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Local Lawmakers Study ER Diversion Plan

The program would divert people with behavioral, alcohol or substance abuse issues away from emergency rooms and into more appropriate places for treatment.

Legislators, health care professionals, emergency responders and others this week discussed a blueprint for a pilot program that would divert people with behavioral, alcohol or substance abuse issues away from emergency rooms and into more appropriate places for treatment.

The Special Senate Commission to Study Emergency Department Diversion received the proposal it requested from Department of Behavioral Healthcare, Developmental Disabilities and Hospitals for the plan, which BHDDH is calling the “Sobering Treatment Opportunity Program,” or STOP. If the three-year pilot program, to begin in 2014, is deemed successful, the state could then consider replicating the program in other parts of the state in the future.

BHDDH proposes a privately run 15-bed facility it would oversee, where patients would stay for initial recovery, with a related supported housing facility for an additional 20 individuals. Depending on cost effectiveness, the facility could include detoxification capabilities, or it could provide referrals to existing detox programs. While locating the facility near a place where its target population often congregates would make transportation less of an issue, BHDDH suggests locating it elsewhere, unless the facility is secured, so patients will be less tempted to return to the street.

A pivotal component of the program would be transportation, which the proposal suggests should be a transport van service manned with an EMT and a homeless outreach worker. A community-based outreach team would be able to regularly visit the places where alcohol-dependent people are known to congregate and where ambulances are frequently called to transport intoxicated people to hospitals. Outreach workers could encourage people who need help to go to STOP instead of the hospital, preferably before they reach a state where they require immediate medical attention.

Another important component is housing. The proposal calls for transitional housing for up to 20 individuals to provide them support and assistance, especially employment assistance and connections to sobriety programs and health care, while encouraging peer relationships and a respectful environment.

While much of the commission’s discussion today centered around funding, STOP is designed as both a more effective treatment model and a significant cost saver for the state and the health care system. Currently, it is common for the same handful of intoxicated individuals, most of whom lack insurance, to be transported to emergency rooms by ambulance over and over, at a cost of about $500 per ambulance trip and $2,000 for a visit to the ER. Getting those individuals effective treatment would save significant money in the long-term, but also in the short term, since it is estimated that transport in the van might cost about $80, and an overnight stay in the facility about $200.

Funding might be found by identifying each of the departments within the state (or the city) that would benefit financially from such a program, and using a part of that savings to fund it, said commission members.

“A key to the success of the program is to identify the partners who will be assisted by it, and hopefully they can contribute to its up-front costs. They will all see savings on the other end, so it’s a good investment,” said Sen. Paul V. Jabour (D-Dist. 5, Providence), who co-chairs the commission with Sen. Joshua Miller (D-Dist. 28, Cranston, Providence.)

The state’s Medicaid director, Elena Nicolella, indicated that it is likely that a number of the patients would qualify for Medicaid coverage, particularly when Medicaid’s eligibility limits are expanded next year. Nicolella said the federally funded, state-administered Medicaid program likely would reimburse for most of the services provided at such a facility, other than housing. The plan has been included in the state’s application for a renewal of its global waiver, which will be submitted next month, she said.

The state’s insurers, hospital networks, and the City of Providence, have all indicated support, since all would likely save money, but the General Assembly must still include some funding in the budget for the program in the 2014 budget in order for the pilot program to become a reality.

But Senator Miller said he’s encouraged by success of similar programs in Massachusetts and other states, which have experienced better health outcomes and overall cost savings, and the fact that so many of the services such a program would provide will be covered by Medicaid as well as other insurance.

“Most of the real hurdles are behind us. Everything costs money, but this program is a cost savings for everyone involved in caring for the people who it would affect, and would be more effective at getting people sober and off the streets,” said Senator Miller.

Members of the commission plan to meet with administrators at homeless shelters and other service providers to discuss the possibilities of partnering on services and perhaps facilities, both for effectiveness in reaching those in need and in saving money.

The commission’s leaders indicated that they would like BHDDH to hone the proposal over the next month to have something closer to a request for proposals by its next meeting, which is not yet scheduled.


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