Through the Opioid Systems of Care (SOC) initiative, HMA is providing system-wide stakeholder engagement services, coaching and other technical assistance (TA), on behalf of the California Department of Health Care Services (DHCS), to strengthen treatment and recovery ecosystems throughout the state, to develop a predictable and consistent knowledge base, and encourage transitions of care for individuals suffering from SUD. The ultimate goal of SOC is to facilitate the recovery journey of those with SUD by supporting counties to expand access to and provide continuity of treatment as these individuals transition between locations, such as emergency departments, inpatient hospital settings, primary care clinics, jails, prisons, and/or the community at large; and levels of care, such as residential, intensive and other outpatient care. Despite the expansion of the Drug Medi-Cal Organized Delivery System (DMC-ODS), many locales throughout California still grapple with how to build an accessible, high quality treatment and recovery ecosystem, leaving their residents struggling to access, navigate, and realize continuity of services in fragmented systems that can be overwhelming.

The California DHCS received funding for Systems of Care from the Substance Abuse and Mental Health Services Administration (SAMSHA) under State Opioid Response Grants (SOR). The program aims to address the opioid crisis by increasing access to medication for addiction treatment using the three FDA-approved medications for the treatment of opioid use disorder, reducing unmet treatment needs, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids, heroin and illicit fentanyl and fentanyl analogs). DHCS awarded Health Management Associates (HMA) funds to administer its Systems of Care project. The first-round grant period was October 2018 to September 2020 (SOR 1). The second-round grant period is October 2020 to September 2022 (SOR 2). Under SOR 1, HMA worked intensively in 10 counties: Fresno, Humboldt, Imperial, Kern, Lake, Mendocino, Orange, Riverside, Shasta, and Ventura. Copies of county process improvement reports can be found in the resource library search results at the bottom of the page. These reports summarize activities completed during two-day community wide events held in the SOR 1 counties.

Under SOR 2, HMA has invited counties to apply for TA and coaching assistance, and will select six counties to participate in SOC. This state-funded assistance includes collaboratively conducting a deep dive and a virtual process improvement effort to understand the county’s current ecosystem; providing counties with current value stream maps and an agreed upon future state for their system with appropriate ASAM levels of care; identifying and implementing medications for addiction treatment sites at a range of access points to greatly reduce treatment delays; and building and mobilizing a knowledge base to create consistent vernacular and instill system-wide understanding and use of best practices.

Payment for Substance Use Disorder SUD services, identification of patients with SUD, access to SUD care, residential treatment services, and hospital-based services, may look substantially different based on each county’s geographic, cultural and other factors.

To address the specific needs of an individual county’s treatment ecosystem, HMA is providing a cutting-edge program of process improvement, coaching and other technical assistance provided by a team with deep subject matter expertise in OUD/SUD, system redesign and performance improvement. The effort focuses on strengthening addiction treatment systems through a multi-pronged approach. HMA, in collaboration with county leaders and stakeholders in addiction treatment of all types, will convene multiple, two-day process improvement events to provide fundamental addiction treatment didactics, county-wide dialogue for the identification of system gaps and barriers, and facilitated consensus-building to develop a blueprint for an improved future state for the treatment system.

Following the two-day events, the HMA team works over the course of a year providing follow-up TA to address the gaps and barriers and conducts direct coaching to increase the number of MAT providers in the county. Through this program’s activities, HMA is helping to build a consistent knowledge base to provide high-touch, evidence-based MAT and behavioral therapies for SUD patients. Specific activities include ongoing monthly one-on-one coaching for sites working to provide/expand MAT, quarterly county-wide check-ins, webinars, resource documents and toolkits, on-demand TA, Systems of Care: DATA 2000 waiver trainings, MAT readiness assessments and workshop, and cross-site learning and connectivity activities. In addition, HMA launched this comprehensive website of opioid addiction treatment information for California, with durable training material, and an HMA data dashboard with county-level SUD risk and treatment resources.

The project demonstrates HMA’s ability to tailor this work within a county to mobilize an initiative and garner exceptional engagement of cross-sector partners to design a future state SUD delivery system incorporating evidenced-based best practices, including detailed implementation strategies.

For more information about Systems of Care, please contact John O'Connor at joconnor@healthmanagement.com.

A minimum of six additional counties will be selected to participate in the program beginning in January 2021.