Exploring issues and solutions to chronic pain and opioid use in Vermont
The community in Franklin and Grand Isle counties is dedicated to tackling complex health issues. In the years leading up to the COVID-19 pandemic, there was a focus on planning an in-person event to explore the issues and solutions to chronic pain and opioid use. By the time the organizers reconvened after the onset of the pandemic required the event to be put on hold, the environment had changed and expanded priorities emerged. Increases in mental health concerns, alcohol and drug misuse, and delays in seeking health care led the organizing committee made up of northwestern Vermont health care and social service agencies to identify two issues to prioritize: death by suicide and death by overdose—two pressing issues not just in northwestern Vermont, but throughout our state and nation as well.
Increase in death by overdose between April 2020 and April 2021
Recent data show that over 200 Vermonters died from opioid overdose in 2021, with other data demonstrating a 70% increase in death by overdose between April 2020 and April 2021. Meanwhile, death by suicide data show that 142 Vermonters died by suicide in 2021 compared to 109 in 2019. As health care providers and other helping professionals shared, these are urgent and serious problems that demand our entire community’s attention. Firm in the knowledge that solutions to complex community health issues require involvement from both community-facing organizations and clinical medicine, organizers convened stakeholders from multiple sectors to co-create robust, solution-focused content for a series of in-depth monthly learning sessions referred to collectively as a “Learning Collaborative.”
Led by a partnership among the Howard Center, Northwestern Counseling and Support Services, Northwestern Medical Center, the Vermont Department of Health, and OneCare Vermont, the learning collaborative built upon the existing local accountable community for health which provides the framework for bringing clinical and community resources together to solve complex social problems impacting physical and mental well-being. Engagement in the Learning Collaborative was strong. Across the four monthly, half-day sessions there were over 120 participants from throughout northwestern Vermont working in family medicine and pediatrics, as well as leaders from social service agencies.
Denise Smith, director of population health programs and strategy at Northwestern Medical Center, described the four-part series as, “a perfect opportunity to use population health data from OneCare and the Vermont Department of Health to identify and prioritize local issues.” Smith continues, “The Learning Collaborative model is one that we’ve seen be successful with issues like asthma and COPD [chronic obstructive pulmonary disease]. What set this series apart was the expanded partnership with stakeholders like law enforcement, Howard Center, Vermont Department of Health, Northwestern Counseling and Support Service, and education. Deepening those relationships by working together on common priorities set the stage for continued collaboration and information sharing.”
A perfect opportunity to use population health data from OneCare and Vermont Department of Health to identify and prioritize local issues.
In the session focused on reducing death by overdose, representatives from the criminal justice system and experts in addiction medicine led sessions to explore and challenge assumptions about addiction and how those with substance use disorder have historically been treated. Their presentations sparked compelling conversations about the stigma that persists for those seeking or engaged in treatment, with particular emphasis on those with opioid use disorder.
While the first two sessions of the Learning Collaborative were explicitly focused on grounding in the complexities of the two priority health issues, the second two were more about how to move forward. In the final session, led by Dr. Krista Goldstine-Cole, Director of Research and Learning Initiatives at the ANSR Foundation and Assistant Professor of Social Work at the University of Montana, the topic was creating a trauma-informed community—a community that acknowledges the impact trauma has had on communities and strives to mitigate those effects by elevating those with lived experience as thought-leaders and solution-makers. This was a common theme throughout the collaborative: a person-centered approach that meets people where they are to build trust and engagement in community-based solutions.
This is OneCare’s payment model at its best—making possible reinvestment in local population health solutions.
These learning collaborative sessions were supported in part by OneCare Vermont, through both project planning and financial assistance. OneCare’s Value-Based Incentive Fund (VBIF) provides support for innovative special projects, and the St. Albans health service area leveraged their VBIF funds to create this collaborative. The VBIF program is designed as a payment reform initiative to give health care providers a path to receive additional funding when their organization meets or exceeds specific quality measures. The program provides the flexibility for individual communities to decide how best to use their funding.
“This is OneCare’s payment model at its best—making possible reinvestment in local population health solutions,” states Dr. Carrie Wulfman, chief medical officer at OneCare Vermont. As we begin to emerge from the pandemic, the Learning Collaborative provided a space for partners to consider how they want to work together on shared goals and there is opportunity for communities across Vermont to replicate this model to address priority health issues in their communities. Collectively, the sessions left participants with a powerful combination of best practices and renewed energy and focus on supporting individuals by creating thriving communities.