CODAC receives health home accreditation

CODAC Behavioral Healthcare, the oldest and largest nonprofit provider of substance use disorder treatment in Rhode Island, has recently received CARF accreditation for its medication-assisted treatment health home services. While CODAC has been accredited by either the Joint Commission or CARF since 1996, its latest accreditation is considered much more significant.

According to CODAC president and CEO Michael Rizzi, Rhode Island has stipulated that all opioid treatment programs (OTPs) in the state must provide health home services for their patients receiving medication-assisted treatment such as methadone. Once that criterion was included in licensing, it became incumbent upon the programs in the state to obtain the health home accreditation in addition to a standard accreditation.

“Accreditation never anticipated health homes as a service. So when the opioid treatment health home model was approved by the Centers for Medicare & Medicaid Services (CMS), the accreditation bodies looked at this as an add-on service,” says Rizzi. “CODAC chose to examine what we [had] done over the course of the time period that the health home had been implemented. Because our three years was up on our normal accreditation, we requested that we also be accredited for our health home.”

CODAC has been providing medication-assisted treatment since 1974 and currently has about 1,440 patients—not including general outpatient—among its five locations . A primarily methadone and buprenorphine treatment program for opioid addiction, CODAC now possesses an accreditation that helps acknowledge that its patients receive more than a daily dose of methadone, and are being offered comprehensive care.

“We demonstrated the ability to have our OTP health home accredited, and we were the first in the nation to have that happen,” Rizzi continues. “It sets the bar, because the folks from CARF were looking at this as a first-time-out-of-the-box process.”

CARF has 800 standards for health home accreditation and 1,100 standards for OTP accreditation, so there were roughly 2,000 standards for CODAC to meet. There were also 57 pages of licensing requirements to consider from Rhode Island’s Department of Behavioral Healthcare and Development Disabilities and Hospitals (BHDDH).

“The first 800 standards were without precedence, so there was no benchmark; we set the benchmark,” says Rizzi.

Value of health homes

“[The health home model] also recognizes that patients in OTPs have a high probability of other co-occurring physical and mental health disorders and chronic conditions,” Rizzi adds. “For instance, many of our folks have hepatitis C, diabetes or cardiovascular disease, nutrition diseases, and all kinds of illnesses associated with poor health maintenance, some of which are consequent to their drug-use lifestyle.”

Rizzi adds that opioid treatment patients often live largely outside of the healthcare system because of their inability to navigate it well. 

“They don’t present well in doctors’ offices, they’re not necessarily accepted in doctor’s offices, so they refuse to go and therefore their condition worsens,” he says. “By the time they get to some type of critical juncture in their lives, their medical condition is at a point where there may be very little that can be done.”

The role of the health home is to coordinate, integrate and collaborate with primary care and specialty care physicians so that opioid treatment patients can enter the medical care system, be treated with respect and be encouraged to follow up, Rizzi says.   

For example, a case manager from the opioid treatment program might meet a patient at a doctor’s office, and the case manager would join the patient and the physician in a case conference. Similarly, it provides an opportunity to find out what physicians’ concerns or fears might be relative to treating opioid patients.

“It has really opened up the dialogue that’s enabled patients to more fully participate in their care, while getting respectful care at the same time,” says Rizzi.

How it all started

According to Rizzi, the health home initiative was launched by BHDDH, which approached six of the states’ methadone treatment programs and inquired whether they would collaborate with them on creating an amendment to Rhode Island’s Medicaid plan in addition to a health home model for eligible opioid patients.

Linda Hurley, CODAC's chief operating officer, says one of the main reasons the OTPs were chosen for this is because the opioid patient population has some of the highest spenders of Medicaid dollars, and these individuals already frequently visit clinics.   

Rizzi adds that the opioid patient population was ideal because of the continuing contact and level of support that already exist in day-to-day operations of an opioid treatment program.

The project began in February 2012 and involved meeting weekly with providers, BHDDH, the State Opioid Treatment Authority (SOTA), the Department of Health and Human Services (HHS) and other stakeholders, to ensure what Rizzi describes as “high fidelity and regularity,” for 18 months to create a state plan amendment to be submitted to CMS. “This was the first time that the providers were ever invited, encouraged or interested in working on a project of common concern,” says Rizzi.  

One recommendation that was given by accreditors was for CODAC to utilize a newsletter to make services better known among the community, stakeholders, and other care providers, as well as making the information available on its website for patients and staff. Hurley says CODAC is already taking steps to initiate this in February.

Attention from elsewhere

“There are a number of states that are currently looking at how they might be able to implement health homes for their opioid treatment patients, because they see the value that goes with it,” Rizzi says.

Part of what fuels the interest is that under the state plan amendment, new Medicaid money is supplementing opioid treatment counseling and medical services that are directly involved in treatment—services that were not ordinarily provided in the traditional opioid treatment setting because there was no funding for it.

“These are eight-quarter projects, two years, where CMS is paying 90% of the cost of this program and the state is picking up 10%,” he says.

This is enabling programs such as CODAC’s to hire the necessary staff members to fulfill the scope of the health home mission, which is a broader wellness objective. The team that is required consists of six individuals: a master’s-level team leader or program director, a case manager, a medical liaison case manager, a health home-specific RN, a counselor and a pharmacist.   

Although CODAC is in the process of conducting some stakeholder focus groups, Hurley says that anecdotally, patients have expressed gratitude for the additional services. She adds that the initiative has brought tremendous growth to their patients and attests that the model is worth pursuing.   

To those who might still be wary about providing medication-assisted treatment, both Hurley and Rizzi recommend speaking with an open-minded professional in the opioid treatment field about what options are available.

“There is a great deal of accrued science around this solid medication and its outcomes since its inception,” Hurley says.

Rizzi adds that it’s important to recognize that the patient has a voice and can only make an informed decision when knowing about all available options.

“You wouldn’t want to go to a cardiologist who said, 'I only believe in diet; I don’t believe in surgery if it’s necessary,'” he says. “To include residential treatment, 12-Step and halfway houses but not discuss the medical, physiological and pharmacological benefits of medication-assisted treatment is failing to provide the patient with all the information to make a good decision.”