complexity rather than a single disease-specific issue. Instead of having one program that tackles substance use disorder, we provide addiction training for each of our care team members regardless of which patients they see. In addition to our standardized addiction training, our care team is coached in supplemental care principles, such as harm reductiontrauma-informed care, and motivational interviewing. These care principles are essential to providers who are working with patients that have complex medical needs and are experiencing substance use disorder.

“When people with a substance use disorder seek care, they often encounter a healthcare system that siloes medical care from behavioral health and a society that stigmatizes their behavior,” said Victor Murray, Director of Care Management Initiatives at the Camden Coalition. “We’ve set our work up in a way that each of our care team members and our interventions are able to address medical, social, and behavioral health needs, without judgment, regardless of where we meet them.”

Download the brief

Published on May 6th, 2018

Murphy Transition Teams Elevate Complex Care

Last November Governor Phil Murphy and Lt. Governor Sheila Oliver assembled 14 Gubernatorial Transition Teams tasked with identifying the policy priorities and opportunities for the new administration. The final reports, released by Governor’s Office on January 26, set a powerful foundation for the new Governor’s next steps.

We are thrilled to see GCC policy recommendations reflected in both the Healthcare and the Housing Transition Reports and a commitment to complex care initiatives and health equity.

GCC recommendations included:

  • Develop next-generation Medicaid Accountable Care Organizations
  • Accelerate the implementation of the Integrated Population Health Data (iPHD) Project with an emphasis on the social determinants of health
  • End homelessness in NJ by setting a progressive Housing First policy

Complex care recommendations included:

  • Establish an Office of Health Transformation
  • Introduce a comprehensive plan to improve maternal health and birth outcomes
  • Develop a pilot to provide legal representation for low-income NJ residents facing eviction or foreclosure
  • Endorse legislation to allow counties to increase Homeless Trust Funds

Review all reports

Published on February 13th, 2018

GCC 2017: A year in review

Dear Friends and Colleagues,

As this year comes to a close, I would like to extend my gratitude to this community for your powerful contributions to improving care for patients across New Jersey. I am inspired and motivated by your commitment to collaboration and your resilience in the drive towards advancing complex care in our state. We look forward to continuing this work in the new year!

Highlights of 2017:
The transformative impact of Medicaid ACOs in NJ
The 3rd annual GCC Conference
Policy Position Papers

Sincerely,
Natassia Rozario
Camden Coalition of Healthcare Providers

Published on December 21st, 2017

Opinion: How to reduce Medicaid spending in NJ

Care team member visits patient in Camden

In an opinion piece published by both the Cherry Hill Courier Post and NorthJersey.com, Natassia Rozario, Senior Director of External Affairs for the Camden Coalition of Healthcare Providers, outlines the need for intelligent spending of Medicaid dollars in New Jersey. Read the op-ed below.

Courier Post online        northjersey.com

Healthcare Recommendations for Phil Murphy

New Jersey spends about $14.5 billion a year on Medicaid, more than anything else in the budget except education. Given that expense and the uncertainty in Washington around healthcare, it’s crucial that Governor-elect Phil Murphy spend those dollars intelligently and efficiently.

The Good Care Collaborative met last month in Trenton to discuss recommendations for the next governor about how to deliver the right care in the right place at the right time to reduce waste and achieve better health outcomes. We represent a diverse set of stakeholders in the health care system from across New Jersey, including hospitals, providers, patients and faith leaders.

Our focus is on people with complex health and social needs, the five percent who represent 50 percent of health care costs nationwide. In New Jersey, 10 percent of individuals on Medicaid account for about 75 percent of state expenditures.

New Jersey’s healthcare system, like the rest of the American healthcare system, has evolved to serve the typical person with typical health needs. It’s not built to serve people with multiple chronic illnesses, usually exacerbated by social stresses like housing or food instability. Individuals with complex needs often have struggled with addiction, have had contact with the criminal justice system, or have a history of childhood trauma.

There is no one type of person who has complex health and social needs. They might look like Robert, who was experiencing homelessness on the streets in Camden and struggling to manage his substance use disorder and COPD. Or Shirley, who is a middle-income woman with a graduate degree, severe anxiety, and is living with uncontrolled diabetes.

For healthcare consumers like Robert and Shirley, care is fragmented, uncoordinated and sometimes duplicative. Their care is marked by repeated emergency room visits, over-testing, hospital readmissions and other unnecessary or inefficient uses of Medicaid.

It’s well known that the United States spends far more on healthcare than other developed countries without achieving better health outcomes. It’s less commonly known that we spend far less than other developed countries on social services. Research shows that the conditions in which people live, work and play have an enormous impact on health.

The Good Care Collaborative held a robust policy discussion to envision an improved Medicaid system that would help those most in need and shift costs to ensure that taxpayer money is being spent on care that is appropriate. When people with complex needs get the right care in the right place at the right time, we all win.

We congratulate the governor-elect and offer a few recommendations that would prioritize smart Medicaid reform.

  • Integrate healthcare with social services. We have found that social barriers such as homelessness or the lack of access to reliable transportation have huge impacts on patients’ health.
  • Innovate locally. Strengthen and develop our Accountable Care Organizations, which are finding ways to design and scale community-based, data-driven models in Newark, Trenton and Camden.
  • Use data to build a smarter healthcare system. New Jersey is already a national leader in the use of data to determine what’s working and what’s not. The administration should support successful initiatives like the Integrated Population Health Data Project at Rutgers that use data to strengthen accountability.
  • Focus on mental health, addiction and pain. These are foundational conditions that cost lives and strain the system. We must get rid of barriers to the use of evidence-based treatments like buprenorphine for opioid addiction.
  • Ensure access to healthcare for all New Jerseyans. An efficient system that provides coordinated care to individuals in their community and before they’re in a crisis is the way to provide the right care in the right place at the right time. The next administration should fight threats to the Affordable Care Act that would shrink Medicaid and deny care for the most vulnerable.

Without access to community-based treatment, people delay care and end up in the most inefficient and expensive care settings, including emergency rooms, inpatient care, long-term care, or worse, the criminal justice systems.

Medicaid is our second biggest expenditure. We’re making great strides toward reducing the inefficiencies in the system, and given the lack of clarity at the federal level, now is the time to double down on evidence-based, data-driven solutions here in New Jersey.

We can reduce avoidable hospital stays, emergency room visits and lost lives. Better care at lower cost is possible, but only if we transform our systems so that they work for us when we need them most.

Published on December 13th, 2017

Policy Recommendations for the New Administration

As the federal and state government look to reform the Medicaid system, the next gubernatorial administration has the opportunity to set a national example for the Medicaid program. In collaboration with partners across the state we have developed strategic policy recommendations to improve quality, outcomes, and efficiencies in New Jersey’s Medicaid program. Although the recommendations detailed in the below policy position papers are focused on individuals with the most complexity, the lessons from this work may be applied to the broader Medicaid population, as well as beneficiaries across payor types. It is our hope that the incoming administration is able to use these recommendations to guide their strategies for advancing complex care in New Jersey.

The Policy Position Papers

Recommendations Overview

Housing First

Non-Emergency Medical Transportation

Integrated Data

Community-Based Medicaid Accountable Care Organizations

Introduction to the Camden Coalition

 

National Center for Complex Health and Social Needs: 

Community-Based Care Management

Published on October 30th, 2017