Statement of The Hospital and Healthsystem Association of Pennsylvania For the

Senate Democratic Policy Committee

Submitted by Jennifer Jordan
Vice President, Regulatory Advocacy

The Hospital and Healthsystem Association of Pennsylvania

Media, PA February 12, 2020

Chair Senator Lisa Boscola, Senator Tim Kearney, Senator Anthony Williams, and members of the Senate Democratic Policy Committee, on behalf of The Hospital and Healthsystem Association of Pennsylvania (HAP), thank you for inviting us to provide testimony today.

HAP advocates for approximately 240 member organizations across the commonwealth, as well as for the patients and communities they serve. HAP’s vision is “A Healthy Pennsylvania,” and HAP’s mission is to empower hospitals and health systems as the leading advocates for improving health in their communities. HAP appreciates the opportunity to provide comments related to combating the overdose epidemic in the commonwealth.

The commonwealth’s response to the opioid overdose epidemic is multidimensional; however, various stakeholders still act within their own silos—the federal government and state agencies have overlapping programing, essential treatment services are still funded by fragmented and temporary public and private funding streams, and patients must navigate multiple county and local delivery models to receive necessary services. The Pennsylvania Department of Human Services (DHS) implemented a new quality initiative during late 2018, aimed at increasing the number of opioid use disorder patients entering into treatment. We saw that individual hospitals and health systems were working to make meaningful progress, develop internal infrastructure and implement evidence-based practices, but for the most part, they all were approaching this issue by themselves. For example, as required by the Patient Protection and Affordable Care Act of 2010, not-for-profit hospitals conduct Community Health Needs Assessments every three years to identify their community’s health needs and challenges and make plans to address them. Opioid and substance use related health concerns rank high in many communities and individual hospital plans identified specific strategies for addressing those concerns. While some hospitals, including those in the Delaware County region, work collaboratively with their peers on the assessment and planning process, the majority work alone.

We at HAP, know that hospitals can make a bigger impact working together. HAP is one of 16 Centers for Medicare & Medicaid Services funded Hospital Improvement Innovation Networks (HIIN). In this capacity, we work with 95 Pennsylvania hospitals to reduce patient harm and lower readmission rates. Recently, we joined forces with the New Jersey and Ohio hospital associations to help hospitals in the tristate region assess and advance their opioid stewardship efforts. Building off of our history of convening and supporting practice improvement, we decided to convene hospitals across the commonwealth to work collectively to address the overdose epidemic. We recruited organizations throughout the state, organizations who were just getting started in the fight against overdose deaths, and ones who already had robust initiatives in place. Our goal was to help hospitals work collectively to go further, faster, together.

What is the HAP Opioid Learning Action Network?

The HAP Opioid Learning Action Network (LAN) is a two-year project designed to bring the commonwealth's hospitals together to adopt evidenced-based best practices to prevent overdoses and help patients recover. This effort is funded as part of Bloomberg Philanthropies' grant to address the opioid crisis nationally and administrated by Vital Strategies. The funding allows us to offer this opportunity to all hospitals, free of charge.

More than 125 Pennsylvania hospitals participate in this effort—a true testament to the hospital community’s commitment to addressing individual hospital and community needs as well as the larger, statewide opioid crisis. Since our launch and kick-off conference last August, hospitals have gathered at webinars, office hours, and regional meetings to share tools and learn about promising practices. As part of this effort, hospitals collect and submit data on opioid use disorder-related processes and provide feedback to inform future programming.

Our programming to date has focused on implementing effective emergency department practices; the LAN’s year one goal and the pathways identified in the DHS quality initiative, and supported hospitals in the following statewide aims:

• Increasing medication assisted treatment (MAT) initiation in the emergency department (ED) and warm hand-offs to MAT in the community
• Increasing direct warm hand-offs to community providers for MAT or abstinence-based treatment
• Increasing evidence-based opioid use disorder (OUD) treatment and warm hands-offs for pregnant women
• Increasing the number of direct inpatient admission for MAT initiation from the ED, and MAT initiation of OUD patients hospitalized, overall

Year two of this effort not only will focus on sustaining ED-initiated momentum but also will widen the lens to improve practice at other clinical entry points:

• Increasing warm hand-offs in primary care settings
• Increasing access to MAT in primary care settings
• Quantifying reimbursement gaps and financial shortfalls
• Developing recommendations about meaningful reimbursement/funding structures

Who are our partners?

The LAN is a collaborative effort—participating hospitals share clinical expertise and help each other solve implementation barriers. We at HAP direct the LAN initiative with project management support provided by Health Care Improvement Foundation and oversight from Vital Strategies. LAN Clinical Advisors, Pennsylvania College of Emergency Physicians, and John Hopkins Medical Center all advise and provide clinical and operational expertise to support the effort. Johns Hopkins Bloomberg School of Public Health will evaluate the overall LAN impact.

We are actively forging new partnerships at the state, regional, and local levels and welcome opportunities to build new relationships. The relationships we build help to bridge existing chasms and smooth patients’ road to recovery.

What are we learning?

We only are six months into this two-year engagement and we still are grounding ourselves in the operational strengths and challenges of each hospitals’ OUD response. We are actively culling information and promising practices from our participating hospitals and we are just now starting to see hospitals’ performance data. While we welcome the opportunity to share more substantive policy recommendations in future, we are happy to share the following key, early learnings:

• People can and do recover from opioid use disorder—we are finding that this statement can be a useful antidote to compassion fatigue and cannot be said or demonstrated enough in our clinical, administrative, and even public policy discussions
• Peers with lived experience can be part of the solution—many of the hospitals with robust warm hand-off operations connect patients with peers who understand the patient’s experience and can help them navigate towards the patient’s desired goals. We are learning why peer recovery services is emerging as a promising practice
• Building and sustaining access to evidence-based recovery services requires stable, ongoing funding—through our conversations with hospitals, we are learning that most organizations are building promising practices and necessary infrastructure with a patchwork of temporary funding streams. Expanding, lasting access to high-quality care in every Pennsylvania community will require sustainable reimbursement instead of temporary grant funding
• Pennsylvania’s requirements governing the disclosure of substance use treatment information limit coordination between necessary stakeholders—Pennsylvania’s statutes and regulations are more restrictive than what is required under federal law. Providers are unclear about their rights and responsibilities and there is no clear source of definitive guidance. The current legal landscape poses a barrier to access by limiting coordination between physical health care providers, treatment providers, and social services

Hospitals are part of the solution—but not the only solution—to addressing the state’s overdose crisis. With the LAN, the hospital community is working more collaboratively to improve care across the state. We welcome opportunities to work in partnership with other key stakeholders to address an issue that continues to cripple our communities.

Thank you for this opportunity to share HAP’s perspective about the work we are doing to address the commonwealth’s overdose crisis. Please feel free to contact me should you have any questions or need any additional information.