For 3 years, Lifeline, an opioid treatment program (OTP) of Stanley Street Treatment and Resources (SSTAR) has been providing methadone treatment at its site in the South End of Fall River, Massachusetts. In 1990 SSTAR became a federally qualified health center (FQHC) providing methadone, primary care, and behavioral health care to their OTP patients. SSTAR was the first OTP in the country by many years to do this—because it couldn’t find any local physicians willing to see OTP patients, according to Lisa Garcia, executive director of the SSTAR OTP.
This spring, SSTAR opened a satellite clinic, South End Services. At the new site there is the large OTP; an outpatient behavioral health program, which includes psychiatry; and the health center with all medical services. There are no OTP patients on the North End site; all 446 patients are going to South End Services. Before the expansion, the patient census was in the “low 300s,” said Ms. Garcia.
Federal stimulus funds grant of $480,000 provided by the Health Resources and Services Administration (HRSA) enabled SSTAR to renovate and expand the satellite clinic. SSTAR also contributed $130,000 to complete renovation of the satellite so that all OTP, behavioral health and now medical care services are provided at one location.
Benefits of Coordinated Care
FQHCs have been funded for 40 years by the federal Health Resources and Services Administration to provide community-run comprehensive primary care services to high-need communities. For an OTP, the benefits of being part of a FQHC are many. Having access to the services of a FQHC makes it easier for the OTP to coordinate health care for its patients.
Having the health center connected to the OTP makes it easy if a methadone patient comes in ill. Each patient has his or her own assigned nurse and physician. The OTP can call and schedule an appointment for the patient. It’s more difficult to get patients to follow through on medical appointments if the appointments are not on site, Ms. Garcia said.
Some patients do come in with their own primary care physicians (PCPs), but they have the option to switch to the health center’s physicians at any time. It’s also beneficial to the patient to have collaboration between the OTP and their PCP, if the patient signs a release so that confidentiality protections are waived. One patient told Ms. Garcia that she liked “being treated as one piece, instead of being treated as tiny pieces.”
“Within the first 90 days after patients are stabilized on methadone, we will talk to the patient about going to a PCP and a dentist,” she said. In addition, many patients have small children, and the health center will be able to offer pediatric care—another plus for patients.
Patients love the site, reported Ms. Garcia. “I spent a lot of time in the waiting area the first week we opened. I watched the way they came into the building.”
At SSTAR, the goal is not just “treating” the patient, she said. “We’re trying to get the patient to feel better and to do better.” Even small things can help. Some people’s first reaction when they walk into the well-lit foyer is: “Glass doors in an OTP?” Ms. Garcia’s response: “We did that to let the sun shine in.” She was speaking about the building, but she was also speaking about the feeling of the program. “We have windows, we have glass doors. That’s part of how the building treats OTP patients with respect.”
Ms. Garcia added, “We spent a lot of time looking at the space and making sure it’s not just white walls—we wanted soothing colors.”
A great source of satisfaction was the parking lot. “For the first time, we have our own parking for patients,” said Ms. Garcia. “One of the things they like best is that they can park without getting frustrated looking for a space.”
Check-in is through the patient’s electronic medical record (EMR), which lets the front desk know whether the patient needs to see a clinician first, or needs to go to the financial department, or can go straight to dosing. This makes patient-flow much easier, according to Ms. Garcia.
At the old site, the OTP was located in the hallway, so patients had to wait in the hallway. At the new site, there are three dosing windows, so the wait isn’t as long, and there is enough space between the windows so patients have privacy. “They feel as if they are going to a real medical office,” said Ms. Garcia. “It’s welcoming to them.”