Breaking Down Silos, New SNF Targets Substance Misuse Disorders

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.”

Collaborating for the best treatment


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.”


Allegheny County “really stepped up,” Jaffe noted, working with HM Home & Community Services, Gateway Health and the Center for Inclusion Health at AHN to bring the unit to fruition. The stakeholders first came together at the beginning of 2018, and the unit officially opened in October. The result was a “remarkably fast process,” Jaffe said, helped somewhat by the fact that the unit was an existing one in a long-standing building. It was renovated to become the new SNF.

The county’s flexibility was particularly helpful because due to the types of patients the unit will be admitting, there were multiple levels of regulation to address, Jaffe said.

“There were new policies involved, because this is not a treatment or detox unit,” she explained. “This is a skilled unit for people with drug misuse disorders, and we want to be sensitive to that and continue to treat the patients that way. But there were some questions on: What are the policies in this unit? What are the visitations on this unit? If people want to take a leave of absence, can we do that? How do we store the medications? What kind of education and certification do we want for the staff?”

As a result of the different considerations for the skilled unit, the stakeholders worked to make sure they were in compliance with all the regulations for long-term care facilities, Jaffe said. The unit is unlocked, which means there are some patients it couldn’t take.

“If someone is actively psychotic and needed a locked unit, or if someone is in withdrawal and needed medical attention for withdrawal, it would not be an appropriate unit for them to be on,” she explained.

An integrated approach

The unit has to have specific staff in place because of the unique patient population it serves. The nursing staff and the attending medical physician are provided via Allegheny County, while Gateway is providing a program manager with behavioral health expertise. There’s also a nurse manager, and those two serve as leads at the unit. AHN is supplying a nurse practitioner with addiction expertise who will serve in a consultative role for a half-day five days a week. A physician with chemical dependency expertise as well, from AHN will also be there two half-days a week to direct the addiction services.

The nurses who staff the unit volunteer to be there, Jaffe noted, and the Center for Health Inclusion works with them to provide education around addiction.

“We wanted to make sure the staffing model we established was integrated — both the skilled medical need as well as the addiction treatment,” she said. “We really wanted that to be an integrated approach, with the patient experience integrated on a day-to-day basis.”

The facility is currently open as a pilot program, with that goal of care integration. It’s something Jaffe hopes the unit as a whole can facilitate.

“This unit is designed to bring down silos, not only within specialties, but also across the care continuum,” she said. “So someone who has an underlying problem with medical difficulties gets the right care as they move across the continuum.”

Written by Maggie Flynn

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