The Hotspotting the Overdose Epidemic Program (The Hotspotting Program), a partnership between the Staten Island Performing Provider System (SI PPS) and the MIT Sloan School Initiative for Health Systems, is a value-based care coordination program for Overdose (OD) and Opioid Use Disorder (OUD) treatment and prevention. The Hotspotting Program combines advanced predictive analytics, holistic person-centered medical and social needs support, and an innovative reimbursement paradigm.
A $5 million pilot program is currently underway on Staten Island, New York. Building on early successes in the pilot program, The Hotspotting Program is currently working to scale this value-based program beyond the pilot location and aims to partner with the public sector, healthcare organizations and Medicaid Managed Care Organizations (MCOs) throughout New York State and the nation to create a sustainable path forward.
Staten Island was uniquely selected for the program’s pilot 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 about 170% 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, which has been proven to incorporate known high-risk factors for future opioid harm, and identify a small cohort of at-risk individuals of future opioid misuse events; the top 1% and 15% of which respectively will account for 70% and 90% of opioid misuse events within the following 12 months in the entire sample population.
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 coordination 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.
To this end, The Hotspotting Program provides each care partner with fully funded Certified Peer Recovery Advocates (CPRA) who lead focused interventions, drive engagement in care and deliver care coordination to those most at risk and potentially hardest to reach.
Initial results from the two-year pilot program have been promising at the six-month mark, with over 50% reductions in ER and hospital admission among the engaged Medicaid patients who are at risk of an imminent opioid misuse event.
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.
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.