The Hotspotting the Overdose Epidemic Program (The Hotspotting Program) is an evidence-based, data-driven overdose prevention and outreach initiative led by the Staten Island Performing Provider System (SI PPS), a division of Northwell Health, and funded by a $3 million grant from The Secure Futures Project and $1.5m from SI PPS/Northwell Health. The goal of the initiative is to identify individuals who are at the highest risk of overdose and engage them prior to an adverse event, using a person-centered care management model.
Building on the positive results of the first year of the program, The Hotspotting Program aims to scale its program and model throughout the nation by partnering with the public sector, healthcare organizations, and Medicaid Managed Care Organizations (MCOs). The employment of the program’s proven combination of predictive analytics, person-centered care coordination and Contingency Management has demonstrated the unique capacity to reduce overdoses and SUD-related healthcare utilization.
Staten Island was uniquely selected for the pilot of the program as it is one of the most socio-economically and demographically representative counties of the United States. In addition, Staten Island has disproportionately suffered from the overdose crisis. The number of overdose deaths per 100,000 on the island is much higher than the national rate and it maintains the second highest borough rate of death due to overdoses in NYC.
The Hotspotting Program is distinguished by its analytics platform, developed in partnership with MIT Sloan School of Management. The analytics model, which incorporates known risk factors for overdose, is used to identify individuals at high risk for a future overdose.
Another important feature of The Hotspotting Program is its peer recovery led, person-centered care management model. Using this predictive data, the program then employs a proactive care management model to engage, screen and refer to care those most at-risk before an overdose occurs. The Hotspotting Program recognizes the powerful impact of engaging those at highest risk with individuals who have similar lived experiences.
The program also incorporates Contingency Management for Medication Assisted Treatment patients. Contingency Management is a proven intervention that is effective in increasing treatment retention rates, improving treatment compliance, and reducing substance use in a cost-effective way.
The Hotspotting Program demonstrated greater initial results in overdose reduction and an increase in services provided to participants in the first year of the program. There was an 81% reduction in non-fatal overdoses for those clients engaged in the program. More importantly, there were two overdose-related deaths compared to 11 in the non-engaged group. This data strongly suggests that the Hotspotting Program has had a powerful effect on overdose prevention and a significant impact on lives saved.
Utilizing a proven predictive analytics model developed by the SI PPS and MIT, participating entities will use data sharing arrangements to identify those most at-risk a future overdose, many of whom have been inadequately engaged in care, have left treatment programs or have been impacted by system wide issues such as a lack of access to in-person services. The Predictive analytics model incorporates 107 predictor variables and 9 outcome variables to identify this high risk population, the top 1% of which have been shown to account for more than ⅔ of future overdose events and the top 15% of which account for 90% of future overdoses within the patient sample.
Upon identification of the high risk pool, the program places fully funded peer recovery advocates with participating treatment partners to deliver peer-led, person-centered services to at-risk individuals ‘where they are’ in a safe and collaborative manner. Dedicated teams will focus on preventing overdose harm, engaging individuals in recovery, delivering value to the health system, and addressing critical social determinants of health which impact health outcomes and lead to stressors that contribute to the initiation of an overdose, substance use disorder or relapse.
Consistent with the National Drug Control Strategy calling for evidence-based models of care, the program also incorporates Contingency Management (CM) for Medication Assisted Treatment patients. CM uses the science of behavioral economics to help individuals develop and maintain healthy habits and care plan routines. It is a proven intervention that is effective in increasing treatment retention rates, improving treatment compliance, and reducing substance use in a cost-effective way.
The Hotspotting program integrates an innovative value based reimbursement model which combines an engagement focused per member per month reimbursement rate alongside an incentive reimbursement attached to the absence of an overdose incident as well as the reduction of avoidable healthcare utilization. The program’s goal is to develop a business case for insurance companies to incentivize opioid use disorder (OUD) prevention, mitigation and treatment. All too often, managed care organizations underfund substance abuse care and maintain perverse incentives which neither benefit the patient or the system at large.