Opioid Treatment Provider Pilot - Success Story

The Methadone Maintenance Treatment Program (MMTP) at Beth Israel Medical Center, the largest non-profit methadone treatment program in the United States, has been operating for more than 40 years, with 18 clinics throughout Manhattan and Brooklyn.

Clinic2F on Second Avenue in New York participated in the first NIATx Opioid Treatment Provider Process Improvement Learning Collaborative (2009–2010).

The goal of the project was to increase client continuation in treatment.

The Beth Israel MMTP change team wanted to reduced the number of clients who were leaving treatment within the first 30 days. A significant number were leaving within six days of admission.

The Beth Israel Medical Center MMTP change teams thought that improving engagement during the screening and intake process could improve the 30-day retention rates. They restructured the overall process to allow for same-day admissions in a single location. They revised the information packets to make sure that all patients received consistent and uniform information. Other changes included:

• Stressing better customer service during the intake process.
• Having managers conduct screenings. This ensured that the patient received a thorough assessment and an appropriate treatment recommendation.
• Implementing a “5-in-5 post-admission plan:” A counselor from each of five service areas saw the patient within five days of admission. Clients met with financial and vocational counselors, the treatment program manager, the medical provider, and a social worker. Previously this had to be accomplished within the first 30 days.
• Assigning new patients to a primary counselor within three days of admission.
• Requiring newly admitted patients to attend an Early Intervention/Orientation Group within the first 30 days.
• Providing newly admitted patients with a wallet-sized clinic-specific information card that lists the program address, hours of operation, clinic manager, and the names and contact info for the patient’s counselor, nurses, and patient advocate. This condenses the most important information about how to stay connected with the program in a handy form that patients can carry in their pocket or purse.

• Implementing the “5 in 5” reduced the percentage of clients lost to contact within the first 30 days from 23% to 15%, with a positive impact on revenue.
• Patients reported feeling better informed and more engaged in the treatment process.
• Clinical staff appreciated the reduced paperwork that resulted from the change projects.

Although continuation was the initial focus, the change process helped all personnel prepare for a shift in the MMTP paradigm. This shift expanded the MMTP focus from providing medication assistance only to providing comprehensive clinical and social services.

The “5 in 5” approach helped the service areas work together to benefit the patients. By being involved earlier, social workers reported that they could be more proactive, helping patients before problems arose. Nurses commented that the clinic is about “more than medication, and the 5-in-5 approach establishes a sense of belonging for the clients.”

The modified admission process has been integrated and adopted in five Beth Israel MMMT clinics, with the goal of adopting it in every Beth Israel MMMT clinic. The next focus will be on improving three- to six-month continuation rates.