July 20, 2022
A Penn Medicine virtual care program allows patients with opioid use disorder to easily access prescriptions for buprenorphine — a medication that soothes opioid cravings and treats withdrawal symptoms — by setting up a single visit with Penn's virtual urgent care.
Penn's CareConnect "warmline" is expanding its outreach to more Philadelphians experiencing opioid use disorder, particularly in Black, Indigenous and other communities of color that face disproportionate barriers to health care access, thanks to a $200,000 grant from Independence Blue Cross.
CareConnect was largely made possible by the Drug Enforcement Administration, whose guidance in the early days of the COVID-19 pandemic allowed doctors to prescribe some medications over the phone. Still, Penn Medicine's emergency department already was working to help those living with opioid use disorder get started on treatment.
If a patient in Kensington experienced an overdose pre-pandemic, one of Penn's outreach workers would be available in the community, offering to transport them to Penn's emergency room to start treatment. Once at the hospital, the patient would be quickly assessed and easily able to access care within the emergency department.
"The idea is to destigmatize substance use treatment by integrating it into another problem you would typically see a primary care doctor for, like chronic diseases," said Dr. Jeanmarie Perrone, director of Penn's Center for Addiction Medication and Policy. "It allows patients to see a regular doctor and not feel like they're standing in line at a clinic to get treatment."
When the pandemic started in March 2020, outreach workers were unable to be directly in the community, and many people living with opioid use disorder were afraid to go into an emergency room. The DEA's late guidance, issued late that month, allowed doctors to prescribe Suboxone — a common buprenorphine medication used to treat opioid use — directly over the phone.
For the first six months of the pandemic, CareConnect's warmline was directly prescribing the medication to patients with a simple FaceTime call or similar virtual visit. The problem, Perrone found, was that prescribing directly over the phone did not generate a patient chart, which made it difficult to track.
Soon after, CareConnect partnered with Penn's virtual urgent care and later with the city's Department of Public Health. This provided the program the initial funding it needed to hire two substance use navigators, who take information from patients, talk to them about buprenorphine, and refer them for a prescription.
After a week or two, the patients are brought in for an in-person visit, either at Penn Medicine or at a clinic near their own homes, in order to continue treatment.
"We don't ever close the door," Perrone said. "We want to be that bridge so that as people are getting more stable, they can get the support they need. The first few months of recovery have enough hurdles and we want to be a safety net for those patients."
The aim of the warmline is to provide low-barrier access to these prescriptions for communities that are disproportionally impacted by opioid use disorder, including the community around Penn. Since receiving the grant from IBX, Penn Medicine has been working to provide additional care and improve awareness for community members so that they can seek opioid use treatment by simply walking into the emergency room.
"What we're seeing is that people are presenting differently in our own community," Perrone said. She noted that many patients admit to taking oral Percocet, and do not realize that what they're taking is really fentanyl pressed down into a tablet. The emergency department also provides the overdose antidote Narcan and fentanyl testing.
The Center for Addiction Medication and Policy is looking for community members to join the program's advisory board. CareConnect organizers want to find ways to be more culturally sensitive when educating communities about the benefits of buprenorphine and dispel common misconceptions about medication treatment for opioid use disorder.
"Globally, many people don't recognize that medications for opioid use greatly reduce the risk of overdose," Perrone said. "Many people worry about the risk of substituting one drug for another. Being able to frame that and understand that buprenorphine is not replacing one drug with another, but is actually a medication to treat a chronic disease."
More than 100,000 Americans died of drug overdoses in 2021, according to the Centers for Disease Control and Prevention. The overdose rate set another record in terms of overall overdose deaths since the beginning of the opioid epidemic. The total translates to nearly one overdose death every five minutes throughout the year.
Philadelphia has been among the cities hardest hit by the opioid epidemic. An estimated 1,250 people died of overdoses in the city in 2021. In recent years, about 4 of 5 overdose deaths involved fentanyl, a particularly potent synthetic opioid.
The CareConnect warmline also works with those leaving incarceration and reentering society. Incarcerated people can sometimes receive medication services for opioid use while they are in prison, though that care ends when they reenter.
CareConnect works with reentry organization to help bridge that gap, providing prescriptions and other recovery services to help continue their care.
Since beginning CareConnect, Penn Medicine has been able to help more than 150 patients. Perrone said she hopes that with the additional grant funding, they will be able to support more people experiencing opioid use disorder throughout the city.
“We chose to support the CareConnect initiative because it addresses opioid use disorder, which is one of our city’s greatest public health issues,” said Dr. Rodrigo Cerdá, senior Vice President of health services and chief medical officer at IBX. “Philadelphia has the highest unintentional overdose fatality rates among large cities in the United States. It’s a complex problem that the Penn Medicine team is proposing to meet with a multi-pronged approach that incorporates warm handoffs, community-based outreach, and technology to ensure better navigation and access to lifesaving medication and other recovery services. Bringing this care to members where they are will hopefully make it easier for them to benefit from it.”
In addition to CareConnect, IBX awarded Clinical Care Innovation Grants to five other projects undertaken by health care systems in the Philadelphia region. Each project received $200,000 to support its expansion.
Two other Penn Medicine projects also received grants, including one that has implemented urgent care for the early stages of pregnancy, including follow-up care for those who experience miscarriages. The other is an AI-chatbot from the Center for Digital Health that answers questions new mothers have about themselves and their babies.
Other grant recipients include a program from Trinity Health Mid-Atlantic that aims to provide a caregiver support model for patients experiencing long-term, serious illness.
At Jefferson Health, an advanced care program for patients with dementia uses telehealth to provide palliative care. Temple Health's "I COPE MORE" program uses a screening tool to identify at-risk patients experiencing behavior health issues related to social issues and chronic disease.
