Episode 10 - Big Changes at the Top

INTRODUCTION

Julie: [00:00:06] This is BACON, brief ACO News from the MaineHealth Accountable Care Organization, a wood-smoked monthly podcast for health care providers. I'm Julie Grosvenor.

Mike: [00:00:14] And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO.

Julie: [00:00:19] During this special episode, we'll alter our usual format a little bit to allow more time for two important topics: MaineHealth's response to the opioid epidemic and a major leadership transition happening here at the ACO.

Mike: [00:00:34] Yes, that transition is our Meaty Topic this month. So let's dig right in.

MEATY TOPIC

Julie: [00:00:41] We welcome two special guests to our Meaty Topic discussion today. But before I introduce them, let's set the stage a little bit. Early in December, the ACO's president and CEO Dr. Betsy Johnson announced that she would be stepping down at the end of February to take on a new leadership role in Massachusetts after seven years at the helm of the ACO.

Mike: [00:01:02] Yes, big news indeed. And then a few weeks later, more big news. The ACO board announced that the next president of the ACO would be Jennifer Moore, our current chief operating officer. I think it's fair to say that this was met with a sigh of relief at the ACO office. Jen is well-liked and highly respected here and has a long history with the organization.

Julie: [00:01:24] Betsy, let's start with you. Tell us a little bit about the work you're going to be taking on in Boston.

Betsy: [00:01:29] I'm going to be the new chief medical officer for primary care at Beth Israel Lahey Health, which is a newly merged health care system in the Boston area.

Julie: [00:01:38] That sounds like a big undertaking.

Betsy: [00:01:40] It will be a big undertaking. But, you know, it's going to be using a lot of the skills and strategies that we have used right here at the ACO. And so I'm looking forward to being able to continue the work that I'm so passionate about.

Julie: [00:01:56] That's great. That's great.

Betsy: [00:01:58] It will be it an adventure. And it's something that I am really thrilled to be taking on, particularly at this time in health care transformation. You know, something that we have thought a lot about here at the ACO is how we continue to build upon our own MaineHealth newly merged system and how we can continue to bring providers together and engaged in the care of our patients.

Mike: [00:02:30] You know, speaking of health care transitions, you've led the ACO Betsie through a lot of change and growth over the past seven years. As you prepare to leave the ACO, how do you see the ACO? Where does the ACO stand now?

Betsy: [00:02:42] Absolutely in a position of strength. And I really would like to call out a couple of reasons that I feel that that's where we are. First and foremost, we're in a position of strength because of our ACO team. We are 90 plus strong. The senior leadership that we have, the executive leadership with Jen Moore and our chief medical officer, Rob Chamberlin, together with our senior leaders and the teams with them, have really created an environment where people love to come to work and love to do hard work to improve the lives and the care of our patients and working with providers. So hands-down our ACO team. Another important factor for why I think is such a strong place is our ACO board. We are a physician led board. We had Dr. Mike Albaum, the chair of our board for the past six, seven years and we just recently had that taken on by Dr. Mark Fourre and we have a 15 member board that's an excellent mixture of both system leaders, primary care, specialist, CFO, CEOs, behavior, health. So it's really a strong board to help lead this entity. And finally, we're in such a position of strength because of our network and our providers who we serve.

Julie: [00:03:58] Well, I think you helped us get that all of those pieces in order. We appreciate it. Thank you.

Mike: [00:04:03] Definitely. Thank you, Betsy.

Julie: [00:04:05] So, Jan, you are stepping into these shoes, so you're going to be the ACO leader at this pivotal time. So what lies ahead for you and for the organization?

Jen: [00:04:18] Well, this is an interesting time in healthcare, for sure. And I think we are going to continue to see new models come out from CMS and CMMI, the Centers for Medicare and Medicaid Innovation. We continue to see that the Medicare Trust Fund is projected to run out by 2024. We hear from our local commercial payers that employers are increasingly frustrated by rising health care costs. And so they are putting out models, market disruptors are coming into town. And so I think the ACO is really at the center of this and needing to respond to some of these models and increasingly CMS and some of our commercial payers feel that downside risk is the way that we need to be responding to these. They seem to believe that unless we have. Quote unquote, skin in the game that we're not making meaningful change, and so I think what will be ahead for us over the coming months and years will be to decide to, if we jump into the models, to what extent we jump into them and then how deeply we jump into them. And so that will be exciting for us to figure out. There's a lot of opportunity. Some of these models are actually really great models. The Primary Care First model is a good example where we think that could really change the way that we function in primary care. And primary care is supported financially. And so we can learn from these and hopefully truly make meaningful change in health care.

Mike: [00:05:39] Yes, the depth of understanding and your history with the organization and with organizations like the National Association of ACOs, I think you bring a lot to the table in stepping into this leadership role and also, as you know, this podcast reaches the ears of many providers who participate in the ACO. And so what can the providers expect from the ACO and from you, Jen, going forward?

Jen: [00:06:06] Sure. So I have been in in the organization, as you know, for about 21 years and in health care for over 25. I've always had provider support roles, always externally facing the provider community. And so I go back to our mission, and I'll paraphrase here, which is to really support providers in the provision of high value care. And so we can only do that by listening to what the needs are of the provider community and doing our best to meet those challenges. I think that you as physician liaisons help us do that. You're our eyes and ears. You're bringing information back from our community that we can hopefully respond to effectively. I think Rob Chamberlin, our new chief medical officer, has a strong voice, having also led a large primary care practice and also being a practicing physician. He can help provide that lens that clinical physician lens to all the work that we do. And our boards and committees have that voice of all of the physicians in our community, or at least representative of the community, and so I think what you can expect from us is to continue to think about how we can best provide value to support the work.

Mike: [00:07:20] Thank you, Jen. And I can speak actually personally as a you know, as a small town community, independent primary care guy that I've always felt supported by you as I've known you and worked with you through our practices relationship with the ACO. And I can attest to your integrity and your support. And I've been grateful for that. And I am personally excited that you've agreed to step up to take this role at this time. Thank you.

Julie: [00:07:44] Yeah. We're both excited. Glad to see the ball being handed off to your capable hands and the great team that you've got around you.

Jen: [00:07:51] Thank you. Looking forward to it.

Julie: [00:07:55] And we will miss Betsy.

Mike: [00:07:56] Yes.

Jen: [00:07:57] Yes, we will.

Betsy: [00:07:58] It's been a privilege to work with all of you. And and I am very grateful that the ACO is left in such good hands. I look forward to seeing what you guys continue to accomplish.

Julie: [00:08:10] Well, I get down to Boston every now and again, so I'll look you up.

Betsy: [00:08:14] Stop by and visit.

Mike: [00:08:16] Great. Thank you.

THE SIZZLE

Mike: [00:08:22] And now an extended version of The Sizzle. Our celebration of providers successes this month. Our producer, Paul Santomenna, talks to Kristen Silvia about her work helping to lead MaineHealth's iMAT program.

Julie: [00:08:35] Mike, what's the iMAT program?

Mike: [00:08:37] It's integrated medication assisted treatment, and that's for patients with opioid use disorder. And in addition, Kristen offers some educational resources for providers interested in supporting their own patients’ recovery.

Paul: [00:08:52] I'm here with Dr. Kristen Silvia, who's the primary care director for MaineHealth's iMAT program, among many other titles. Also a practicing provider with MMP. So, Kristen, I wanted to ask you first off, what is the current status, so to speak, of the opioid crisis here in Maine?

Kristen: [00:09:13] Well, Paul, unfortunately, we're really just still in the midst of the whole crisis. We have seen some improvement in terms of the number of people dying from overdose. You know, that seems to have plateaued at least over the last couple of years, but we don't really know what's on the horizon next. I think that certainly what we've been able to accomplish is more options for people. There are definitely more treatment providers out there now. And so folks who are in more of the populated areas have choices now that they didn't have before, that they may have more than one program that they could go to if they're ready for treatment. We're not seeing the same thing, unfortunately, in the rural areas. So it's still a struggle up there. But I would say overall there are more providers treating opioid use disorder and more options for people.

Paul: [00:10:10] Talk a little bit more about the infrastructure specifically, MaineHealth growing infrastructure in this whole hub and spoke model which which I've heard a lot about but don't quite understand. So can you get into that little bit?

Kristen: [00:10:23] Sure. We've really been working very hard at MaineHealth for the past few years in creating a hub and spoke model. So the hub and spoke model is actually based on the model that is used in the state of Vermont with some slight modifications. And the idea is that patients who are early in their recovery journey, really still quite acute with their symptoms, can start at a hub. And the hub is where we have more expert level of care. We have addiction medicine and addiction psychiatry providers there with a lot of behavioral health support and patients can get stabilized, get started on the right medications and get a lot of behavioral therapy. So as they progress in their recovery and need less and less treatment, they can potentially move to one of the spokes. A spoke would be primarily patient centered medical homes. So, primary care offices where there are providers who have buprenorphine waivers, so they are by law allowed to prescribe buprenorphine to patients as well as other medications for substance use disorders. But in those places, there are still behavioral health clinicians able to help to assist the prescribers. And patients can be seen there for not only their substance use disorders, but for all the rest of their health.

Paul: [00:11:48] Clinicians who see these patients but aren't necessarily waivered or part of the iMAT infrastructure, what can they do to help?

Kristen: [00:11:58] Well, I would say the first thing is to know what's going on in your own office and your own system. While we have a number of providers within MaineHealth -- in fact, I believe the number is up over 80 now waivered providers -- there's still places where we need capacity and we need those who don't have waivers to step up and join their partners and get a waiver and help prescribe, even if it's just to your own patients, even it's just to a handful of people, so that we're all taking part in the treatment system and doing what we can for our patients.

Paul: [00:12:35] And then I understand, too, that MaineHealth has developed some resources for providers. Can you talk about those a bit?

Kristen: [00:12:43] Sure, absolutely. Besides hosting waiver trainings themselves so that people can actually come and get their training done to get a waiver, we've done a lot of work over the last year to raise awareness, number one, of some harm reduction techniques that that all providers can participate in. The first one is prescribing naloxone. So we know that naloxone is considered an overdose antidote. So if somebody has too much of an opioid in their system, you give them naloxone and hopefully be able to reverse that. And so what we did was we created an online learning module where we talk about what the risks are for overdose, what patients you should really think about prescribing naloxone to, and then described all the different formulations of it and how to talk to patients about it. Some patients may be hesitant to accept a naloxone prescription because they worry about what their doctor might think about that or what they're prescriber or might think about that. The second thing is something that we've called difficult conversations. We heard from a lot of providers that they're really uncomfortable talking to patients about opioid use disorder. They are not sure how to approach a patient who they worry might have that condition. And so what we did was we came up with various clinical vignettes that we recorded with real providers. And we take a provider through a scenario and talk about what went well, what didn't go well, how one might model the conversation in the future to get a good response from the patient. Both of those are very helpful. We've gotten very good feedback from providers that they were useful and they can be found on the MaineHealth web page. It's www.mainehealth.org/opioid-education. Both of those provide CME credit for providers and count towards the every 2 year three hour commitment that the state of Maine requires for prescribers.

Paul: [00:14:53] You mentioned the waiver training. Can you talk about those a little bit more?

Kristen: [00:14:57] Sure. So just for people who don't know what you need to do, so if you are a physician, so either an MD or DO, you have to have eight hours of training by federal law to prescribe buprenorphine in your office. And so that training can be done all online or might be done in what's called a half and half training, where you do four hours online and four hours live, or now we can actually do a full eight hour live training. So we at MaineHealth have been hosting trainings for the past few years in various locations and we've trained over 200 people in the last couple of years. And so that's been very successful. I think that providers who step up and start treating patients with substance use disorder, in particular opioid use disorder, find it to be really rewarding and whatever initial hesitation or anxiety they might have about adding this to what already feels like so much work that they already do, the vast majority of them find that the work is so rewarding for them and it actually has given them kind of like a little jolt to their own practice. And it's extremely fulfilling when you can see somebody get their life back together again and what that ripple effect that it has on their family and on their community and I think that whatever hesitation a provider might have will go away quite quickly once they start doing the work. And what we've tried to do here at MaineHealth is provide the structure and support for providers so that they know they're not doing it alone. And so, you know that is our imperative to continue to do that so that we can improve access for everybody.

Julie: [00:16:48] Do you have a provider success that others might learn from? Please email us at bacon@mmc.org.

Mike: [00:17:01] So, thanks for listening to this special edition of BACON. We'll get back to our usual format next month. Find information related to this episode at our podcast web page, mainehealthaco.org/BACON.

Julie: [00:17:14] And if you have questions, comments or suggestions, email us at bacon@mmc.org

Mike: [00:17:20] So, BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services.

Julie: [00:17:30] Thanks for joining us. See you next month.

Mike: [00:17:32] See you then.