In February of 2017, San Mateo County launched an expanded Drug Medi-Cal Organized Delivery System (DMC-ODS) services pilot, significantly expanding the continuum of substance use services available for Medi-Cal beneficiaries in San Mateo County. The pilot is part of California’s 1115 Waiver, known as Medi-Cal 2020. A California Department of Health Care Services External Quality Review (EQR) was conducted to review quality, timeliness and access to these services. The review included an extensive review of data, as well as findings from focus groups with BHRS staff, clients and key stakeholders.  

Strengths

The final EQR report highlighted many strengths in the pilot, including our capacity to deliver culturally appropriate services to a large population. Clients gave us positive feedback and ratings in the areas of access, timeliness, engagement, therapeutic alliance, quality and outcomes.  Some of the highlights include:

• A significant number of BHRS staff dedicated to outreach and engagement for high need and complex individuals.
• Our Integrated Medication Assisted Treatment (IMAT) program, which combines medication, counseling and support to help people overcome their substance use issues. The IMAT team performs outreach in places like the psychiatric emergency services wing of the San Mateo County Medical Center, and maintains many partnerships with law enforcement, shelters, substance use providers and more. The IMAT team has engaged 206 clients in the program during FY 2015 – 2017, resulting in a decline in hospitalization and increase in outpatient services, ultimately reducing overall health care costs for those clients. In the past year, the IMAT program has expanded to treat clients with opioid use disorders, in addition to alcohol disorders.
• Voices of Recovery (VOR) San Mateo County was also highlighted as an excellent peer support program. Voices of Recovery creates peer-led opportunities for education, wellness, advocacy and support services for individuals and families in or in need of long term recovery from substance use issues. Due to VOR’s success in engaging clients, it was identified for further development.

Challenges

Among the challenges identified in the report were

• Inadequate data analytics, lack of timeliness in transferring Medi-Cal coverage for those who move to San Mateo from other counties.
• A need for ongoing training and support for staff and providers on the American Society of Addiction Medicine clinical model and charting requirements.
• Low service utilization rate among youth. Our penetration rate among youth is .07 percent, which is higher than the statewide average of .03 percent.
• Although our IMAT program was cited as a strength, the use of medication to treat substance use disorders is still stigmatized. The report cites access barriers and stigma from multiple providers and systems relating to IMAT.

Recommendations

The EQR made recommendations for Fiscal Year 18/19, including:

• Development of special support groups for IMAT clients and strategies for educating the public on how medications can assist in positive treatment outcomes.
• Developing a plan to outreach and engage youth in need of substance use disorder treatment, partnering with schools, community-based organizations and providers to enhance referrals.
• Increased tracking of client requests, referrals and appointments; monitoring of system capacity needs.
• Implementation of ongoing training for contract agencies.