The National Academy for State Health Policy (NASHP) recently spoke to Robert Hansen, executive director of West Virginia’s Office of Drug Control Policy, to learn how the state is expanding opioid use disorder (OUD) treatment access and capacity through strategic partnerships that support its Substance Use Response Plan’s goals.

West Virginia has made expanding access to medications for opioid use disorder (MOUD) a priority. How are you doing this?

In an experiment, conducted by the West Virginia Drug Intervention Institute at the University of Charleston, to locate a treatment provider willing to accept a new patient immediately, we found that access was dismal – no messages or voicemail and no appointments available until seven to ten days, or three weeks, or a month down the road. If you look at a listing in Kanawha County, you’ll see a lot of providers and you might assume that means a lot of treatment. But can you get in when you need help? West Virginia has had a growth in medically assisted treatment availability throughout the state. At last look, we have had a 59 percent increase in the number of waivered providers, but access is still an issue. Our state is very rural and most providers are available 9 to 5, Monday through Friday.

If we know anything about substance use disorder (SUD), we know people need access to treatment as quickly as possible. So, how do you do that in a state with many transportation challenges? West Virginia is tackling access issues by working with Bright Heart Health, which is helping the state expand MOUD availability. This national, for-profit organization specializes in using telehealth to provide round-the-clock treatment as well as rapid access to virtual assessment, enrollment, and crisis intervention. Through this partnership, people living in West Virginia can access care and treatment when they need it and regardless of where they are located, so long as they have access to a phone, tablet, or computer, and a reliable internet connection.

You’ve indicated that West Virginia’s expansion of Medicaid has been crucial in facilitating access to treatment in the state, how is Medicaid supporting this particular partnership?

Medicaid is very central to paying for ongoing services. We have three managed care companies that were just re-awarded contracts to work with our bureau of medical services. All three of them were able to fast track BHH’s application and enrollment, ensuring that these services could be implemented for Medicaid coverage quickly. Sometimes credentialing gets very bogged down, but I think all three companies in West Virginia have embraced this concept and this company.”

How have the state’s emergency departments supported access to OUD treatment? Is COVID-19 a factor?  

Increasing access to treatment has to be a goal for addressing not only the COVID pandemic, but the opioid epidemic. We have several emergency rooms in our state that were [providing buprenorphine] before COVID, and that’s why we’ve made it a big initiative and worked with Mosaic to build out assessment, identification, and linkage to SUD services. Mosaic’s approach is multifaceted and involves working with ERs to screen all patients for SUD and develop clinical pathways to address individuals’ treatment needs, including incorporating peer recovery coaches into ER settings in order to fast-track people into treatment. There’s still stigma within the medical community, as there is in the community at large. I think that we lost momentum in [some of our initiatives] since mid-March, and now we’ve got to pick it back up.

How will West Virginia ensure that individuals remain engaged in treatment once they have been linked to treatment?

We are working on measuring [treatment] retention and continuous engagement, and I think we’re making strides – but, we have a long way to go. [Soon], as part of the Shatterproof ATLAS pilot initiative, we plan to go live with a webpage about West Virginia’s providers and how well they’re doing in delivering services according to Shatterproof’s National Principles of Care for addiction treatment. Through this pilot, West Virginia will be working with Shatterproof’s data partner to review Medicaid claims data and determine how providers are performing on a variety of key indicators, including treatment retention. These data will be available to state officials, as well as to managed care companies and individual providers.

How will West Virginia measure the effectiveness of these initiatives?

There are two big benchmarks that I live and die by – one is the number of overdose fatalities and two is the number of suspected overdose incidents. If you look at the national CDC (Centers for Disease Control and Prevention Centers) data on West Virginia fatalities, our rate per 100,000 is so much higher than the national average. [These projects] are just starting to hit the ground in West Virginia, and it’s going to be an evolutionary process, but the more individuals [we] engage, the better.

This blog is funded through a two-year grant awarded by the Foundation for Opioid Response Efforts (FORE). NASHP would like to thank Catherine Dunne, court accounts and special projects manager with Bright Heart Health, for her valuable contributions.