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Bringing Care Coordination to the Fight for Recovery From Opioids

Mary Caffrey
A symposium at Seton Hall Law School examined the role of care coordination and transitions in helping those with substance use disorder find success in treatment. Some experts say that managed care has not supported care coodination despite evidence that it works and ultimately saves money for health systems.
Frank Mazza, program director for the Hudson County Department of Corrections and its Community Integration Program, has used the tools of the Affordable Care Act to drive change for those leaving the corrections system, who are often chronically homeless and not in touch with a primary care provider. Hudson County has a Federally Qualified Health Center (FQHC) within the corrections facility, one of the few in the country. Hudson uses medication assisted treatment (MAT) to treat addiction, and engages clients in workforce training.

And yet, Mazza said, much depends on what happens after people leave. “Successful treatment for this population is reliant upon a uniform approach for health insurance, housing assistance, public assistance, healthcare navigation, and case management,” which historically has been lacking. “The role of re-entry should always be to heal that fragmented system.”

That’s what Mazza and McGreevey, in his role as chairman of the New Jersey Reentry Corporation, have been trying to do. The nonprofit McGreevey chairs works closely with government agencies like Mazza’s to smooth the path to employment, health, and stability for those leaving the corrections system, many of whom landed there because of substance use issues. McGreevey advocates the use of MAT and drug courts to increase the chances of success, and pointed out that treatment costs far less than incarceration. It’s up to the system to create “seamless linkages” to connect people between stages of recovery, he said.

If care coordination challenges a patient who has insurance, a family, and a place to stay, imagine what it is like for someone recovering from heroin addiction who has none of these things—but who has a trail of warrants, unpaid bills, and chronic health problems. “A lot of our clients have hepatitis C, diabetes, HIV,” McGreevey said. “It’s a challenge to get the antipsychotic medications,” and other expensive therapies.

Mazza’s description of what happens in Hudson County is nothing less than what an ACO does, but without the advantages that designation would bring. It’s not enough, for example, to enroll people in Medicaid; those who have never used health coverage must be taught how. Mazza identified 27 “frequent users” of the system and used vouchers to put them in permanent housing; only 2 landed back in jail.

He warned the attendees that this is not easy.

“Whenever you try to develop a re-entry system at the local level, you find there are reimbursement variations across the systems, which discourage the coordination of care, they also encourage the duplication of services and unnecessary care. Components of care are not speaking to one another, which will impact the level of care. The most important piece of what corrections brings is understanding who that person is, and educating the various systems when they walk out of our jail as to need, and to how best to apply those systems to the person.

“But more than that, jails have a responsibility and understanding of the needs of their inhabitants, and [they] hold these systems accountable," Mazza said.

He has developed a proposal for a full ACO, which would be a public–private partnership based on the Hennepin Health model in Minnesota. The proposal, which was provided separately to attendees, would aim to generate revenue to invest in a sober living center, to reduce unnecessary visits to the emergency department (ED).

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