A new skilled nursing unit in McKeesport, Pa., is targeting the needs of patients with a primary medical condition and co-occurring substance misuse disorders, in collaboration with an integrated delivery and financing network, a local county government and a managed care network.
“It’s designed for patients who have a primary medical diagnosis as well as a secondary drug misuse disorder,” Dr. Emily Jaffe, vice president and executive medical director of Highmark Health company HM Home & Community Services, told Skilled Nursing News. “It primarily came out of the opioid crisis, but we are not saying you have to have opioid misuse only; you can have other substance misuse disorders.”
The 45-bed skilled nursing unit is located in the Kane Community Living Center in McKeesport. Under the dual-need strategy, it will combine skilled nursing and addiction services for patients who meet Nursing Facility Clinically Eligible (NFCE) criteria, requiring 24-hour care. It represents a collaboration between Allegheny County, which operates Kane; Highmark Health; its health system Allegheny Health Network and the managed care organization Gateway Health. Highmark Health is one of America’s largest integrated delivery and financing systems and the parent of Blue-branded insurer Highmark.
There may be more opportunities for such collaborations like this one in health care in general, Jaffe told SNN. Highmark Health noticed many patients were being hospitalized with medical problems related to drug use. These patients, who need a skilled stay in the same way other patients with a medical issue might, can be hard to place because of regulatory or staffing restraints related to that secondary substance misuse diagnosis, Jaffe said. That leads to longer hospital stays with all their inherent risks such as infection.
“We wanted to find a way to get patients to the appropriate level of care and get them the care they need across the continuum,” she said. “Payers in particular are watching their members to make sure they get appropriate care, no matter where they are in the continuum. If you discharge someone with an opioid use disorder and you don’t keep that at the forefront of the treatment, you may lose sight of that initial problem, which led to the initial hospitalization anyway.”
Read the full story at Skilled Nursing News.