How Payers Address the Nation’s Opioid Crisis, Patient Safety

April 05, 2018 - Commercial payers leverage community financing and engagement techniques to limit patient safety risks related to the nation’s opioid crisis. Payers find that contributing information to datasets can help stakeholders detect opioid risks within clinical settings and community environments.

An alarming number of patients have access to opioids and providers sometimes contribute to the opioid crisis through under-addressed over-prescribing habits.

In 2017, the BlueCross BlueShield Association (BCBSA) found that 21 percent of their beneficiaries filled at least one opioid prescription. The organization also said that the rate of opioid-use disorder among BCBSA beneficiaries rose by 493 percent from 2010 to 2016.

“Opioid use disorder is a complex issue, and there is no single approach to solving it,” said BCBSA Senior Vice President and Chief Medical Officer Dr. Trent Haywood. “It will take a collaborative effort among medical professionals, insurers, employers, communities and all levels of government working together to develop solutions that effectively meet community needs.”

Payers realize that financing local or state-level programs can help address social and environmental factors that contribute to opioid abuse. Dedicating funds can help other experts and community leaders address social and environmental opioid risks.

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The Aetna Foundation has launched a funding initiative that will donate $6 million to community programs across the country to manage opioid-use risks. Aetna started the initiative with a $1 million grant that funds the North Carolina Harm Reduction Coalition’s “Rural Opioid Overdose Prevention Project.”

Aetna determined that funding the project may help reverse the negative public health effects of opioid abuse within North Carolina.

North Carolina’s public health statistics found that an average of five people died each day from opioid overdoses and that overdoses cost the state $2 billion annually in medical costs and work losses.

Aetna’s grant will fund community-level risk education in five rural counties in North Carolina, distribute naloxone kits to rural and high-risk opioid users, and encourage adoption of best provider policies on overdose prevention.

“For the first time in our history, our children’s generation is not expected to live as long as our own. That is due in large part to the epidemic of opioid abuse, which presents a clear and present threat to our communities and health care resources,” said Garth Graham, M.D., M.P.H, president of the Aetna Foundation and vice president of Community Health for Aetna.

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“The innovative work that the North Carolina Harm Reduction Coalition is doing on the ground is promising, and it’s our hope that it can also offer a road map for outreach in other rural communities.”

WellCare employed similar tactics to distribute $35,000 in funding to local addiction recovery centers in Kentucky.

An organization called The Healing Place will receive $10,000 to perform outreach and social reform programs related to substance use disorder (SUD). The Healing Place’s social recovery programs have a 75 percent success rate and can continue these programs past their current capabilities.

WellCare allocated the remaining $25,000 to an organization called Addiction Recovery Care (ARC), which specializes in holistic addiction treatment by incorporating medical and vocational programs into care services. ARC reported an 85 percent completion rate among clients who participated in the organization’s vocational wellness programs.

Heroin overdoses skyrocketed by 266 percent between 2013 and 2016, according to Kentucky’s public health data.

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"Our interest is in saving lives and improving the health of people in Kentucky," said WellCare of Kentucky President Bill Jones. "Opioid abuse is life-threatening – that's obvious. But it, and other addictions, also prevents entire families from living healthy lives and meeting their full potential."

Payers can successfully increase patient safety through internal policies and mandates that reduce clinical risks related to opioids. Healthcare payers employ tactics such as prescription limits and safe prescribing education to drive noticeable improvements in opioid safety.

BlueCross BlueShield (BCBS) of Tennessee has experienced a 52 percent drop in opioid prescribing through clinical interventions such as prior authorization limits and quantity limits.

BCBS of Tennessee worked with providers by supplying them with prescribing scorecards. The scorecards contained data that revealed a provider’s prescribing practices in comparison to peers as well as opioid abuse risks for patients.

Natalie Tate, Vice President of Pharmacy for BCBS of Tennessee, believes that sharing comprehensive data allows a payer to help providers deliver pain medication in a safe and efficient process.

“Pain relief is important, but it’s clear that both overprescribing and extended periods of opioid use can increase the risk of addiction,” Tate said in a press release. “We will continue to focus on ensuring that providers follow best practices in prescribing – and that they consider alternate pain medications and treatments for patients whenever possible.”

The BCBS Association has recently re-asserted itself as a leader in clinical interventions to promote opioid safety. The organization has issued new provider guidelines that remove opioids as a primary pain treatment for most clinical situations.

The opioid epidemic still presents significant challenges for payers that want to keep their beneficiaries healthy. Payers are leaders in the healthcare industry and can create positive improvements in beneficiary safety risks in regards to opioids