Geisinger’s outpatient addiction medicine clinics primarily focus on MAT, including buprenorphine or naltrexone, to manage maintenance of substance use disorders. However, the clinics additionally provide a more holistic approach to patient care and focus on care coordination related to social determinants of health, peer support, and connecting individuals to community counseling resources. One of the critical components of the initiative is that the patient’s specific substance use disorder treatment information is embedded into Geisinger’s electronic health records (EHR) system. This allows for treatment information to be seen by providers across the health system, for the abstraction of key performance indicators (KPI) in a dashboard that tracks clinical and operations trends, and allows for data-driven decision making and policy development to support clinical outcomes and patient engagement.3
In addition to these services, Geisinger designed a color-coded patient acuity scale that classifies patients into two different treatment objective categories:3
- Functional improvement: Goal of gradual cessation of substance abuse
- Harm reduction: Goal of keeping the patient engaged and alive while mitigating the spread of infectious disease via intravenous injection
The objective of this acuity scale is to define clinical criteria which can standardize practice according to best practice guidelines for common clinical presentations. A downstream impact is the ability to cohort patients for purposes of clinical outcome tracking on objectives such as increasing patient engagement and decreasing overdose mortality.
Those in the “harm reduction” category are required to attend fewer clinic visits and counseling verification requirements are less stringent than for those in the “functional improvement” category. This policy decision is based on evidence that even some patient engagement is better than no engagement. It is designed to not only keep more patients in the program, but also to make more clinic time available for access by all patients. With physician agreement, patients can choose to move from the “harm reduction” to the “functional improvement” category at any time.3
Geisinger’s addiction medicine clinics are staffed by addiction coordinators who are familiar with local patient resources and have backgrounds in substance abuse treatment. Multidisciplinary teams are led by addiction specialists. The team maintains close relationships with community resources, which provide many of the counseling services offered to patients.3