Table 1.

Primary Care Clinic Characteristics and Examples of Opioid Improvement Efforts

State	Clinic Type	Location	Payer Mix	Example Opioid Improvement	Building Block(s)
PA	FQHC, nurse-led	Urban	4% Medicare	Chronic pain group therapy	4,5
			58% Medicaid
			14% commercial
			23% uninsured
WV	FQHC, AHEC	Rural	17% Medicare	Chronic pain group visits	1,2,3
			25% Medicaid	Pain registry
			22% commercial	Chronic opioid prescribing policy and pathway
			30% uninsured	Chronic opioid prescribing policy and pathway
SC	FQHC	Rural	32% Medicaid	Standard care plans	2,3,4
			12% Medicare	Patient agreements
			15% Other	In house physical therapy
			40% uninsured	Suboxone
OR	FQHC, residency	Urban	20% Medicare	Chronic pain group visit	2,3,4
			50% Medicaid	In-house CAM therapy
			0% commercial	Revised policies
			30% uninsured	Random urine drug tests
				Patient agreements
				Suboxone
				28-day refills
NH	MMG	Rural	45% Medicare	Patient agreements	2,5
			2% Medicaid	Opioid QI team
			50% commercial	Revised policies
			3% uninsured
WA	MMG	Rural, Suburban	20% Medicare	Chronic pain re-design team	2,4
			9% Medicaid	Suboxone
			61.5% commercial	Pain registry
			9.5% uninsured	Patient agreements
				Random urine drug screens
				Workflow for refills
MA	MMG	Suburban	23% Medicare	Patient agreements	2,3,4
			5% Medicaid	Revised clinic policies
			70% commercial	Suboxone
			2% uninsured	Chronic pain group visits
				Random urine drug screens
NM	FQHC	Frontier/ Rural	28% Medicaid	Chronic pain group visits	3,4
			30% commercial	Behavioral health integration on teams
			19% Medicare	Mental health “first aid” training for staff
			17% Sliding Fee	Suboxone
			6% self pay
CO	FQHC	Rural	47% Sliding Scale	Revised policies	2
			17% Medicaid	Routine PDMP check with refills
			15% Medicare	Patient agreements
			18% commercial dental	No refills on Fridays
ME	MMG	Suburban	35% Medicare	Registry with chronic pain manager	2,3,4
			4.4% Medicaid	Registry with chronic pain manager
			45% commercial	Chronic pain group visits
			5.4% uninsured	Revised policies
CO	MMG	Urban, Suburban, Frontier/ Rural	20% Medicare	Patient agreements	2,3,4
			21% Medicaid	Pre-visit preparation in daily huddle
			50% commercial	Random urine drug test
			9% self-pay	Track PEG scores and PHQ-9
				Suboxone
OH	FQHC	Urban	50% Medicaid	Random urine drug test	2,3,4
			20% uninsured	State PDMP check with refills
			20% commercial	Clinic refill policies
			10% Medicare
PA	PVT	Suburban	90% commercial	Patient agreements	2
			8% Medicare	Revised policies
			1% uninsured
			1% Medicaid
ME	FQHC, residency	Suburban	26% Medicare	Provider support and learning group	2,4
			25% Medicaid	Provider support and learning group
			40% commercial	Suboxone
			9% uninsured	Revised policies
WA	MMG, residency	Suburban	10% Medicare	Chronic pain registry with dedicated MA registry manager	1,2,3,4
			50% Medicaid	Revised policies
			30% commercial	Patient agreement
			10% uninsured	Nurse intake for new patients on opioids
				Random urine drug test
				State PDMP check
				PEG scores
				Referral for high risk
WI	MMG	Rural	17.7% Medicare	Patient agreement	2
			5.5% Medicare	Revised refill policies
			73.8% commercial
			3% uninsured
MA	CHC (hospital network)	Urban	40% Public	Physical therapy assistant	2,4
			40% uninsured	Chronic pain group visits led by social worker
			20% private	Chronic pain group visits led by social worker
DC	FQHC	Urban	63% Medicaid	Chronic pain group visits	4
			6% Medicare	Massage therapy
			20% DC Alliance
			6% commercial
			5% uninsured
NY	AHC, residency	Urban	10% Medicare	Revised clinic policies	2,4
			50% Medicaid	Patient agreements
			30% commercial	Behavioral Health Social Worker
			8% uninsured
CA	FQHC	Rural	50% Medicaid	Chronic pain group visits	2,3,4
			17% Medicare	Revised clinic policies
			3% commercial	Pre-visit planning in daily huddle
			28% uninsured	Patient agreements

Abbreviations: AHC, Academic Health Center; AHEC, Area Health Education Center; CHC, community health center; FQHC, Federally Qualified Health Center; MMG, Multi-specialty Medical Group or part of large system; PVT, Private Practice; RHC, Rural Health Centerl THC, Teaching Health Center.