Health experts: integrated services needed to combat opioid epidemic

Despite all the extra resources in the state, the number of drug-related overdose deaths is continuing to climb. More than 2,200 lives were claimed in 2016, the most recent year for which data is available. Monday’s Population Health Summit convened to focus on best practices and approaches to the public health crisis.

“So it’s all about, how do we allocate resources, economic disparity, middle class has had frozen wages since the recession despite full employment, so the diseases of despair, depression, drug abuse, alcoholism — all of those diseases are changing the very epidemiology of the country, meaning my children are going to have a shorter life span potentially than my baby boomer wife and me,” said David Nash, founding dean of the Jefferson College of Population Health.

Panelists and state officials presented models and evidence-based research, ideas and road maps for ways to crack down on the problem. Addressing economic disparity and the need for an integrated care approach was the connecting thread throughout the day.

“A big focus of the department is going to create a single license for primary care, addiction treatment and mental health care all to be provided under the same roof,” said New Jersey Health Commissioner Shereef Elnahal. “The number of folks who have all three of those conditions are growing. And so to better meet their needs we have to create a health care system that matches those needs.”

In fact, 60 to 70 percent of those suffering with addiction have co-occurring medical issues, and health experts say the system needs a total overhaul to address it.

“We have a mental health system that’s integrated in the community and an addiction system that’s integrated in the community, but they really don’t speak to each other enough. There’s not enough co-occurring programs that deal with the co-occurring issue for people with addiction and mental health,” said Robert Kley, vice president and COO of the Mental Health Association of New Jersey.

“We have to have much greater access to mental health services, make that a core part of primary care, but the only way we’re going to make that work is by changing how we’re paid. Here’s the answer to the riddle: If we get paid to improve the outcome rather than just getting paid for every test and every procedure, then we’ll have mental health experts in our practice helping us with addiction, with depression, with all the diseases of despair,” said Nash.

So experts recommend changing regulatory systems, providing economic incentives, looking at bundled payments, fee for performance and moving from a volume to value-based system in treating mental health and substance use disorder.

“The reimbursement structure, particularly with Medicaid, has to recognize that care has changed, that we look at the whole person now and we have a whole team of people providing care and slicing it up into little fees per procedure just doesn’t work, it doesn’t reflect the work that’s being done and it doesn’t encourage high-quality care,” said John Jacobi, professor of health law and policy at Seton Hall Law School.

The driving point throughout the day is nothing new — the state needs to put less emphasis on short-term fixes and look to long-term prevention.

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