Burwell Talks Opioids, Health Coverage in Exclusive Interview

by Lydia Nuzum, Health Reporter

U.S. Secretary of Health and Human Services Sylvia Matthews Burwell visited West Virginia twice last week to talk about both the trials and triumphs of the state in combating its poor health outcomes. She joined President Barack Obama Wednesday during his forum on opioid addiction in a state that suffers from it more than any other, and she returned two days later to talk about solutions like the health coverage gained by West Virginians under the Patient Protection and Affordable Care Act.

For Burwell, a native of Hinton, growing up in West Virginia gave her the grounding to go on and serve as president of the Walmart Foundation and as president of the Global Development Program at the Bill and Melinda Gates Foundation before her appointment as the 22nd secretary of HHS in June of 2014.

“The values I learned growing up in a beautiful place called Hinton, West Virginia, are what anchor how I manage, how I work, and what I work on,” Burwell said in a 2014 speech at The George Washington University.

Burwell sat down prior to her appearance at the University of Charleston Friday night, where she spoke to health-care advocates at West Virginians for Affordable Health Care’s fundraiser, to talk about some of the issues of health-care delivery and poor health outcomes surrounding the Mountain State.

Gazette-Mail: A few months ago, we talked about the [Centers for Medicare and Medicaid] regulations for senior centers. Around here, stakeholders are saying it might cost an additional average of $40,000 per nursing home in West Virginia. Why, in your mind, was updating those regulations so important, and what are your thoughts on the concern that there might be too many changes too soon for small, rural nursing homes?

Burwell: So with regard to the issue of the updates, the idea that it — this has been in process since I came in, and the career staff that I talked to about how long we’d been trying to get through and do regulations — it’s been over a decade. Important changes have occurred in terms of advancements in the system; everything from technology to care, and our rule-making needs to be updated in order to help serve and support the facilities that are doing that. It’s a very important rule in terms of serving the community we want to serve — both the consumers themselves and the provider. A number of things in the rules, I think we’ll probably hear from providers, are very important to update. With regard to the question of the cost, getting that balance on what we know about safety and some of the things that do cost, it’s something we focus on. At CMS, they know that any time they’re going to present any rule making to me, we have to go through what it means for rural America, because sometimes it’s different than what it means for more concentrated settings. What we seek to do in the rule making is to make sure that we balance the questions of improvements in quality and safety with these issues of cost. Right now, as you probably know, we’re in the middle of the comment period and hoping to bring that to closure, so we will of course take into consideration the comments that we’ve heard throughout that period, and continue to work to get that balance on how we can best serve the consumer and make sure we don’t put too much burden on the provider. But it is a balance, and that’s how we think about it and what we do to make the decisions.

Gazette-Mail: All right. Now, during his visit Wednesday, the president spoke kind of broadly on the need to focus more on the “demand side” of drug abuse, as opposed to just strictly going after the supply side, although that’s important. Looking more at treatment options and things like that — what do you see as HHS’ role in achieving that goal, and what are some of the concrete steps you’d like to see in the next few years in addressing more treatment options?

Burwell: So I think it’s important to put those comments in a broader context of the strategic approach to dealing with this problem. I think we need to both address the problem from a prevention aspect, as well as from a treatment aspect. It’s very important that for those who are currently suffering from addiction issues, that we have appropriate treatment, but it’s very important that we do not continue to fuel the pipeline. As I spoke about in the beginning of my comments, at HHS we have a three-part strategy, evidence-based, that focuses on both of those issues, and it consists of improving prescribing practices, and that has a number of elements to it… we will at the [Centers for Disease Control and Prevention], put out new guidelines on prescribing in the first part of next year. It has to do with how we support and help prescription drug monitoring plans, which I think you know, in this state, has recently become mandatory, that people register and become a part of it. The second step is the medication-assisted treatment, which is a very important part of this. I think you know, as the president mentioned, the $133 million that he mentioned — $99 million of that is to HHS, and it’s to go against all three of these priorities, but getting more medication-assisted treatment, and how we fund and support that. We’re already doing some of that through our Substance Abuse and Mental Health Services Agency, SAMHSA; we’re also doing some of that by improving the work that we’re doing in our Federally Qualified Health Centers (FQHCs), which we have a lot of here in the state of West Virginia. The last piece is the naloxone, which is a form of treatment in a very acute situation, but sadly, and certainly in the state of West Virginia, an important part of treatment, because we can save lives. So getting the naloxone and the access to the naloxone is important.

Gazette-Mail: [Here’s] sort of a different kind of question: What does it mean for you to come back here, twice in one week, to talk about some of the problems that are facing the state that you grew up in?

Burwell: You know, it’s about the problems, but it’s about the solutions, and I think what we saw in the conversation with the president — I was very proud of the leadership of our state, and whether it was Cary [Dixon] and the parent representing parents all over this country, or local law enforcement creating innovative ideas and approaches that, as the president said, we need to make sure more people know about. So while the problems are acute, you see great work going on, and that’s also [part of] the event I’m about to do. [West Virginians for Affordable Health Care] has been an important part of West Virginia setting records in terms of the drop in the number of uninsured, in terms of its ability to focus on these issues of making sure that people are getting access to that insurance and then access to that care. This organization, and the community that supports it and works with it, are making great strides. As I’m getting ready to go into open enrollment, it’s great to be in a place where I can highlight this kind of work and leadership in terms of — this is one of the top 10 states in terms of reduction [of uninsured] in the entire country, and a lot of it has to do with this work that has been ongoing for a long period of time. To be able to highlight my own home state in terms of this work, as we’re gearing up for open enrollment, and the kind of work that stakeholders in local communities are doing to make a difference to individuals on the ground in terms of their ability to access affordable, quality care.

Gazette-Mail: Again, back to the president’s visit — as it was touched on at several points, there are a lot of different modes of treatment to look at when you’re talking about opioid abuse. What are your thoughts on — I know you touched on this a little bit — supporting medicine-assisted recovery versus other types of programs, 12-step programs, peer-to-peer — long-term things that don’t necessarily involve the use of things like suboxone or buprenorphine? What should we be supporting? Are there any particular avenues of drug treatment we should be focusing on, and if not, what needs to happen to build treatment options?

Burwell: So one of the things, I think, when I sort of started, in terms of our three areas of focus — we spend a lot of time on evidence, and talking to folks around the country. Two times, we’ve gathered, and I’ve called meetings for all 50 states to attend, once in my first year, and most recently West Virginia participated in a 50-state convening. Getting the evidence from states, as well as the scientific evidence from our (CDC), as well as others, we see medication-assisted treatment as an important approach. One of the things I think is very important is that it is medication-assisted treatment because it also works on behavioral health issues, and so just giving people the medication is not what we consider a solid program. It has to be a program that is also helping to get to the root causes for these individuals and work through other issues that might have led there, or at least are now intertwined. I think it’s important that the behavioral health aspect — and sometimes that’s talk therapy, sometimes thats other kinds of things — be an important part. And so what we have seen analytically is that when you combine those things that people might consider alternatives to medication with the medication, that that’s when you get the maximized results. One of the concerns about medication-assisted treatment is diversion, and that’s one of the things you want to protect against.

Gazette-Mail: This is my last question. I think a lot of West Virginians are very proud of you, and some are really hopeful you could provide a voice for them in national discussions regarding health. What are your hopes for the future for a state that is beset with so many different health problems?

Burwell: You know, my hope and belief is — I’m an optimist by nature; it’s why I do the work I do, and when I come and see how the community is working together, it’s reflective of what I knew as a child and my time in West Virginia. The communities come together to solve the problems. The problems are big, and whether it’s the issue of quality, affordable health care or the issue of the addiction and the resulting deaths and pain to families, I believe we can do this. I believe as a state, you just see that great things can happen. The drop in the uninsured? That’s results already. I think it’ll take a little more time, but I think the state’s putting in place many of the things we need to do with regard to the substance abuse issue, so as I said, I’m an optimist, and a big part of why I’m optimistic in this state is because I have confidence in the people and their commitment to working together on these issues.

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