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. Gastfriend, MD, served on the faculty of Harvard Medical School for 25 years, most recently as Director of the Addiction Research Program at Massachusetts General Hospital (MGH). His studies of the Patient Placement Criteria published by the American Society of Addiction Medicine (ASAM) have been supported by the NIH's National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the U.S. Centers for Disease Control, U.S. state governments, managed care corporations, including Aetna Behavioral Healthcare, and foreign governments, including Belgium, Finland, Iceland, Israel, Norway, Switzerland, and the World Health Organization. The author of over 125 scientific publications, he has served on the Boards and Editorial Boards of a number of societies and journals, including ASAM and the International Society of Addiction Medicine (ISAM). He is co-editor of the leading book on treatment matching in the field, The ASAM Patient Placement Criteria for Substance-Related Disorders and editor of Addiction Treatment Matching. In addition to his role at RecoverySearch, Dr. Gastfriend is also Vice President for Scientific Communications at Alkermes, Inc. (NASDAQ: ALKS) where he is involved in research, education and scientific publication on extended-release naltrexone (VIVITROL®) and the company's efforts in the field of addiction treatment.
Dr. Brian Hurley, MD, MBA, DFASAM
Director of Addiction Medicine, Los Angeles County Department of Health Services
Dr. Brian Hurley is an addiction psychiatrist and Medical Director for Co-Occurring Disorder Services for the Los Angeles County Department of Mental Health (LACDMH), supporting the identification and management of co-occurring substance use among patients with mental illness served by LACDMH. He is an assistant professor of Addiction Medicine at UCLA.
Brian serves as the Treasurer and is a Distinguished Fellow of the American Society of Addiction Medicine. Brian joined ASAM in 2002 as a first year medical student, and has served on the ASAM Board of Directors in various capacities since 2003. Brian previously served as chair of ASAM’s Membership Committee and Physicians-in-Training Committee and is formerly ASAM’s alternate delegate to the American Medical Association. Brian additionally served on the EVP/CEO search committee in 2010 that led to Penny Mill’s selection as ASAM’s current EVP/CEO. He has additional served in various roles for the Massachusetts Society of Addiction Medicine, New York Society of Addiction Medicine, and California Society of Addiction Medicine.
Brian completed the Robert Wood Johnson Foundation Clinical Scholars Program at the University of California, Los Angeles (UCLA), and was previously a Veterans Administration National Quality Scholar at the VA Greater Los Angeles Healthcare System. He completed residency training at the Massachusetts General Hospital and McLean Hospital, where he was Chief Resident in Addiction Psychiatry and addiction psychiatry fellowship training at Bellevue Hospital and the New York Veterans Administration. Brian is a graduate of the Keck School of Medicine and Marshall School of Business of the University of Southern California. He was a 2012 American College of Psychiatrists Laughlin fellow, a 2010-2013 American Psychiatric Association (APA) Public Psychiatry Fellow, and a 2015-2017 Group for Advancement of Psychiatry Fellow. Brian has previously served on the Board of Trustees of the APA.
Eric E. Gastfriend
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.