Why did we develop the Six Building Blocks?

  • Overuse of opioids for chronic pain has created a crisis of opioid addiction, overdose and death.
  • The majority of opioid prescribing occurs in primary care clinic settings.
  • These clinics need a blueprint or roadmap to improve appropriate use of opioids in their patient population with patient safety as a top priority.
  • The Six Building Blocks provide such a roadmap, based on evidence from exemplar primary care clinics across the US and results of a recent study.

What are the Six Building Blocks?

Building Block #1: Leadership, goals, and assigned responsibilitiesBuild organization-wide consensus to prioritize safe, more selective, and more cautious opioid prescribing.  The organization will collaborate with other health care organizations and agencies in the local community to ensure good communication between all parties participating in the health and safety of patients and families in the community.

Building Block #2: Aligned policies, workflows, treatment agreements, patient education materialsRevise and implement clinic policies and patient agreements and workflows for health care team members to achieve safer opioid prescribing and Chronic Opioid Treatment (COT) management in each clinical contact with COT patients.

Building Block #3: Proactive Population ManagementImplement pro-active population management before, during, and between clinic visits of all COT patients to ensure that care is safe and appropriate AND to measure results of COT improvement activities.

Building Block #4: Planned, patient-centered visitsThrough planned visits, conduct pro-active population management before, during, and between clinic visits of all patients on COT to ensure that care is safe and appropriate. Support patient-centered, empathetic communication for COT patient care.

Building Block #5: Caring for complex patientsDevelop policies and resources to ensure that patients who become addicted to opioids, or who develop complex opioid dependence, are identified and provided with appropriate care, either in the care setting or by outside referral.

Building Block #6: Measuring successContinuously monitor progress and improve with experience.

Where are the Six Building Blocks (6BBs) being used?

Rural Clinics in WA and ID – The 6BBs were developed in 2015 as part of a 3 year, AHRQ funded research study to implement team based care for opioids in 20 rural clinics in Eastern Washington and Idaho. This research study is in its third year and the clinics report significant improvements in their management of opioids for chronic pain as well as an increase in satisfaction for both patients and clinical staff.  See attached research paper and project website at improvingopioidcare.org.

Oregon Prescription Drug Overdose Project – Oregon has adopted the 6BBs as the statewide framework for their 4 year, CDC funded project.  A team of clinical experts from WA and OR worked to customized the 6BBs to incorporate the CDC opioid recommendations, and to promote  collaborating with other community health care organizations and agencies, expand access to alternative therapies and addictions treatment, and help educate the community.  The 6BBs will be used in 10 critical access regions throughout the state.  See attached 6BBs being used in the Oregon state initiative.

CDC Opioid Guidelines Implementation Project – The CDC is developing an “implementation package” to be used with 6 – 9 large healthcare systems in the US.  This implementation package has incorporated the 6BBs, customized to this project, and including a set of proposed national opioid metrics to track progress.  Implementation will start in 2018.

Potential Benefits of the 6BBs for the WA Medicaid Transformation Project

We think all Accountable Communities of Health (ACH) will benefit from using the 6BBs and customizing them to their respective regional projects.  If some or all of the ACHs were to use this common framework, it would have the following benefits:

  1. Promotes partnerships within each community – healthcare organizations, community-based service providers, tribal organizations, consumer groups, first responders, schools, and churches.
  2. Accelerates the planning and, subsequently, the implementation efforts of each ACH.
  3. Eliminates some duplication of effort by the 9 ACHs doing similar work.
  4. Ensures that all ACH plans comply with WA state AMDG and CDC opioid prescribing guidelines,
  5. Since clinics and other community partners would be using a common framework, it makes sharing of policies and approaches easier.
  6. Provides a common framework and simple scoring system for assessing current status and future progress.  Easy to incorporate and link to performance metrics.
  7. Promotes use of the PDMP within the clinic for patient safety and for regional tracking on key opioid metrics.

Resources and Support Available

We have a team of experts from the University of Washington and Kaiser Research Foundation with experience applying the 6BBs to the three projects referenced above. We can provide support in the following ways:

  • Briefings – Initial briefings on the 6BBs (during August and September).
  • Planning – Assisting ACHs to incorporate the 6BBs as part of their transformation plans to address the opioid crisis in their communities.
  • Workshops – Self-assessment workshops with primary care clinics.
  • Practice Coaching – Practice coaching for selected clinics and other community partners.
  • Developing local and regional expertise – Training for local and regional personnel in the 6BBs, including customization.
  • Shared learning opportunities – Virtual meeting at which participating clinical sites can learn from each other as they implement the 6BBs.
  • Telepain Webinars – University of Washington Telepain webinars including patient cases and didactic presentations on aspects of the 6BBs.
  • Community Summits – Help convening community summits with healthcare organizations and other community partners, such as first responders, schools, churches, and counselors.
  • Shared Resources – Provision of website resources, online training, regional and state dashboards, shared access to resources.
  • Tracking progress – Consultation on quality metrics to track progress and basic tools to accomplish the tracking, including utilizing clinics’ existing systems and the state PDMP.

Consulting Team

  • David J. Tauben, MD, FACP | Chief, UW Division of Pain Medicine; Clinical Professor; Hughes M & Katherine G Blake Endowed Professor; Depts of Medicine and Anesthesia & Pain Medicine
    University of Washington, Seattle, WA
    Phone: 206-616-0717 E-mail: tauben@uw.edu
  • Michael L. Parchman, MD, MPH | DIRECTOR, MacColl Center for Health Care Innovation
    Kaiser Permanente Washington Health Research Institute
    Phone: 206-287-2704  E-mail: parchman.m@ghc.org
  • Laura-Mae Baldwin, MD, MPH | Professor, University of Washington Department of Family Medicine, Director, WWAMI Region Practice and Research Network
    Phone: 206-685-4799  E-mail: lmb@uw.edu
  • Brooke Ike, MPH | Practice Facilitator and Research Scientist, University of Washington Department of Family Medicine
    Phone: 206-685-1052  E-mail: bike2@uw.edu
  • Mark Stephens | Project Consultant with MacColl Center for Health Care Innovation on Team Based Opioids, Project Consultant with Oregon Prescription Drug Overdose project, Project Consultant for CDC Opioid Guidelines Implementation, Technology Specialist on pain management websites, opioid MED calculator, webinars, opioid metrics tracking, online training for clinicians and patients.
    Phone: 425-970-3170  E-mail: mark.r.stephens@comcast.net


  • Published research paper on the AHRQ research study using the Six Building Blocks
  • Six Building Blocks – simplified format for quick self-assessment and workshops
  • Six Building Blocks – extended version that includes detailed guidance

Six Building Blocks © 2015 MacColl Center for Health Care Innovation