Look for the Public Health Leverage

One of the things that’s most important to remember when you’re a public health practitioner is to look for your leverage.  By that I mean it’s important to set your priorities and use your resources in a way that creates the biggest long-term change with the resources that you have. 

Sometimes that means looking to statutory levers to improve health outcomes.  A good example of that is the Smoke Free Arizona Act, a voter initiative that banned tobacco smoking in workplaces, bars and restaurants.  By all accounts, it has had a profound impact on public health by limiting secondhand exposure and reducing smoking rates. High return on investment.

Sometimes a policy change does the trick.  For example, Maricopa County Department of Public Health worked hard with the community colleges to make their campuses smoke free.  Again, a smart move as it uses policy leverage to influence public health outcomes.

Sometimes it’s changing a rule or regulation.  A few years ago, the Arizona Department of Health Services overhauled their licensing regulations for health care institutions to make it easier to integrate acute care and behavioral health services in order to improve public health outcomes. 

Sometimes leverage means using your contracting authority as a payer of services to drive a public health intervention.  An example of that is the Executive Order issued last year directing AHCCCS to leverage contracts with their Medicaid managed care plans to limit the first fill of addictive prescription opioids to 7 days except for cancer, chronic disease and trauma.

Fortunately, the Substance Abuse and Mental Health Services Administration also recognizes that it has leverage in helping to reduce the opioid painkiller epidemic by releasing grant funds to states to implement interventions that reduce the number of people with Opioid Use Disorders and to reduce the number of opioid-related deaths. 

Earlier this year Arizona received a $24M Opioid State Targeted Response (STR) grant to implement a series of projects and interventions to stem the tide of opioid addiction and deaths.  AHCCCS is administering the grant, and is implementing prevention and treatment activities and working with other state agencies, Regional Behavioral Health Authorities, and contractors to increase access to Opioid Use Disorder treatment and coordinate and integrate care, recovery support services and prevention activities to reduce Opioid Use Disorders and opioid-related overdose deaths. 

The project plan includes developing and supporting state, regional, and local level collaborations and service enhancements to develop and implement best practices to comprehensively address the full continuum of care related to opioid misuse, abuse and dependency.

There are several core areas of work underway including:

  • Increasing use of data-driven decision-making;

  • Improving access, participation, and retention in comprehensive Medication Assisted Treatment services;

  • Increasing prevention activities to reduce Opioid Use Disorder and opioid-related deaths; and

  • Purchasing Rx drug drop boxes, toolkit trainings, technical assistance, and implementing Screening, Brief Intervention and Referral to Treatment (SBIRT) in targeted areas.

Of course, each of these elements are complex to implement and have all sorts of activities and collaborative projects underway.  If you’re interested on reading more you can explore their website materials including their Arizona Opioid STR Fact Sheet and the detailed 52-page Opioid STR Project Narrative Arizona.

Shana Malone from AHCCCS is the project lead for the STR grant and will be serving as the moderator in our “Payer” breakout sessions at our upcoming Fall Conference and Annual Meeting on September 28 entitledArizona’s Opioid Epidemic: Evidence – Interventions - Policy.  

In addition, our keynote speaker will be Jon Perez, Regional Administrator for SAMHSA who will share his perspective on where SAMHSA is headed regarding the epidemic.

We look forward to you joining us at this important and timely conference.  You can View our Agenda, register, and check our sponsorship opportunities on our www.azpha.org website.