REACH Medical, the first low-threshold harm reduction medical practice in Ithaca, New York is, for many, a place where hope lives. Inside a renovated home just blocks away from downtown, there are patient exam rooms, offices, and a welcoming reception area. REACH stands for Respectful, Equitable, Access to Compassionate Healthcare. Patients will not only find stigma free care at REACH, where individuals can access compassionate medication-assisted treatment, REACH also provides comprehensive primary care, a small food pantry, clothes, and hygiene supplies.
REACH was founded by Dr. Justine Waldman, a Board-Certified Emergency Medicine physician with extensive experience working with individuals with opioid use disorder. Dr. Waldman, now Medical Director of REACH, recognized that there were too many barriers for the lowest-income population to receive treatment for substance use disorder. In December 2016, Dr. Waldman began serving as the provider for the Drug User Health Hub, operated by the Southern Tier AIDS Program (STAP), the first in Upstate NY. The NYS Department of Health’s AIDS Institute provided grant funding to a small number of Syringe Exchange Programs (SEPs) to embed part-time providers, certified with a DATA 2000 waiver. The waiver allows providers to prescribe the opioid replacement treatment medication buprenorphine, also known as Suboxone. The idea behind the Drug User Health Hub program was to present substance users, who were visiting the SEP to get clean needles and supplies, with the opportunity to engage with the provider and understand the alternative medication assisted treatment available.
Federal law restricts physicians prescribing buprenorphine to 30 concurrent patients in the first year of holding the waiver and 100 patients the second year. Dr. Waldman’s slots filled up in just three weeks, with 70 patients from Tompkins County along on the waiting list.
Understanding that access to this lifesaving medication was extremely inadequate, Dr. Waldman decided that something more had to be one. In the summer of 2017 she approved Amy Gecan who she had worked with through DSRIP (Delivery System Reform Incentive Payment) program. Gecan was then working as the Director of Strategic Planning and Integration at Cayuga Medical Center and was familiar with the population that Dr. Waldman was targeting.
“Dr. Waldman helped me realize that there was this huge gap and unmet need in the population,” Gecan remembers. The two came up with the idea to open REACH Medical, a captive professional corporation and medical practice that would be owned and operated by the 501(c) 3 organization named The REACH Project, Inc. This allows them to circumvent the regulatory constraints that are present with typical OASAS or Article 28 providers and be able to fully integrate services. Instead of just providing medication assisted treatment REACH Medical can provide comprehensive primary care, behavioral health services, psychiatric medication management, and Hepatitis-C testing and treatment. It also enables the organization to receive grant funding and philanthropic donations. “When it boils down to it, it’s a one-stop shop for this population,” shares Gecan.
Currently 11 waivered providers are on staff at REACH Medical, and a twelfth is being on-boarded in October of 2018. The population that REACH Medical services is generally a high cost to the healthcare community and presents greater challenges to manage than typical populations. Substance use is a chronic relapsing disorder but, as Gecan puts it, “by treating as if it’s an actual medical condition as opposed to a moral failure or a motivational issue, the idea is that you’re able to help some of these patients move into a place of wanting to do something that’s good for themselves and improve their quality of life.”
This stigma-free compassionate care is the key component of the model being used at REACH and it’s working. In the six months that REACH Medical has been open the clinic has served over 600 unique patients at over 2,500 visits by using a low-threshold model of care. This means that REACH removes all barriers to care using evidence-based progressive models that revere honest relationships between the patient and provider. As well, should there be an emergency situation, REACH is able to see a patient and get them on buprenorphine that day. Before REACH existed, this immediate access wasn’t readily available in the community.
This model of care was designed to function in a Value-Based Payment model, so there is no expectation that providers have a certain number of visits per hour. Providers at REACH are able to develop relationships with their patients and have meaningful clinical interactions. Because of this, providers have sought out employment at REACH, “We have lists of people going through the credentialing process and we can’t get them on-boarded fast enough,” says Gecan.
REACH uses trauma-informed care and has implemented a policy to provide a minimum of one cultural competency training each quarter, ensuring that staff and providers are able to maximize patient engagement by providing care in the most compassionate and culturally competent manner. “This population has been so deeply stigmatized, and there is so much bias that people carry with them that they aren’t even aware of,” Gecan explains. “As a result of that the patients that come to us are expecting not to have a trusting relationship. They are expecting not to be treated well. They are expecting that they are going to have the same repeated, negative experience they may have had in other settings. But instead they come here and they are welcomed like family and they are able to develop a relationship within which they can have an hones conversation with their provider – which is absolutely critical for the healing process to begin.”
The retention rate for patients at REACH Medical is 88%, compared to the national average of 50% for similar programs. This number is based on patients who have been in treatment for 3 months or more and does not account for people that become incarcerated during treatment or find treatment elsewhere.
REACH plans to expand access to this life-saving treatment beyond Tompkins County as 40% of patients come from outside the county. “That is a really important point,” Gecan remarks. “What it says is that access to this service is severely inadequate.” REACH will be opening a part-time site in Johnson City, which has some of the highest opioid overdose mortality rates per capita in New York State. In fact, 15% of REACH’s patients come from Broome County. REACH will again partner with STAP and place a part-time provider in the SEP on Main Street in Johnson City.
REACH hopes to continue collaboration within the existing provider network and with Community-based Organizations (CBOs) that have expertise in areas the complement the work that they are doing including food pantries, supportive housing, care management, law enforcement, and the criminal justice system. Gecan says, “as long as we can find common ground I think there is an opportunity for us to work together to make sure that patients have as many options as possible in their local community for treatment and support services. That’s really important for saving lives.”
REACH Medical also recognizes and thanks Care Compass Network (CCN) for their support. “There is something unique about CCN. Their acknowledgement that they Community-based Organizations and the infrastructure that supports them is what is needed to transform healthcare,” says Gecan. “DSRIP has made the early work of REACH possible. The kind of innovation and creative, out of the box thinking and funding to serve the unmet needs of the Medicaid population made REACH possible.”