Improving Care with Triage, Assessment, Contingency Management & Monitoring Technology (1.5 CME)
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Academic-entrepreneurial partnerships have generated computer-assisted innovations in: 1) comprehensive assessment/placement, 2) triage, and 3) contingency management. Data suggest improved outcomes and adoption. 1) Comprehensive assessment with CONTINUUM TM, the standard implementation of ASAM's Criteria, is a computer-guided, structured interview that operationalizes medical necessity criteria. CONTINUUM's decision engine can automate utilization review (UR). Through CMS's 1115 federal waiver program, county/state Medicaids are preparing to adopt it. In Los Angeles county (population: 10.1 million), piloting began in July 2016. UCLA is evaluating feasibility and impact on intakes and patient engagement. The web application captures: duration of assessment, completion rates, recommended placements, reasons for discrepant placements, patient characteristics, and satisfaction. The data may determine whether and how to proceed with county-wide adoption; how to streamline Medicaid and commercial insurance UR; determination of what levels of care, numbers of beds/slots are needed; and quality improvement. 2) Triage with the first derivative product of CONTINUUM, CONTINUUM Triage TM, emerged at the request of LA County and is also used in Massachusetts. This 20-question, computer-guided, structured interview (10-15 minutes, telephonic or in-person) determines the provisional level of care in which to complete the patient's CONTINUUM comprehensive assessment. SUD outcomes are improved when patients are provided the right care, at the right time, in the right setting, for the right duration - the goals of CONTINUUM Triage. Massachusetts also piloted both CONTINUUM and Triage, also for the CMS 1115 Waiver. Funded by the Governor's Opioid Working Group, Triage is being piloted in walk-in Opioid Urgent Care Centers in three high overdose cities. Both pilots analyze how often Triage's provisional recommendations are correctly matched to the final LOC recommendations of CONTINUUM. 3) Contingency management (CM), a high efficacy evidence-based practice, has been limited in its adoption by implementation burdens. CM restores healthy brain reward function with immediate small incentives that grow along a progressive reinforcement schedule. CM rewards healthy behaviors (e.g., sobriety) across all addictive substances, in many populations. DynamiCare Health, a fully-automated, scalable, patent-pending technology alleviates provider burdens by (1) ethically managing CM incentives, (2) automatically tracking/reporting data, and (3) using machine learning to provide impending relapse/dropout alerts for proactive intervention. Programs enroll new patients via the web. It provides an easy-to-use escrow account into which the patient deposits funds for CM reward incentives (e.g., from wages, welfare, family allowance, crowdfunding donations). The patient downloads the DynamiCare smartphone app for appointment tracking (via GPS), random/smart drug testing, and reward notifications. DynamiCare ships "selfie"-validating breathalyzers, CO detectors, and/or saliva drug test cups to the patient. Abstinence, medication adherence, or treatment attendance rewards transfer from the escrow account onto a debit card. Initial back-testing on spending data with machine learning has generated new, previously un-hypothesized independent variables in drug addiction, correctly predicting 70% of acute drop-outs. These technology developments offer nationwide implementation of data-driven care, service provision, payment reform, and outcomes improvement. Data for all three approaches are informing clinical and policy interventions.
David R. Gasfriend
MD, DFASAM
"In his 25 years at Harvard Medical School, Dr. Gastfriend directed the Addiction Research Program at Massachusetts General Hospital and founded the MGH-McLean Addiction Psychiatry Fellowship. His research operationalized and validated ASAM’s Criteria, contributing to their endorsement by most U.S. states, the VA and the Department of Defense. These NIDA- and NIAAA-funded studies led to CONTINUUM - the ASAM Criteria Decision Engine(TM), developed with the support of the U.S. Substance Abuse and Mental Health Services Administration for nationwide release.
From 2004-2013, Dr. Gastfriend was Vice President at Alkermes, Inc., where he supported gaining FDA approval of VIVITROL® for alcohol and opioid dependence and conducted clinical, criminal justice, and health economic research in addiction.
In 2014-2015 he was CEO of the Treatment Research Institute (TRI), the Philadelphia-based international research and policy center. He continues as Scientific Advisor, providing guidance to its researchers on projects such as the Addiction Severity Index and the Kennedy Foundation Parity Monitoring Project.
In 2016, he co-founded, with his son, Eric Gastfriend MBA, DynamiCare Health(TM), to provide a nationally scalable, standardized, low-cost smartphone implementation for contingency management and foster wide-scale adoption of this evidence-based approach to incentivizing healthy recovery behaviors.
NIDA granted him a Mid-Career Investigator Award for Patient-Oriented Research in 2000. In 2007, he received the Boston Business Journal's “Champion in Health Care – Innovator Award”. He is currently Principal Investigator on the $13 million PCORI-funded PATH Study of integrated addiction and primary care. He received ASAM's 2012 McGovern Award and Lecture for contributions to addiction treatment and society. Among his 150 scientific publications are ""The ASAM Criteria"" and ""Addiction Treatment Matching"". He has advised the governments of Belgium, China, Iceland, Israel, Norway, Russia and the U.S. on alcohol and drug addiction treatment. "
Brian Hurley
MD, MBA, DFASAM
Brian Hurley, MD, MBA, DFASAM is an addiction physician and the Director of Addiction Medicine for the Los Angeles County Department of Health Services. Brian is currently a Director at Large for the American Society of Addiction Medicine (ASAM) and will assume the position of President-Elect this April 2021. He co-chairs the Los Angeles County Department of Health Services’ Substance Use Disorders Workgroup and the SafeMedLA Medications for Addiction Treatment Action Team, and is the Clinical Director of the Addiction Treatment Starts Here programs through the Center for Care Innovations, focused on increasing the delivery of Medications for Addiction Treatment in California’s community health centers. He is the PI of two MAT Access Points projects funded by the Sierra Health Foundation, a co-PI of a TRDRP funded smoking cessation implementation project, and a co-investigator on NIDA, NIAAA, and PCORI funded addiction related implementation science grants managed through RAND. He is a member of the Motivational Interviewing Network of Trainers and regularly conducts motivational interviewing trainings throughout the United States. He is a Volunteer Assistant Clinical Professor of Addiction Medicine in the Department of Family Medicine at the UCLA David Geffen School of Medicine. He additionally serves on the American Board of Psychiatry and Neurology’s Addiction Psychiatry examination writing committee.
Brian completed the Robert Wood Johnson Foundation Clinical Scholars Program at the University of California, Los Angeles (UCLA), and was previously a UCLA - Veterans Administration National Quality Scholar at the VA Greater Los Angeles Healthcare System. He completed a fellowship program in addiction psychiatry at New York University School of Medicine. He completed residency training at the Massachusetts General Hospital and McLean Hospital, where he was Chief Resident in Addiction Psychiatry. Brian is a former National President of the American Medical Student Association.
No relevant financial disclosures
Eric E. Gastfriend
MBA
Eric Gastfriend is the Co-Founder and CEO of DynamiCare Health, a tech startup that is fighting substance addiction with evidence-based motivational tools. Previously, he was General Manager of Happy Cloud, a cloud gaming startup, where he oversaw software development and business development. Happy Cloud raised $7M in venture capital funding to make on-demand gaming possible for customers such as Warner Bros. Eric is currently managing DynamiCare Health’s strategy, operations, and fundraising. He earned his B.A. magna cum laude from Brown University and MBA from Harvard Business School.
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