Strengthening the Health Safety Net through Collaboration
The Regional Quality Improvement & Access Council is a group of health system partners from Grays Harbor, Lewis, Mason, Pacific and Thurston counties that aims to address immediate safety net issues through shared learning, exploration of potential opportunities, problem-solving, and collaborative action. This group evolved from the Thurston County Safety Net Council—a similar group that is Thurston County-centric. Partners from hospitals, public health, physician practices, and various state government agencies convened on Wednesday, November 17 to have their first meeting, and there was a great turn-out from every county. This first meeting explored two critical issues facing the five-county region mentioned above: 1) opioid misuse and our Emergency Departments, and 2) the impact of Washington State budget cuts on the mental health safety net.
The council heard four guest speakers present their expertise and answer questions. Dr. Gary Franklin, MPH, is a research professor at University of Washington, Medical Director for Washington State L&I, and Chair of the Washington Agency Medical Directors Group. He gave his presentation titled Opioids for Chronic, Non-Cancer Pain: A Rapidly Changing Landscape, which presented in great detail the data and research associated with the drastic escalation of opioid-related deaths, opioid prescription practices, and the interventions being deployed to mitigate what can only be called a crisis. Some of the more striking data include:
- Whereas a study published in 1986 showed that, from a group of 38 patients, only four were taking greater than 40mg of pain medication per day, in 2010 there are approximately 10,000 patients just in Washington State that are taking greater than 120mg of pain medication per day
- A study conducted in 2007 showed that 100% of patients on opioids develop some form of chemical dependence
- Over half of the “best practices” for the prescription of opioids are sometimes, almost never, or never used by prescribing physicians (as opposed to often, almost always, or always)
Dr. Franklin’s entire presentation can be viewed here.
Kara Elliott, RN, MPA, is the Emergency Department Consistent Care Program (EDCCP) administrative coordinator, and spoke to the program’s purpose, structure, and operations. EDCCP exists in Providence St. Peter, Providence Centralia, and Grays Harbor Community hospitals, and uses a team comprised of physician and nurse care coordinators from the hospital ED, a community-based health resource coordinator who provides intensive client support, a primary care physician or clinic representative, and mental health and substance abuse specialists to redirect frequent and inappropriate users of the ED to a more efficient and better quality plan of care. Ms. Elliot’s presentation also discussed the Emergency Department Information Exchange (EDIE)—a HIPAA-compliant technological solution to tracking inappropriate ED use across participating hospitals. You can view the entirety of her presentation here, and can learn more about EDIE here.
John Masterson, CEO of Behavioral Health Resources, and Eric Cummins, Executive Director of Willapa Behavioral Health, presented on the Washington State budget cuts and their impact on the mental health safety net. All of these cuts greatly affect the Regional Support Networks (RSNs) in the five-county region, to which state funding is given to administer mental health services at the local level. One of the biggest concerns is with the $65 million cut to Non-Medicaid funding, which provides services for both voluntary and involuntary individuals who are acutely and/or chronically mentally ill. You can view their presentation here.
In closing, this first meeting of the Regional Quality Improvement & Access Council was a highly dynamic and encouraging session. The health system partners in attendance were genuinely engaged and concerned about the issues presented (view agenda and minutes). Though concrete, action-oriented outcomes have yet to be realized, the foundation has certainly been laid; and, again, it has been proven that often it simply takes getting the right people in a room together in the spirit of collaboration to affect change.