DART 2.

0 Prevention/Treatment table discussion notes:

Jan. 14, 2014
We had 16 attendees at this table; our task was to examine what
the gaps are in treatment/prevention, and what we as the
Kingdom need to fill these gaps and move forward

The need for real detox beds located in the kingdom (1-7 day stay).
This could be in a central location, or split between St. Jay/Newport or
another location
The need for a continuum of treatment; those coming out of detox
would progress to either a 28 day early Recovery Inpatient Center
located in the Kingdom; or, a 14 day inpatient/14 day intensive
outpatient; or any combination of this determined by the needs of the
client.
Need treatment for immediate beds, beds for both detox and
inpatient that are close and immediately available.
Perhaps availability of more IOP programs and types, and more overall
choice in the continuum of care, as mentioned above
How can we get Big Pharma to help finance this treatment?

My note: perhaps we can have a Hazelton/Betty Ford type Center open a

branch in the Kingdom, perhaps in a therapeutic farm setting, as a
private/public cooperative endeavor. A certain amount of slots would be for
Vermonters at an affordable price Vermont would cover, and other slots
would be available at a premium for out-of-staters desiring world-class
treatment in the Vermont setting. Eric Clapton used this model in his
treatment center in Jamaica, Mon

A barrier for some is that they cannot afford their meds and counseling
because of insurance issues. A case surfaced this week with a person
wanting to taper off Suboxone who is now working and applied on the
Exchange, as he needs to come off VHAP. BC will supposedly not pay
for the Strip/film, only generic Buprenmorphine, and Treatment
Associates will only prescribe the film for safety reasonsthere are
exceptions in case of allergic reaction. In addition, his meds,
counseling Doctors visits and groups will now have a prohibitive cost

and will threaten his Recovery. This will undoubtedly happen to others
and should be addressed proactively.
In addition, BAART does not bill Medicare or private insurances; this
could be a large problem as more clients transition to the Exchange
What are the costs associated with treatment and lost productivity
etc., versus not treating those in need?
2.

It was figured out in the past that a preventative intervention for an

individual w/HIV saves $1,000,000
A relatively low percentage of those in treatment have been paying out
of pocket or at a pharmacy (usually $77.00 per week, or $60-80 range
NKHS states that most of their clients are 3rd party billed. They do
supply MAT treatment for their clients, but are not open to the general
public for walk-ins. They do have prescribing Docs, one of whom
attends P/T at NVRH
HUB & SPOKE: Induction is now thru BAART, and clients can be treated
there, thru the PCP setting (ideally with a Behavioral Health Specialists
licensed as a drug counselor), or thru NKHS, depending on the clients
needs. The primary care providers prescribe Suboxone.
Kingdom Recovery Center has a Pathway Guide (thru a SAMHSA grant);
this guide works with MAT patient to find supportive services and
venues. Cindy, the Guide, facilitates two groups, with more to come
thru The Recovery Coalition at NVRH. KRC also has Recovery Coaches
available, who provide peer guidance to those suffering any form of
addiction
The OBOT program supports up to 30 clients per PCP; the PCP can
apply for up to 50, and then 100. This, however, supposes support staff
to provide full treatment such as counseling, monitoring, etc. The HUB
will supply medical staff and licensed SA counselors depending on the
case load per 100. Dr. Kraus treats 15 patients; Dr. Ajamie treats 19.
We need better numbers for Medicaid patients versus self and third
party. Also, there are believed to be quite a few people who have not
sought treatment because it is not available, or when they were ready
treatment wasnt.
Having pharmacies (VPMs) produce letters notifying ER and BAART of
issues with clients was discussed. BAART and the ER are implementing
a program that will have the client give permission to BAART to speak
to the ER closest to their residence in case of ER visit

A suggestion was made that a HIPPA release be signed by any new

client to speak to the ER and PCP as part of the admission process. It
was not sure that it would be ok to do that
Finally, MORE and SMARTER FUNDING, specific to the Kingdomwe
have few assets here

Respectfully submitted by Jenny Hook and Steve Kline

Please send corrections and additions to Steve at kline503@hotmail.com