The second day of the Camden Coalition’s Putting Care at the Center 2023 conference in Boston offered attendees a wide range of tools, techniques, and the business case for building authentic relationships with patients as well as with policymakers.
The day kicked off with the launch of the Complex Care Certificate, an online, self-paced training program that’s designed to build frontline providers’ skills and confidence in delivering person-centered care for people with complex needs. “This curriculum is based on our experience and the hundreds and hundreds of hours that we’ve spent not just with patients but with other people in the complex care field,” said our CEO Kathleen Noonan.
Throughout the day, presenters on the main stage and in workshop rooms demonstrated how authentic healing relationships with patients, forged in some cases over years, led to important insights and policy changes that have improved care and saved countless lives. One of the most memorable was a conversation between Jim O’Connell, MD, the founding physician of the Boston Healthcare for the Homeless Program, and Derek Winbush, a patient who has served on the organization’s governing community advisory board for two decades.
Jim described how patients shaped the entire program, beginning in the 1980s when they insisted on having a role in governance and planning. “We had to learn what people wanted before we could do it,” Jim said. Among other innovations, they insisted on team-based care, to be provided by practicing clinicians, not students or volunteers, and respite services. Their willingness to challenge prevailing practices in health care has been critical to reform, Jim said. For Derek, who also serves on the National Health Care for the Homeless Council, being treated with dignity by medical staff was lifesaving.
“That’s the thing about our program. We treat people like human beings. I’m not the ex-convict, Black dude with AIDS and all that other stuff. I’m someone’s brother. I’m someone’s father,” he said. “I needed that unconditional love, to know that somebody cares about me.”
In other sessions, presenters described new federal and state policies that have the potential to dramatically reshape care, particularly for patients with mental health and substance use needs. Most talked-about was the expansion of the Certified Community Behavioral Health Clinic (CCBHC) model, a designation for clinics that offer immediate access to mental health and substance use supports for people in crisis, as well as coordinated and comprehensive ongoing care. As part of a federal demonstration program, the clinics receive flexible funding that covers a wide range of urgent and more routine behavioral health services for Medicaid beneficiaries, including peer supports and case management services.
“The payment model creates so much opportunity to do the work that we all know is best for patients,” said Natasha Dravid, Senior Director of Care Management and Redesign at the Camden Coalition.
“This model is a gamechanger. It’s a once-in-a-generation type opportunity to improve care,” said Brent McGinty, President and CEO of the Missouri Coalition for Community Health Centers.
Attendees also heard about the ways healthcare providers in New Jersey worked with the Camden Coalition and the state’s Medicaid agency to increase access to medications for addiction treatment (MAT) for opioid use disorder as well as the opioid overdose reversal drug naloxone. At the time this work got underway, New Jersey had the seventh highest rate of overdoses in the US. “While the risk of overdose was increasing, we were actually seeing the risk triple among Medicaid beneficiaries,” said Laura Sorenson, Senior Program Manager for Substance Use, Harm Reduction, and Behavioral Health Initiatives at the Camden Coalition.
To increase access to lifesaving medications in primary care settings, the state Medicaid agency introduced a series of practice supports, including incentive payments that enabled medical practices to hire new staff, and demanded the removal of prior authorization requirements for prescribing buprenorphine, a form of MAT. To make the case for these changes, clinical champions like Iris Jones, LPC, manager of clinical operations at the Cooper Center for Healing in Camden, NJ, collected data that showed declines in emergency department visits and hospitalizations for patients who received MAT. “We could see in real time that this wasn’t increasing risk,” Iris said.
Other sessions gave attendees a view of other promising models for coordinating and integrating supports across communities for people with complex needs, including the Atlanta Regional Collaborative of Health Improvement and New Jersey’s Regional Health Hubs.
For conference attendees, these innovative models and policy shifts are concrete evidence for the importance of solutions that reduce stigma against patients with complex needs. “This is part of the change — a whole room full of us here,” said Derek as he looked out at the hundreds of people crowding the Park Plaza ballroom. “I see that there’s people that care. There are people that truly care.”