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January – February 2019
A message from Dr. William Beecroft
We’re expanding our CLIMB opioid treatment model to select Blue Cross members
 Traditional methods for treating opioid use disorder sometimes work, but 36 percent* of patients relapse. Of those who do relapse, 72 percent* do so multiple times.
Patients typically go through detox, are stabilized and then sent on their way with referrals for further services. It sometimes seems like we’ve been treating a complicated addiction like we do a broken bone — and it doesn’t reflect the biology and psychology of how people became addicted in the first place.
That’s the reason we launched a new clinical pilot program May 1, 2018 for 250 Blue Care Network and BCN AdvantageSM members. It’s called CLIMB, or Community-based Life-changing Individualized Medically-assisted evidence-Based treatment program, and it’s already showing promising results. The 12-month pilot project serves members at Pine Rest Christian Mental Health Services near Grand Rapids and at Henry Ford Maplegrove Center in West Bloomfield.
I’m pleased to report that we’re rolling out the program to Blue Cross Blue Shield of Michigan fully insured commercial PPO members this year. Providers can now refer these members to the program for addiction treatment at Pine Rest Christian Mental Health Services and Henry Ford Maplegrove Center.
To provide background, I’d like to offer an overview of the brain chemistry behind opioid use and how the CLIMB treatment protocol helps treat patients suffering from opioid use disorder.
Why people become addicted
Opioid use over time actually changes brain chemistry. Opioids trigger the same receptors in the brain responsible for feelings of pleasure. The brain gradually becomes less receptive to opioids, causing people to increase their usage. Addiction to opioids occurs when the drugs become necessary for a person to feel normal or as a means to avoid withdrawal symptoms. Understanding that a person battling opioid use disorder is fighting a chronic illness is at the heart of the CLIMB program.
Treatment protocol
Patients will start with the same type of detox protocol but then spend a longer time under supervision in an inpatient setting. During the inpatient stay, therapists will work with patients to assess their family and support network so they can start to think about how they’ll successfully move forward. Medication-assisted treatment is a key part of the treatment protocol. It’s typically started during inpatient care to make sure the patient doesn’t experience adverse side effects.
The next step is developing a multi-disciplinary treatment plan. Determining what types of treatment will be needed as an outpatient, looking at how to avoid relapse and what will happen if a relapse does occur are all discussed. Patients will also receive a smartphone app that provides peer support, strategies to avoid relapse and daily monitoring by a therapist. The app is called ACHESS, and it stands for Addiction Comprehensive Health Enhancement Support System.
When patients don’t check in, this app can help a counselor or therapist intervene quickly. The app will also track the patient’s location, alerting their sober supports and their therapist if they’re in close proximity to a self-identified high-risk location, such as a place they used to purchase drugs.
Eventually, patients in the CLIMB program move to an intensive outpatient care to help them transition to everyday life. They’ll attend group treatment programs three days per week, which can really help patients resist temptation brought on by the same stressors that might have caused them to start abusing drugs in the first place.
They’ll receive routine drug screenings during the intensive outpatient phase and the outpatient portion of care. Intensive outpatient treatment will last for about two months. At that point, patients could transition to a more traditional outpatient care model.
Recent program enhancements
Since the pilot began, we’ve made some program modifications, identified some barriers to success and implemented some new technology and practices that are making a difference. For example:
- We’ve added a cognitive behavioral therapy component and a depression screening tool to the ACHESS app.
- We’re making improvements in the transitions of care from inpatient to outpatient. We want to ensure that the outpatient provider gets complete information from the inpatient social worker before being contacted by the patient.
Successes
- We’ve seen a significant increase in first fills of medications used in the medication-assisted treatment protocol once the patient leaves the inpatient facility — to 78 percent from 36 percent.
- Michigan State University has received a grant to work with us to analyze the program and publish an article about its findings.
Keep in mind that once a person remains substance-free for two years, his or her relapse rate is about the same as someone who never used opioids. That’s why a comprehensive treatment plan is so important. The body and mind do have the capacity to heal.
If you have any questions about this program, feel free to email me at WBeecroft@bcbsm.com.
Dr. William Beecroft is medical director of behavioral health for Blue Care Network.
*Statistics based on an internal audit of member data conducted in January 2018. |
