[Congressional Record Volume 165, Number 37 (Thursday, February 28, 2019)]
[Senate]
[Pages S1585-S1586]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
OPIOID CRISIS
Mr. LEAHY. Mr. President, this morning, the Senate Appropriations
Subcommittee on Labor, Health, and Human Services and Related Agencies
held a hearing on the opioid epidemic and how States are responding to
the crisis. I was pleased Beth Tanzman, the executive director of
Vermont's Blueprint for Health, agreed to be a witness at today's
hearing to share the innovative approaches Vermont has taken to combat
opioid use disorders. Ms. Tanzman has also served as Vermont's deputy
commissioner for mental health and also directed adult mental health
services for Vermont's Department of Mental Health.
While certainly not spared from the opioid epidemic, Vermont is ahead
of much of the country in many ways: Our State openly identified the
problem, and our former Governor, Peter Shumlin, dedicated his entire
State of the State address in 2014 to constructively seek ways to not
just help addicts get clean, but to halt this scourge in its tracks.
Public health leaders, addiction specialists, doctors, and State
leaders came together and implemented a system to integrate substance
abuse treatment with primary healthcare.
Ms. Tanzman's testimony focused on the system developed through this
collaboration, known as the Hub and Spoke Model. The plan helps support
those in recovery with nine regional
[[Page S1586]]
hubs, offering daily medication assisted treatment for those with
complex addictions, and spokes, where patients receive follow-up care,
counseling, and general wellness services. This framework has allowed
Vermont to virtually eliminate wait times for treatment, which can be
enormous barriers for individuals needing help.
Every State in the Nation has seen the impacts of opioid abuse. Ms.
Tanzman's testimony was informative and offers an important perspective
for other States struggling with treating addiction. I ask unanimous
consent to that her testimony from the Appropriations Committee hearing
this morning be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Department of Vermont Health Access, Vermont Blueprint
for Health
Testimony to the U.S. Senate Appropriations Subcommittee on Labor,
Health and Human Services, and Education Regarding the Opioid
Epidemic--February 28, 2019
Beth Tanzman, MSW, Executive Director, Vermont Blueprint for Health,
Department of Vermont Health Access
Chairman Blunt, Ranking Member Murray, and Senator Leahy
and staff thank-you for the opportunity to outline what we
are learning in Vermont about addressing the opioid epidemic.
Vermont is here before you because we have successfully
scaled treatment availability for Opioid Use Disorder
statewide. Through our Hub and Spoke program we are currently
treating over 8,000 Vermonters (1.6% of the adult population)
with Medication Assisted Treatment (MAT). Vermont treats a
higher percentage of people with Opioid Use Disorder than any
other state in the nation.
We provide Medication Assisted Treatment in primary care
offices (Spokes) and in specialty addictions treatment
programs (Hubs). Through a Health Home Medicaid plan we've
built a programmatic framework that links primary care
(Spokes) and addictions treatment programs (Hubs). Patients
can move between Hubs and Spokes based on their needs.
Clinical expertise is shared across primary care and
substance abuse treatment providers.
There are strong signals that the Hub and Spoke program is
facilitating positive outcomes. Vermont has the lowest opioid
overdose death rate in New England. Vermonters receiving
Medication Assisted Treatment have lower rates of:
incarceration, hospitalizations, and emergency department use
than do Vermonters with Opioid Use Disorder who receive care
as usual. Our system of deploying teams of nurses and
counselors to primary care Spokes--2 FTE for every 100
Medicaid Members--combined with a strong back-up from Hub
programs has dramatically increased the number of primary
care providers offering Medication Assisted Treatment in
Vermont.
What we're learning may be helpful to others and a few
conclusions stand out.
Medication Assisted Treatment, the combination of
medications and counseling, is the most effective treatment
for opioid use disorder and as such, it should be
consistently available as the standard of care for this
condition.
Insurance should pay for Medication Assisted Treatment. In
Vermont we developed a Medicaid Health Home State Plan
Amendment under the authority of section 2703 of the
Affordable Care Act to create the Hub and Spoke Program.
There are other approaches to using Medicaid that states can
employ including: 1115 B Substance Use Waivers, State Plan
Amendments, including MAT in managed care organization
contracts, and increasing reimbursement rates for targeted
services. Commercial payers should also participate: in
Vermont two of our major commercial plans are piloting
payments for Hub and Spoke Services.
The health system--especially primary care--has a key role
in treating opioid addiction. The addictions treatment system
cannot do this alone; there is simply not enough treatment
capacity to meet the need brought on by this epidemic. The
participation of primary care can effect greater integration
of care, especially by coordinating pharmacological
treatments with counseling, rehabilitation, and recovery
supports.
The barriers to primary care participation in MAT (not
enough provider time, patient complexity, difficulty
integrating counseling supports) can be addressed by adding
nursing and counseling resources to the primary care
prescribing teams, as we did in Vermont.
Treatment is one element of a comprehensive response to the
opioid epidemic. Other elements include prevention--reducing
peoples' exposure to opioids in the first place, harm
reduction such as wide availability of the overdose reversal
medication Narcan to help prevent overdose deaths, and
recovery supports--including vocational services to help
people in recovery participate fully in our communities.
Leadership focus matters. I have had the honor of serving
under two consecutive Governors, Democratic and Republican,
who have both provided leadership and resources to address
the opioid epidemic in Vermont.
In closing, we have made much progress in Vermont, much of
it with the support of our federal partners. Yet while we
have some of the best access to treatment in the nation, we
have not solved this problem. Every week two Vermonters die
from a drug overdose. Tragically we've also experienced high
numbers of children under the age of five, who come into
state custody due to this crisis. We must learn how to do
better by our families and communities.
Thank you.
(At the request of Mr. Schumer, the following statement was ordered
to be printed in the Record,)
____________________