Understanding the Right Customer

October 2013

Jay Ford, Ph.D.

Executives at Procter and Gamble learned some powerful lessons when seeking to expand their customer base to India. Their experiences highlight the importance of two  NIATx principles: understanding the customer and getting ideas from outside the field. The P&G story highlights the importance of understanding the right customer.

In 2008, executives at Gillette, which is now a division of Proctor and Gamble, wanted to increase its market share in India among men who shave. The prior introduction of a new shaving product in 2002 initially failed. At that time, they introduced a new razor with a bar to unclog hairs that collect in the razor. Market testing among Indian students at the Massachusetts Institute of Technology indicated that the new product was a big improvement. However, the introduction into the market was a complete failure. Why? The answer was simple:  the lack of running water.  Most men in India shave with a cup of water, which rendered the new razor useless. Alberto Carvalho, Vice-President of Global Gillette called it an “Another ‘aha’ moment’." Simply stated, they had not taken the time to understand the needs of the right customer.

So in 2008, Gillette was ready. They sent 20 staff to India. Once there, they conducted “walk-throughs” with their customers, spending over 3,000 hours watching men shave under many different circumstances and situations. They also conducted focus groups, another powerful tool to help understand the customer. Armed with this knowledge, they were able to develop and introduce new products in the market. Efforts to understand the needs of the right customer have resulted in an 11.8% increase in market share. To learn more about Gillette’s story, I encourage you to read the recently published article about their experience.

The implementation of the Affordable Care Act will change the market place for behavioral healthcare organizations. Through Health Information Exchanges, many more people with new  access to behavioral health care will will be seeking services. These people will become your new customers. The Gillette story highlights the importance of understanding their needs. 

Applying the first NIATx principle: Understand and Involve the Customer takes on a new meaning now. A walk-through conducted now should focus on understanding the needs of the right customer. Several California providers recently told me about how the new Health Information Exchanges present opportunities for them to provide care for different populations. As a result, they are taking steps to understand customer needs to show them--as well as new payers--that their services result in quality outcomes.

The choice is yours. You can repeat Gillette’s failed experience of 2002 or you can follow the approach they took in 2008 to clearly understand the needs of the right customer. What approach will you chose? 

What new customers will your organization be serving in the near future?  How will you know that you're  providing quality services for the right customers? Share your thoughts with the ATTC/NIATx Service Improvement Blog!

 Jay Ford, PhD, FHIMSS, FACHE
Assistant Scientist
Center for Health Enhancement Systems Studies/NIATx 

University of Wisconsin-Madison
fordii@cae.wisc.edu

Inspiring Change through SBIRT: Start with the “Why”

October 2, 2013

Catherine Ulrich Milliken

Director, Addiction Treatment Program

Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

I recently saw a fantastic  Ted Talk by Simon Sinek on how great leaders inspire action.   I was struck by the notion that people don’t buy what you do, they buy why you do it. What is your cause?  Your purpose and belief? How are they reflected in what you do?

As The Dartmouth Hitchcock Medical Center Addiction Treatment Program (DHMC-ATP) staff began to work on strategic planning for the next year, we recognized the need to clarify our “why.” In doing so, we realized that we must do more to address the entire SPECTRUM of substance use from a preventative, health promotion orientation.

Like treatment providers across the country, DHMC ATP has seen in increase in the number of pregnant women in need of substance abuse treatment. According to SAMHSA (2012), 5 percent of pregnant women are current illicit Drug Users. Between 2000 and 2009, maternal opioid use at time of delivery increased more than four-fold, with a 35% increase in healthcare expenditures for neonatal abstinence syndrome (Patrick et al., 2012). The incidence of opioid-related neonatal abstinence syndrome has increased nearly three fold (Chopra et al., 2009). These facts combined demonstrate that opioid use during pregnancy is a growing problem of great public health significance—and one that the staff at the medical clinics and hospital our center is affiliated with is facing.

Our program identified the need to integrate SUD treatment providers into settings where we can affect change with those who may be at risk for developing substance use disorders, and at the same time, welcome medical professionals into our setting to provide care for our patients.

The How: Relationship building

As part of a medical center that includes ob-gyn clinics and a hospital, ATP could easily identify partners to work with on meeting this need. Building upon existing provider relationships between the Geisel School of Medicine Department of Psychiatry and DHMC Maternal-Fetal Medicine, we came to a shared “why.” We all believe in healthy moms and healthy babies and strive to provide caring and thoughtful evidence-based, integrated, cost effective care.

Together, we agreed to implement SBIRT into the OB/GYN clinics at Dartmouth Hitchcock Medical Center. ATP staff drafted a one-page proposal and convened a meeting with stakeholders from DHMC Maternal Fetal-Medicine to pitch expanding care for pregnant women beyond traditional treatment—to include a specialty clinic for pregnant women at the ATP, as well as screening and brief intervention in the OB/GYN clinics. We also applied for an auxiliary grant to help fund contingency management in the clinic and consultation and training for the SBIRT initiative and are hopeful we will receive funding.

From this shared vision, the DHMC ATP developed a Specialty Clinic for Pregnant Women, which opened in July 2013. The clinic provides individual, group, and medication-assisted substance treatment as well as on-site access to psychiatric care, and soon to include obstetric care, and case management services. As they say, “If you build it, they will come,” and they have! To date we have a group of approximately ten women participating in group, individual and medication-assisted substance abuse treatment. We are averaging two new evaluations per week and will need to plan for expansion in the near future. We have the “T” in SBIRT and by demonstrating our commitment to this shared vision, are working implementing the “SBI” in the DHMC OB/GYN clinics. Women are most excited and looking forward to “one-stop-shopping:” receiving prenatal care and substance abuse treatment in one clinic.

Adding who, what, when and where: Process improvement

The implementation process is no small feat, but could not have gained momentum had we not secured buy-in with a shared “why.” By building upon existing relationships, we identified project champions from each department and formed a change team, following the NIATx process improvement model.

We have decided to use the NIATx rapid-cycle change process with PDSA (Plan, Do, Study, Act) Cycles in our efforts to implement SBIRT. PDSA cycles allow the change team uses quickly test the effectiveness of potential solutions generated from barrier assessment and process mapping  exercises.

One of the first barriers our change team identified was—you guessed it—reimbursement for SBIRT services. New Hampshire has not yet expanded Medicaid or released the reimbursement codes. Other barriers we identified include workflow and training issues across systems. Our next change team meeting will tackle ways to address these barriers, and decide which one to target in our first change project. We will also choose our screening tools and develop a process map of the workflow.

Then it’s off to Kansas City for the SBIRT Training of Trainers, (October 14-16) offered by the National Screening, Brief Intervention & Referral to Treatment ATTC. From this training, I hope to bring home tools to address training issues and help the team move forward with planning our first PDSA Cycle of SBIRT.

As we continue on our journey of implementing SBIRT into the OB/GYN clinics at the Dartmouth Hitchcock Medical Center, our change team invites you along for the ride and welcomes your feedback, experience, and wisdom!  Look for an update on our progress in a future blog post.

We hope you find this blog helpful as you consider implementing SBIRT across settings. Below are some other useful resources on SBIRT:

www.casacolumbia.org/upload/2012/20121003SBIRT.pdf 

http://www.docstoc.com/docs/20275806/SBIRT-Resource-Manual

http://www.integration.samhsa.gov/clinical-practice/sbirt

Catherine Ulrich Milliken, M.S.W., LICSW, MLADC, LCS, is the Program Director for The Dartmouth Hitchcock Medical Center Addiction Treatment Program and an instructor in Psychiatry at the Geisel School of Medicine at Dartmouth. Previous academic appointments included University of Southern Maine, University of New England, and University of New Hampshire. She has worked passionately to improve the care and treatment of women's mental health and substance issues for the last 15 years. Before working at Dartmouth, she was the Director of Outpatient Services at Crossroads for Women, which provides gender‐specific and trauma‐informed outpatient programs and services for substance abuse and mental health, as well as residential rehabilitation and halfway house services for substance abuse in Portland, Maine. During that time, she also saw clients in private practice, specializing in adult psychotherapy, substance use and women's issues and worked with clients struggling with HIV and AIDS diagnoses. She conducts training on the basics of chemical addiction, tools for leading groups, exploring the relationship between substance abuse and child maltreatment, and women's treatment concerns, among other areas.  

Do you have questions or comments for Catherine?  Post them here, or e-mail Catherine at:

catherine.l.ulrich@hitchcock.org

References

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 SAMHSA, 2012

Patrick SW, Schumacher RE, Benneyworth BD, et al. “Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009," JAMA. 2012 May 9;307(18):1934-40. doi: 10.1001/jama.2012.3951. Epub 2012 Apr 30.

 Chopra, M.P., et al., “Buprenorphine medication versus voucher contingencies in promoting abstinence from opioids and cocaine.” Exp Clin Psychopharmacol, 2009. 17(4): p. 226-36.

Recovery: Going Public

September 25, 2013

Cindy Christy
Program Manager, ATTC Network Coordinating Office 

Imagine walking amidst 10,000 people celebrating having their lives back. It happened at the Rally4Recovery in Rhode Island last week, and it’s happening across the country this month. September is National Recovery Month, conceived over 20 years ago to celebrate that recovery in all its forms is possible. Celebrate is the key word here; recovery walks, live concerts, picnics, races, rallies, bike rides, and major league baseball games are just a few ways people are celebrating their recovery. 

This year’s theme, “Join the Voices for Recovery: Together on Pathways to Wellness,” emphasizes that there are many unique ways people can prevent behavioral health issues, seek treatment, and sustain recovery.  People in recovery have a lot to celebrate: they’ve regained their lives, their families and friends, their health, and their self-worth. They’ve become productive members of society, good citizens, and they give back to their community…that IS something to celebrate.

Recovery is everywhere. Social Media is a key feature of Recovery Month; twitter chats, online rallies, live streaming events and Facebook campaigns like the one for Americans in Recovery. Peter Gaumond, Chief of the Recovery Branch of the White House Office of National Drug Policy (ONDCP) talks about the Americans in Recovery campaign as being one of the most significant steps ONDCP has taken recently. In an article featured in the September ATTC Messenger, Gaumond states that “the ONDCP is going to new lengths to raise awareness and reduce the stigma around addiction and recovery and to elevate the voice of the recovery community”.

While NRM is a huge success in spreading the message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover, there is still a long road ahead. Stigma is one the most significant barriers to recovery and recovery supports. Stephen Gumbley, Director of the New England ATTC,  presented September's Third Thursday iTraining webinar, “The Public Face of the Personal Journey of Recovery.” In the webinar, Gumbley challenged the audience to change the enduring perceptions about substance use disorders and recovery and to “bear witness” to the realities of personal transformation and long-term recovery.  He also shared his own story of recovery and his belief in citizenship as a dimension of recovery.  As he pointed out, 25 million Americans in long-term recovery have the potential to become a powerful force for social and political change. To watch Gumbley’s presentation, visit the ATTC Network vimeo site.

One way the recovery community and the general public can exercise their citizenship and help shape national recovery policy is by emailing the ONDCP at: recovery@ondcp.eop.gov, as Peter Gaumond suggests in the article mentioned above.

Another way to show the public face of recovery is through a community event. If you visit the National Recovery Month homepage, you’ll see that more than 700 community events are happening across the country--and the number is growing daily.

One event that’s coming up is Healthy Families, Healthy Communities: It’s All About Recovery! sponsored by the Great Lakes ATTC and taking place on September 30 in Chicago.

“There are many pathways to recovery,” says Lonnetta Albright, Director of the Great Lakes ATTC. “Some people go through treatment, some use medication, some achieve recovery through their faith community or other support groups. But no matter the pathway, people sustain and maintain recovery in their communities and their homes.”

The event will focus on the ROSC framework that the Great Lakes ATTC has been a leader in developing and in helping systems and communities to implement, emphasizing that healthy families and healthy communities are necessary for recovery and wellness to flourish. 

What if one day we turn on the evening news, and instead of seeing a celebrity's struggle to maintain sobriety in lurid detail, we would see 20,000 recovering people and their loved ones celebrating the gift of recovery? That would be a good news story.

Is your organization helping show the public face of recovery through an event or other National Recovery Month activity? E-mail a photo (iPhone photos will be fine—professional quality not required) of your event to Maureen.fitzgerald@attcnetworkoffice.org, and we’ll include it in an upcoming blog post!  

Recovery Month 2013: Sharing Stories From People in Recovery and Coping with Hepatitis C

September 11, 2013

Maureen Fitzgerald
Editor, ATTC Network Coordinating Office and NIATx



“There is no greater agony than bearing an untold story inside you.”

Maya Angelou

Personal stories of recovery have the power to transform lives. Reading stories of others can help you learn about yourself—and sometimes, reading someone else’s story can help you share your own.

Since 2008, the ATTC Network has sponsored the In My Own Words Essay Contest to celebrate National Recovery Month. The essay contests have invited recovery essays from a variety of groups: addictions treatment and recovery services professionals, high school and college students, affected family members, people supported by medication-assisted treatment, and active service members and veterans in recovery.

The 2013 In My Own Words essay contest, sponsored in partnership with Faces & Voices of Recovery, The Hepatitis C Association, Help4Hep, and Harm Reduction Coalition, is calling for essays from people in recovery from substance abuse and or a mental health disorder who are also coping with hepatitis C.

Common misconceptions

Sue Simon, President of the Hepatitis C Association, was diagnosed with the virus in the early 1990s. Sharing her story, says Simon, is one positive way to manage a chronic illness. “It helps me to know that my story might help someone else,” she says.

The Hepatitis C Association works to change misconceptions about the virus. Among them is the belief that it is solely the result of IV drug use. “It’s important for people to know that hepatitis C is a blood-borne pathogen,” says Simon. “A person is at risk for the virus whenever blood is exchanged.”

Another misconception is that hepatitis C cannot be cured. But just as with substance use and mental health disorders, treatment is effective and recovery is possible. Similarly, emerging medications are helping people who have relapsed or not responded to treatment in the past. “More and more patients are getting cured with easier and shorter treatments,” says Simon. “In fact, hepatitis C is the first chronic virus that is actually being cured by drugs,” she adds.

When Simon was first diagnosed, the cure rate with 48 weeks of Interferon (the only drug available at the time) was just 10%. “With the addition of other drugs, the treatment time remained at 48 weeks, but the cure rate increased to 50%,” says Simon. “Today, new drugs in trial are improving the cure rate to between 90 and 100%.” 

Having recently completed a trial herself, Simon now has no evidence of the virus. “I’m in my late 60’s and it looks like I’m cured,” she says.

A silent disease

The Center for Disease Control recommends that anyone born from 1945 through 1965 get tested for Hepatitis C.

“As many as 800 thousand baby boomers in the United States may be infected with Hepatitis C, yet unaware of it,” says Simon. “This is partly because it’s a silent disease with no symptoms in the first couple of decades. One-third of patients with hepatitis C don’t even have elevated liver enzymes, making it difficult for doctors to recognize the need to test,” says Simon.

The only way to know for sure is to request a hepatitis C antibody test. The state of New York is working on legislation requiring medical providers to offer a hepatitis C test to anyone born between 1945 and 1965. Other states are expected to follow suit. However, the best way to make sure you are tested is to talk directly with your doctor and ask for a test.

“It’s always good to know your status,” says Simon, adding that people who test positive can make lifestyle changes and benefit from treatment that will reduce their chances of liver cancer, cirrhosis, or a liver transplant.

Reducing stigma

Through the In My Own Words Essay Contest, people in recovery who are also managing hepatitis C can reduce stigma and change attitudes about these chronic conditions—and maybe encourage others to seek treatment or testing. The top 20 submissions will be included in a compilation, and prizes will be awarded to the first-, second-, and third-place essays.

Adds Simon, “The essay contest is a great opportunity for people to experience the relief that comes from sharing their stories and helping someone else.”

Making Recovery Month Matter

September 3, 2013

By Kevin Kirby, CEO of Face It TOGETHER

National Recovery Month is celebrated each year as an opportunity for all of us affected by addiction to show the power of recovery to transform lives. While this is all well and good, I believe our work needs to go much deeper if we really want to make a difference in our nation’s communities.

We’re all aware of the grim statistics.  Almost 90 percent of people with a serious alcohol or other drug problem won’t get help in a given year. The hard fact is that far too many people with the disease of addiction, and their families, suffer in silence for a lifetime.

But this isn’t only about those directly affected. Every community sector pays the costs of the deep stigma and shame, and the failures in today’s system of care, that keep recovery out of reach for so many.

There are no easy solutions.  No doubt that health care reform and declining public sector funding are ushering in a sea change for the behavioral health field. But this is also a chance for real progress.  Positive social change doesn’t happen by accident. It comes by seizing opportunities and finding creative new approaches to old problems.

At Face It TOGETHER  we’re dedicated to changing everything about the way addiction is addressed in our communities. This means bringing unconventional partners to the table and connecting stakeholders in new ways.

Our work, which began five years ago in Sioux Falls, S.D., uses the power of the private sector to enlist multiple community sectors to transform institutions, systems, and cultures around the chronic disease of addiction.

We’re focused on total system change. We work to engage all the key players in the community – employers, integrated health care providers, payors and other influential stakeholders – to implement financially sustainable, shared solutions to addiction.

For example, our Employer Initiative extends the “community of recovery” directly into the workplace.  About 60 percent of Americans with addiction are employed full-time. The disease hurts employers through lost productivity, higher absenteeism and health care costs and safety problems.

Because employers have skin in the game – and many employers also want to do the right thing – the workplace must be at the core of a recovery-oriented community. Through our initiative, we educate employers and employees about addiction as a chronic disease, remove barriers to recovery like stigma and fear, create a culture of openness, coordinate recovery-supportive benefits, and show return on investment. 

We provide value to employers in return for a sustainable, stable funding stream for our local recovery community organization. Today in Sioux Falls, 25 major employers participate, representing about one-third of the community’s total workforce. 

You can learn more about what we do in communities by visiting wefaceittogether.org.

We don’t pretend to have all the answers. But I hope that this year’s National Recovery Month gets all of us thinking about how we can better serve as society’s “change agents” – asking tough questions and advancing creative solutions to make our communities fundamentally better places to live.

Kevin Kirby is CEO and co-founder of Face It TOGETHER. Earlier this year, he was elected to the influential Ashoka Fellowship for social entrepreneurship.

Wefaceittogether.org

@faceit2gether1