2015-2016: The Response Evolves
In 2015, following the election of Matt Bevin as governor, Kentucky began a push to acquire and leverage more sophisticated data in its response to the opioid epidemic. “Their [the Bevin Administration] level of frustration with the lack of data is one of the things that drove us,” Brenzel recalled. “They found that only beginning steps had been accomplished in terms of the data integration and data infrastructure.”
Thus, Bevin and his staff accelerated efforts to establish globally agreed-upon measures, integrate data across departments, and hold meetings where leaders from different agencies would share and analyze information.
Kentucky also forged a public-private partnership with Aetna, a managed health care company with more than 250,000 Medicaid members in Kentucky, to enhance the commonwealth’s data and analytics work. Specifically, Kentucky and Aetna began employing predictive modeling tools to use available data (e.g., medical, behavioral, and pharmaceutical records) to identify Kentuckians who might be at risk. Of the partnership’s long-term objectives, Kimberlee Richardson, the Director of Behavioral Health at Aetna, said, “What we would like to do, as our deep dive into analytics moves a bit further, is really look to see: What are the trends that the data is showing us? Are there particular geographic areas where the risk factors are higher? …Do the identified members share any significant common factors?” Richardson added, “In Kentucky, Aetna is using their own internal data and partnering with external experts to implement strategies for improving health outcomes based on analytics. The data illustrates where gaps in care may be occurring and the avenues in which Aetna can deploy additional resources in order to support a healthier ecosystem.”
Taken together, these efforts allowed Kentucky to leverage data and an increasingly collaborative ecosystem to enhance its response to the opioid epidemic. A case in point involved the implementation of Senate Bill 192, which supported the creation of local Harm Reduction Syringe Exchange Programs (HRSEP). In a sign of Kentucky’s more sophisticated use of integrated data, the state overlaid the needle exchanges in counties that were considered most vulnerable to HIV and hepatitis C outbreaks; this was because of growing concern that the needles used to abuse opioids could contribute to the spread of hepatitis C and HIV. In addition, in a move that reflected an increasingly collaborative dynamic, officials from the Justice and Public Safety Cabinet sought advice from behavioral health officials about how to spend approximately $20 million in substance use disorder funding that they had received as part of the legislation. “The good news,” Brenzel said, “is we built an ecosystem where they came to us and said, ‘We need help in using data to determine how to target and buy quality services, we need help in engaging in active contract management around this.’ And they did work with us, which has brought us all to the table.”
The collaborative and statistically driven approach soon permeated the broader response to the opioid epidemic. Following numerous public requests for data, Kentucky officials created county profiles on opioid-related issues as well as publicly facing dashboards with granular local data. They also partnered with the University of Kentucky’s Injury Prevention and Research Center and began incorporating real-time syndromic surveillance data to help to guide the distribution of resources, such as Mobile Harm Reduction Units, to communities in need. Finally, Kentucky undertook preventative measures, including partnering with public schools to promote healthy lifestyles and awareness surrounding opioid abuse. “We’ve started thinking about that continuum,” said Jonathan Ballard, the State Epidemiologist in the Department for Public Health. “How do we address the next wave in addiction prevention?”