Delaware officials were facing a crisis - overdose fatalities in the state jumped by 12 percent in 2017, and they had the ninth highest overdose death rate in the country. They knew they needed to act, including taking a serious look at whether people with substance use disorder were able to access effective, evidence-based treatment services.
So in April 2017, officials approached Dr. Brendan Saloner and a group of researchers from the Johns Hopkins Bloomberg School of Public Health and the Bloomberg American Health Initiative to provide recommendations on how Delaware could improve addiction treatment in the state. The team spent more than a year examining and analyzing Delaware’s existing treatment system. Last week, after more than a year of research and review, the team shared their recommendations with state officials.
The report proposes four major strategies, and makes recommendations to guide the state as it pursues those strategies:
Increasing treatment capacity: Recommendations include implementing a Centers of Excellence-type program to provide rapid intake and assessment, treatment, peer services and access to chronic disease management; creating an online inventory of all credentialed treatment providers; the Department of Health and Social Services leading a campaign to increase the number of providers who prescribe buprenorphine; and Department of Health and Social Services developing a plan to support housing and employment for individuals in recovery.
Engaging high-risk populations in treatment: Recommendations include the Department of Correction offering opioid use disorder treatment that includes all FDA-approved medications to all individuals in detention facilities; the state upgrading the three existing withdrawal management centers; and Department of Health and Social Services setting standards for hospital provision of substance use disorder treatment for medication-assisted treatment and the use of peers.
Creating incentive for quality care: Recommendations include the Department of Health and Social Services reviewing its current rates to ensure there is adequate and consistent reimbursement for high-quality care; ensuring that current value-based payment initiatives applied through Managed Care Organizations are extended to opioid use disorder treatment; and developing a compliance strategy.
Using data to guide reform and monitor progress: Recommendations include developing a dashboard that collects and publicizes statewide data on treatment capacity, utilization and quality indicators; Department of Health and Social Services overseeing a linkage project that brings together multi-agency data for understanding system effectiveness and identifies opportunities for improvement; and Department of Health and Social Services evaluating program and policy changes and rapidly disseminating findings to facilitate continuous improvement.