Case Management and the ROSE® Opioid Use Disorder Guide

In the U.S., the use and abuse of opioids is now a national health crisis. As providers seek to identify interventions to deliver long-term solutions, case managers serve a vital role in meeting the needs of patients and facilitating rehabilitation.

RGA’s ROSE Program teamed with the Case Management Society of America (CMSA) to create the ROSE Opioid Use Disorder Case Management Guide. This novel partnership combines each organization’s area of expertise to create a comprehensive guide for both RGA clients and CMSA members.

We sat down with ROSE’s Melinda Baxter and Mary Paquette to learn more about the guide and how case managers can use it to advance their work with patients struggling with opioid abuse.

Why did you produce this guide?

We felt compelled. The increasing urgency of the opioid epidemic is impossible to ignore. We are hearing more and more from our case manager clients about the challenges they face every day in addressing the problem. How do you manage those using and abusing opioids? What can be done in terms of risk identification and screening? What resources are available to case managers? This guide seeks to answer these questions.

If something impacts our clients, the ROSE team is mission-driven to do what we can to help, even if it doesn’t directly impact our reinsurance business. And with the current opioid crisis, it’s really a situation the entire healthcare industry – and our entire society – needs to band together to address. It cuts across all markets – Medicaid, Medicare, and commercial – and impacts people from all walks of life.

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What does the guide include?

The goal is to provide case managers with a tool that outlines strategies and provides resources. We organized the report around five sections:

1. Understanding Opioid Use Disorder: defines the extent of the problem, provides criteria for identifying opioid use disorder, and outlines risk factors
2. Case Management Assessment: provides a broad range of assessment tools – from initial screening to evaluating a patient’s readiness for change
3. Care Planning and Case Management Interventions: presents treatment options and strategies for building a long-term care plan
4. Tips for Working with Pregnant Women Before and After Delivery: offers best practice recommendations for working with this high-risk population to help them navigate pregnancy, prepare for birth, and care for their newborns
5. Ongoing Case Management and Relapse Prevention: provides steps to take in developing a continuing care model for patients with opioid use disorder

The guide concludes with a list of resources and links for further information. At the very least, we hope the guide serves as a conduit to connect case managers with the resources they need.

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Why did you include special focus on pregnant women?

Obviously, pregnant women are a special concern as opioid addiction affects both mother and child. Babies who are exposed to opioids in utero, for example, may experience neonatal abstinence syndrome (NAS), which has increased 300% between 1999 and 2013 according to the CDC. Our ROSEBUD^® Program, which provides specialized case management for high-risk pregnant women and neonates, includes nurse consultants with particular expertise in this population. Based on their many years of experience, the ROSEBUD team compiled best practice recommendations for working with opioid-using women to help them successfully navigate pregnancy, prepare for birth, and care for their newborns.

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The stigma and guilt attached to drug use during pregnancy add a significant challenge as pregnant women are reluctant to come forward for help. This requires an approach that is non-judgmental and compassionate. But we also have to be purposeful and realistic. We need to make sure they know that they could have difficult labor and delivery and that child services may get involved. The key is to stick to the facts of what to expect, avoiding scare tactics or downplaying the situation.

What were the biggest surprises in developing this guide?

Although we were certainly aware of the opioid epidemic before putting this guide together, it is still hard not to be taken aback by the staggering statistics. It is estimated that 2.1 million people in the United States suffer from opioid use disorder related to prescription opioids, and another 467,000 are addicted to heroin. Overdose deaths related to opioids have quadrupled since 1999 and now outnumber those due to car accidents.

But there were some encouraging discoveries as well. We confirmed that screening tools can be very simple – as few as four basic questions – and still be useful and effective. Most importantly, we know that this guide is part of a growing movement in the healthcare industry and in society at large to bring the opioid crisis under control.

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What do you see as the biggest takeaway from this guide?

Perhaps the biggest challenge of opioids is the high rate of relapse – approximately 40%-60%. As a result, opioid addiction needs to be viewed as a chronic condition. This is why case management using a continuing care model plays such a vital role. Case managers can be involved over time, through every phase and every treatment along with the patient, from identification through ongoing follow-up. We need clear plans of action and clear communication with treating providers. Only by working together will we be able to turn the tide on the current crisis.  

The ROSE Opioid Use Disorder Case Management Guide is available for RGA clients and accessible to CMSAmembers on the organization’s website. For more information on the ROSE Program and how our nurse consultants can help meet your case management needs, contact us at rose@rgare.com.