Caring as Communities Podcast: Solutions for Homelessness
Homelessness remains a key issue for over half a million people in the US each year, with the pandemic and subsequent unemployment leading numbers to climb.
Join our guests Rob McCann, CEO of Catholic Charities of Eastern Washington, and Damian Mazzotta, Founder, and Chairman of The Shower of Hope, and learn what communities like Spokane and Los Angeles are doing to address this in our most recent podcast. This podcast is now live on Apple, Spotify, and a number of other smaller platforms as well. A transcript of the podcast can be found, along with the audio, on our hosting platform!
Caring as Communities Podcast: Addressing Homelessness & Healthcare
The COVID-19 pandemic has highlighted shortcomings in our systemic approach to homelessness. Join Dr. Jim O’Connell, Founder of the Boston Health Care for the Homeless Program, and Bobby Watts, MPH, MS, CPH, and CEO, National Health Care for the Homeless Council as they discuss what needs to happen at local, state, and federal levels to better house and care for the health of these vulnerable individuals.
Addressing Racial Disparities in Health: Part 2 – Racism in Healthcare Today
The second in our series, Racism in Healthcare Today, has dropped! It’s available on Apple, Spotify, along with a number of other podcast stations. A transcript of the podcast is available for our friends in the deaf community on our main platform, https://caringascommunities.buzzsprout.com/
Podcast Episode 6: Addressing Racial Disparities in Healthcare- Part 1
Dr. Terralon Knight:
Dr. John Vassall:
- How to be an Anti-Racist, Ibram Kendi
- Caste: The Orgins of Our Discontent, Isabel Wilkerson
- Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, J.D. Vance
Dr. Kellee Randle
Equity Plus Ventures
Caring for Communities Podcast: The Opioid Epidemic and Facilitating Better Medication Assisted Treatment
Listen in as Dr. Enrique Enguidanos interviews Drs. Eric Ketcham and Gregg Miller to discuss what can be done to improve the MAT care available and key strategies for addressing the opioid epidemic.
- Eric Ketcham, MD, MBA, FACEP, FASAM, FACHE, and Emergency Physician & Addiction Specialist at Presbyterian Healthcare Services
- Greg Miller, MD, FACEP, Chief Medical Officer at Vituity
- Dr. Enrique Enguidanos, CEO/Founder of Community Based Coordination Solutions, and practicing Emergency Physician in Seattle
Additional Resources Available for this episode:
SAMHSA (Substance Abuse and Mental Health Services Administration):
Catalyst Program 2: Implementing Customized Care Plans
Catalyst Series Part 2: Implementing Customized Care Plans
Customized Care Plan Development and Emergency Department Relations are integral components of every Complex Care program. As medical professionals, we know the importance of reducing future re-admissions and a solid care plan is crucial for our high resource patients. A care plan should enhance the patient’s treatment plan by providing a list of identified health conditions or problems with a corresponding prioritized list of interventions to meet the patient’s goals.
Typically, this is a 4-month project with our clients. CBCS develops care plans with an emphasis on:
- Input from patients, providers, and pertinent community resources
- Input from patient’s recent ED visits and/or admissions
- Focus on end-user effectiveness
- Emergency department, admission, and out-patient providers
- Timely and effective care plan updates
- Medication reconciliation
- Recommended actionable items for end-users
- Upcoming patient appointments and/or current treatments
- Key triggers such as violence warning
CBCS also promotes care plan recognition and use within the community by meetings and the education of target community resources such as emergency department staff, hospitals, and hospital-based care coordinators, outpatient providers and their staff, regional behavioral health and chemical dependency centers, and other pertinent resources as identified.
By focusing on the individual patient and ensuring their needs are identified and addressed within a Customized Care Plan, re-admission rates go down, and therefore so does the cost to the healthcare system. A win-win for everyone!
Join us next time as we discuss our Controlled Substance Management Program and how it helps identify substance abuse issues specific to your community and what you can do to improve this complex care issue.
Those of us working in the Complex Care community have pain points—areas within our systems that, if functioning better, would work better for our high-utilization clients, our staff, and our bottom lines. With this in mind, CBC Solutions (CBCS) has crafted five (5) individual programs that can help target what we have found to be the most pressing issues that once solved will make a big impact. Learn more here: https://cbc-solutions.org/programs/
Podcast Episode 4: Substance Use Disorder in the Wake of COVID-19
An analysis of hospitals on the Collective network shows that overdose visits as a proportion to overall emergency department visits have increased by about 35 percent since lockdown began across the nation.
Join CBC Solutions’ CEO and Founder, Dr. Enrique Enguidanos, and Kat McDavitt, Chief of External Affairs at Collective Medical, as they interview Anne Zink, MD, FACEP and Chief Medical Officer for the State of Alaska and Hon. Nathaniel Schlicher, MD, JD, MBA, FACEP, Regional Director of Quality Assurance for Franciscan Health System and Associate Director of the TeamHealth Litigation Support Department.
- Obstacles to patients receiving substance use disorder treatment
- Silver linings coming from the pandemic
- What it takes to implement a successful SUD program
5-Part Catalyst Series: Community Multi-Disciplinary Team
5-PART CATALYST SERIES: CBC Solutions Introduces 5 Complex Care Catalyst Programs
Relieving Your Complex Care Community Pain Points One Program at a Time
Those of us working in the Complex Care community have pain points—areas within our systems that, if functioning better, would work better for our high-utilization clients, our staff, and our bottom lines. With this in mind, CBC Solutions (CBCS) has crafted five (5) individual programs that can help target what we have found to be the most pressing issues that once solved will make a big impact. The five programs target the following topics:
- Community Multi-Disciplinary Team
- Customized Care Plans
- Controlled Substance Management Program
- Community Resource Engagement
- Direct Patient Engagement
We begin our five-part Catalyst Series discussing the importance of the Multi-Disciplinary Team (MDT) and how CBCS works with your team to improve this component within your current system of complex care.
The development of a strong multi-disciplinary team (MDT) is an integral component of CBCS’s community-based high utilization program. Generally, high utilization clients need help from many resources in the community. By engaging them in a common approach to client care it serves multiple purposes:
- Clients get the care they need faster as many resources involved in their care work together towards seeking their ideal outcomes
- Community care becomes more efficient as the multiple resources involved in high utilization cases begin to better understand each other’s capacities and limitations, and more effectively work together towards the most effective approach to care
- Improved cost of care as resource utilization amongst involved entities is streamlined
When working to develop your MDT with CBCS, we will be typically on-site for 2-3-day periods each month. During the first month our focus will be on:
- Identifying the community needs and resources most affected by high resource clients, and engaging them in participation in the MDT program
- Working with the contracting agency to identify the appropriate program patients
- Working with the contracting agency to identify the assigned program staff member, and begin training them on MDT administration
Once assembled, the MDT group will begin meeting in month two. Meetings are typically 90 minutes long and involve a review of about 5 patients per meeting; short updates on previously reviewed patients also occur. Typically, by month four assigned staff should be able to run the MDT program by the end of the six-month contract period. In addition to monthly on-site visits, CBCS staff will meet with assigned program staff for weekly teleconference meetings, and via phone and/or additional teleconferencing as needed.
MDT membership varies depending on community needs; core members are typically representatives from local emergency departments, large primary care groups and/or FQHCs, EMS organizations, and behavioral health and substance abuse treatment centers. Ad-hoc (invited as needed for specific cases) members may include representatives from therapeutic court and legal systems, jail/prison programs, housing authority groups, law enforcement agencies, and others. CBCS encourages contacting entities to submit patients for enrollment into the MDT program that they have found to be particularly difficult to engage, and/or have difficult case management histories.
Join us for the next entry in our Catalyst Series where you will learn the importance of Customized Care Plans and how their implementation will help improve your Complex Care programming.
To learn more about all of our Catalyst Programs, click here!
Breaking Free: The Cost and Benefits Behind Breaking the Incarceration and Addiction Cycle of Those with Substance Use Disorder
“Even if you’re thirty years sober, the condition doesn’t go away.”
I first met Terrance in a secured state prison. He was nearing the end of his sentence, and I was meeting with him and his case manager before he would be released the following week.
Terrance had originally been arrested on a drug-related charge, and although he had been sober for the duration of his prison sentence, the call of his addiction was never far. Terrance’s care coordinator in the prison had reached out to us to help ensure that—once Terrance left the system—he would still remain supported.
The high cost of the War on Drugs
The War on Drugs, officially declared in the seventies, has led to the mass incarceration of individuals like Terrance. For over five decades this war has played out—always with politically charged directives but with rarely with the required focus on the individual stories of substance abuse, addiction, and the consequences of both.
Some argue that providing appropriate SUD care is too costly—a close look at the data indicates that nothing could be further from the truth.
The cost of a comprehensive approach to SUD programs that includes acute and outpatient care, Medication Assisted Treatment (MAT), and longer-term support groups is miniscule in comparison to the cost of incarceration. Data shows that the U.S. government spends an estimated $9.2 million per day on incarceration of drug offenders. In addition, the National Drug Intelligence Center estimates that drug use causes society as a whole $193 billion a year—$113 billion of which is associated with drug-related crime.
And how do we put a cost on the loss of human lives? More Americans died in 2017 of drug overdoses than the total number of casualties from the Vietnam War. Of these overdoses, 68 percent were caused by opioid abuse.
Never truly free: the chains of addiction
Roughly 65 percent of individuals in jails or prisons across the U.S. struggle with some form of addiction. Yet research conducted in 2010 by the National Center on Addiction and Substance Abuse at Columbia University suggests that only 11 percent of individuals in our criminal justice system receive any treatment for their SUD. And the trend is actually worsening— a 2019 study by the National Academy of Sciences showed that only 5 percent of inmates with opioid use disorder received specific opioid-related treatment.
This lack of treatment could be a result of the common misconception that sobriety means we’ve won the batter over addiction. In reality, the early recovery stage of addiction can last up to a year, and post-acute withdrawal symptoms (PAWS) can last even longer.
After a sober prison sentence, individuals may experience drug cravings for months or longer. This is a critical period—arguably THE critical period—in which support can translate into long-term success.
Typically, the immediate post-incarceration period results in gaps in SUD support just at the moment individuals need this support most to have any chance for a successful transition into community life. Without appropriate SUD support during this period, individuals may be momentarily free from the penal system, but they remain prisoners to their addictions—never truly being free of either the cycles of incarceration or addition.
Appropriate SUD support upon release from incarceration is critical to breaking the cycles of addiction and incarceration that permeate our society. We CAN win this war, but only by understanding and addressing these dynamics through the funding of programs that effectively provide this support.
Widening access to Medication Assisted Treatment and other SUD supports
Until the Affordable Care Act, costs associated with SUD (and behavioral health) were not supported by Medicare or Medicaid. Since then, great efforts are being made to expand the substance use disorder support available—including the decision by CMS earlier this year to reimburse the cost of approved opioid treatment programs. Still, there’s room for improvement.
Federal, state, and local governments spend a combined $74 billion annually on SUD-related court hearings, incarcerations, and paroles. Only $632 million of that money is spent on actual SUD prevention and treatment. THAT’S LESS THAN 1 PERCENT!!!
If an appropriate portion of that funding were reallocated to the actual treatment of SUD—rather than its criminalization and punishment—we could improve the care addicted individuals receive AND dramatically reduce the financial and human costs of SUD on society.
Data from the National Institute on Drug Abuse shows that every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When healthcare-related savings such as reduced acute and ED care are also factored in, savings jump up further to $12 for every $1 spent! And—most importantly—individuals are finally getting the support they need to leave behind addiction for good.
What we can do as payers and providers?
Ideal post-incarceration SUD care involves coordinated community-wide participation. Appropriate resources for housing and post-incarceration job support yield significant dividends and dramatically increase the success rates of SUD program efforts. Coordination with local law enforcement and corrections efforts all point to long-term community success, as do dedicated coordination between local hospitals, clinics, and Emergency Medical Services.
When communities offer such a coordinated approach, care teams can assure former inmates have access to the medical care they need from day one of their new life. Indeed, when working with care coordinators in the prison system to meet with individuals like Terrance, significant work can be accomplished prior to release from incarceration. Case managers can establish a primary care provider, enroll the individual in Medicaid, and arrange transportation to and from medical appointments. In addition, we can collaborate with prison system coordinators, outside case managers, primary care providers, and MAT facilities to establish a seamless plan for recovery to support.
A collective responsibility
Providing the resources necessary to better support individuals with SUD post-incarceration is critical to breaking the cycle off addiction and incarceration—and ending this fifty-year War on Drugs. This is a shared responsibility. By placing the patient at the center of the “wheel-of-care”, we can better understand how each of us contributes in our own way as an additional spoke to support that center and keep the wheel moving forward.
Patients move forward when we bring all key parties to the table—supporting patients with our time, attention, and financial resources. As primary care providers, payers, and MAT facilities, we bring our individual spokes together to support those of behavioral health organizations, local law enforcement, and community resources offering transportation, housing, and food security. Non-profits, support groups, and employment specialists can be brought in to further support patient progress.
Together, the efforts and resources of all members work to propel patient progress and keep the wheel moving on the path to recovery.
We have to move beyond dialogues on political ideologies and improve our focus and support for patients like Terrance as they leave our prison systems. By providing him with sufficient resources– the right spokes – his wheel begins to turn. And only as Terrance’s wheel turns do we all move closer to victory in the war on addiction.
**This article is provided through a collaborative effort with Collective Medical and is originally published on Becker’s Hospital Review HERE. It was written by Dr. Enrique Enguidanos, CEO and Founder of CBC Solutions and practicing ED Physician.
Podcast Episode 3: Caring & Advocating for Provider Mental Health
Providers across the country face mental health challenges, including burnout and suicidal ideation. Learn more about these unique challenges from the nation’s leaders in provider health research and advocacy.
Join Dr. Enrique Enguidanos, CEO and Founder of Community Based Coordination Solutions and Kat McDavitt, Chief of External Affairs at Collective Medical as they interview Bernard Chang, MD, PhD, FACEP, Vice-Chair of Research and Associate Professor of Emergency Medicine at Columbia University Irving Medical Center and Lisa Wolf, Ph.D., RN, CEN, FAEN, Director of Emergency Nursing Research at the Emergency Nurses Association.
- Data on healthcare workers
- The impact of COVID-19
- How to support each other as healthcare professionals
About the Speakers
Bernard Chang, MD, PhD, FACEP and Vice Chair of Research and Associate Professor of Emergency Medicine at Columbia University Irving Medical Center
Bernard Chang is Vice Chair of Research and Associate Professor in the Department of Emergency Medicine at Columbia University. He has research interests in clinician psychological and physiological health. He has received grant funding at the institutional, state, and federal level for his work on burnout and is currently one of the leading NIH-funded Emergency Medicine Principal Investigators in the United States with 2 active large (R01) federal grants looking at long term cardiovascular and psychological development of burnout in emergency physicians and nurses.
Chang received his Ph.D. from Harvard in psychology, his MD from Stanford and completed his Emergency Medicine residency training at the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women’s Hospital. Prior to going to medical school, he served as a professional sailboat captain doing yacht deliveries internationally.
Lisa Wolf, PhD, RN, CEN, FAEN, and Director, Emergency Nursing Research at the Emergency Nurses Association.
Dr. Lisa Adams Wolf is the director for Emergency Nursing Research at the Emergency Nurses Association. Her work has focused on the intersection of workplace environment, moral agency, and clinical decision-making in the healthcare setting, as well as workplace violence, mental health and suicide in care teams.
Wolf is an adjunct professor of nursing at several area colleges and Universities, and maintains a clinical practice in a local ED. She holds a bachelor’s degree in anthropology from Amherst College, master’s degrees in fine arts (Emerson College) and nursing (Molloy College), and a PhD in nursing from Boston College.
About the Podcast
The Collective Conscious is a monthly podcast aimed at addressing gaps in healthcare for some of our nation’s most vulnerable patients. Each month, we’ll meet with healthcare leaders to discuss what care teams, communities, and government agencies are doing to better support individuals with unique care needs—this includes mental and behavioral diagnoses, substance use disorder, homelessness and social determinants of health, and other complexities of care.
About the Hosts
Enrique Enguidanos, MD, MBA has over 20 years of clinical experience in emergency medicine—much of which has been spent also serving in organizational and systems management roles. As CEO and founder of Community Based Coordination Solutions and a practicing ED physician, he has spent over a decade developing and fine-tuning systems of care and community management systems that have proven very effective for frequent utilizers. He has organized these systems in a manner that allows CBCS to continuously reproduce care results across varying communities and healthcare systems.
Kat McDavitt is Chief of External Affairs at Collective Medical. With over ten years of experience in healthcare marketing, communications, corporate, and government strategy, she has positioned healthcare companies from small angel-funded start-ups to multi-vertical public corporations. Her knowledge of the healthcare industry spans both clinical and administrative innovations—as well as professional services—in the patient, physician, institutional, and payer markets.