Northern Inyo Healthcare District’s success with its new Medication Assisted Treatment program garnered the District top honors last week from the Association of California Healthcare Districts (ACHD). 

Chief Executive Officer Kevin S. Flanigan, MD MBA credited the achievement to the effort put forward by the entire NIHD team with securing the honor. “From the Board of Directors, to the leaders, to the medical staff, to the clinicians, to the administrative staff, to the environment of care team, both new and long standing staff everyone has a part in this award. Without everyone’s commitment to our Mission and our Vision, we could not have saved the lives we have through the work we are doing.”

What gained such accolades for NIHD? Earlier this year, NIHD began a Medication Assisted Treatment program funded and run by the District and other stakeholders for coordination of care. During the preceding three years, the District and others began to review opioid use and identified a trend in escalation of overdoses, deaths, criminal cases and medical issues associated with opioid use, misuse and abuse.

NIHD applied for and was one of 31 named recipients for the Bridge Grant. This allowed for the creation of the MAT program, which is now expanding into other areas of Behavioral Health treatment. Since implementation of the program, NIHD has seen more than 30 enrolled patients in three months; every Emergency Department physician earning special certification to prescribe the highly controlled anti-addiction medication; more than a half dozen patients treated with Narcan by police, first responders or private citizens outside of the hospital; and, adolescents seeking care.

Dr. Flanigan noted his pride in the District’s transition from avoiding patients with obvious signs of addiction, to identifying patient behaviors consistent with addiction and offering services. “Besides being able to offer this care, the culture shift is one of the greatest accomplishments I have seen,” Dr. Flanigan said. 

District snapshot 

The Sheet attended an NIHD “Healthy Lifestyle Talk” presented by Flanigan in August where he laid out a snapshot of the district and some of the challenges and opportunities which lie ahead.    

Flanigan explained that as a healthcare provider it is important to understand “not just who you take care of today, but who is going to need you tomorrow. If it’s young families and young children, that’s one set of specialists (obstetricians, gynecologists, pediatricians). If it is an aging population, [then] you’re going to want a retirement community (internists, geriatricians, orthopedists, and rheumatologists),” he said. 

Flanigan said all residents of Inyo County were invited to participate in the recent Community Health survey conducted from October-December of 2018. A “total of 371 respondents provided zip codes that documented county location. These data show 53.4% of responses were from Bishop and 23.4% were each from Lone Pine and other County areas.” The questions in the survey were based upon “demographics, health factors, mental health and wellness, social and economical factors, economic factors, lifestyle habits, community environmental factors, and Adverse Childhood Experiences (ACE).” (Source: Kemper Consulting Group, June 25, 2019).

Select stats

Respondents with health coverage: 49% reported having private health coverage; publicly funded coverage was 28% Medi-Cal and 15% Medicare.

Hard to access medical care in Inyo County: 22% reported a problem with access to medical care. 

Inpatient Market Share by Service Line: opportunity to increase cases in orthopedics (current market share is under 50%); majority of Psych and Substance Abuse services currently leaving community.

Physician Supply vs. Demand: Lack of medical subspecialities, particularly in cardiology, oncology and neurology; general surgery demand appears to be met by current supply; while orthopedics shows adequate supply, lack of surgical focus translates to shortage and lower subsequent market share in orthopedics compared to other specialty areas.

Hard to access mental health care in Inyo County: 10% of respondents reported a problem accessing mental health care (lowest income respondents and those within the income group of $41,000-$100,000 reported this problem)

Reported behavioral health conditions: more than 20% reported depression and anxiety conditions. This problem affects all income levels and areas 11% of respondents reported an alcohol/substance abuse disorder.

One finding indicated “Inyo County is behind State and National benchmarks for access to exercise opportunities, limited access to healthy foods, and food environment index.” Weird finding given most have exercise opportunities right out tyheir front door.

 Another finding dealt with substance use and driving under the influence, which Inyo County was “underperforming compared to California and National benchmark in drug overdose deaths, excessive drinking, and alcohol-impaired driving deaths.” 

According to Dr. Flanigan, NIHD has been “in an evolution from a care delivery model for several years.” In the model, NIHD is “working on having our primary care practices become Patient Centered Medical Homes. We have also worked at expanding our partnerships with other entities. This has required a complete reset of relationship view and transitioning from isolation and competition to collaboration and partnership. This in addition to transitioning to a new Electronic Health Record. All of these transitions impose cost, frustration and new skills which have to be learned,” said Flanigan.