By Matthew Eyles, President & CEO of America’s Health Insurance Plans
The opioid crisis is the deadliest drug epidemic in American history. It’s a public health crisis that affects individuals and families no matter where they live, how much they earn or how old they are. And while no one should have to live with pain, no one should live with the consequences of opioid addiction either.
The Centers for Disease Control and Prevention estimate that 115 people die each day from an opioid related overdose, which is now the leading cause of accidental death in the U.S. It’s an epidemic on the rise; overdose deaths involving prescription opioids were five times higher in 2016 than in 1999.
We must solve this crisis. But an epidemic this pervasive — one attributable to a complex set of socioeconomic factors, prescribing practices and other factors — will require a full-court press from all parties involved in patient care. Health insurance providers are committed to addressing the opioid crisis, and are proactively working with doctors, nurses, hospitals, community groups and others on the safest, most proven and most effective approaches to manage pain.
Insurance providers have a 360-degree view into care, meaning that they interact with virtually every party involved in a patient’s treatment. That means that insurance providers are well positioned to (1) track the health care industry’s progress in addressing the opioid epidemic and (2) coordinate patients’ care with all of the various players involved in our health care system, including those on the front lines who are battling this crisis every day.
This year, America’s Health Insurance Plans released the first nationwide benchmark data that measures the health care industry’s progress in combating the opioid crisis. The data released is part of a larger effort: the Safe, Transparent Opioid Prescribing Initiative, announced in October 2017, which comprises more than 40 insurance providers. AHIP is collecting this data with the hope that it will encourage widespread adoption of the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.
This benchmark data shows how well providers nationwide are adhering to CDC guidelines on prescribing opioids for chronic pain. Some of these guidelines include recommendations to prescribe the lowest dose and fewest pills that would be effective for each patient, conduct a regular review of the risks associated with treatment and monitor patients closely.
AHIP’s analysis highlights the positive steps that the industry has taken to address this epidemic, and identifies specific actions that can be taken to reduce addiction and abuse. More specifically, the study found that:
- Approximately one quarter of opioid prescriptions are above the CDC-recommended morphine milligram equivalent dosage.
- Nearly half of chronic pain patients also received benzodiazepine prescriptions during their opioid treatment. According to CDC guidelines, this can be unsafe for patients and should be avoided as much as possible.
Here, there is an important role for insurance providers to play. Insurance providers are collecting data regarding how well the CDC’s recommendations are being met, and then using that data to refine clinicians’ prescribing practices. Insurance providers often provide clinicians and hospitals with reports that track clinicians’ prescribing habits, address opioid misuse and prevent overdose. This data allows physicians to track their efforts and refine their practices to best meet the needs of their patients while reducing opioid misuse.
Following these guidelines has delivered results. Anthem BlueCross BlueShield organizations across the country collectively reduced opioid abuse by 30 percent — two years ahead of their publicly stated goal. We’ve also seen Cigna achieve a 25 percent reduction in opioid overdoses among its patients in March 2018, one year ahead of its own goal. It has now aimed to reduce opioid overdoses among their patients by an additional 25 percent by December 2021. We need to continue tracking how well care providers and hospitals adhere to these standards, so we can refine prescribing practices and treatment methods based on their results.
Today, insurance providers construct and coordinate comprehensive approaches to pain management. Often, that means utilizing a combination of tactics, including evidence-based treatments, more cautious opioid prescribing and careful patient monitoring. This is done in collaboration with a variety of parties, including hospitals, care providers, drug manufacturers, pharmacy benefit managers and even community organizations.
Take Highmark Inc., for example, which found that one in 250 of its commercial members were addicted to opioids. In response to the crisis, the Pittsburgh-based health insurance provider launched a three-pronged public health approach in partnership with axialHealthcare, a national leader in pain management and pain medication solutions. Together, the groups are ensuring providers have access to evidence-based decision support tools for pain management — improving practices and clinical outcomes for their members. By leveraging Highmark’s claims data, physicians, clinicians and other providers have access to additional insight into their own prescribing practices and how they compare against their peer group, so they can make changes if necessary. Providers then receive potential care pathways for treating common pain complaints. Here, we see physicians, hospitals and private industry collaborating to improve treatment — all fostered by health insurance providers’ relationships across the healthcare system.
The opioid epidemic won’t be beaten in the doctor’s office alone. In an effort to help localize this national conversation, Anthem Blue Cross and Blue Shield in Kentucky has teamed with the National Urban League to develop a free online toolkit designed specifically to help nonprofits, faith-based groups, parents and others keep their communities safe by preventing opioid misuse and addiction — especially among young adults. The website includes a workshop kit with ready-to-use materials and a step-by-step guide for hosting a local discussion or town hall meeting.
Presented in an easy to understand format, the kit features a video and slideshow designed to help people learn about opioids, risk factors, warning signs and prevention strategies. The workshop kit also provides tips for engaging key community experts such as pharmacists, doctors and first responders who bring expertise and local insights that are impactful to the conversation, as well as customizable post cards and social media posts to help organizers promote their event. It’s a great example of how health insurance providers can coordinate among various parties to achieve results — in this case, community organizations and local families.
Treatment isn’t just about preventing opioid abuse — it’s about helping high-dose-chronic duration patients find viable alternatives that are just as effective and less dangerous. For those already receiving high doses of opioids, plans must help patients taper to safer amounts of opioids, and must make every effort to avoid unintended consequences that may drive patients to look elsewhere for pain relief — including illegal sources. After all, street drugs are driving the increased death rate from opioids.
One insurer, Gateway Health, has forged relationships with provider groups to support whole-person care for addiction management, behavioral health and pain management. Through such partnerships, Gateway Health is expanding complementary care to support patients who are experiencing pain, covering nonpharmacologic options such as massage therapy and physical therapy services. These services can help keep patients off of dangerous street drugs while tapering, and can ultimately help patients curb their opioid use.
A Comprehensive Approach
Insurance providers’ are proactively working to address this crisis. As we continue to tackle this problem head-on, it’s going to take all parties involved in patient care; doctors, hospitals, legislators, PBMs, drug manufacturers, community groups and insurance providers.
There’s reason for optimism; we’ve seen that there is commitment from legislators on both sides of the aisle to take action. The U.S. Senate just overwhelmingly passed bipartisan legislation (approved by the U.S. House last week by a vote of 393-8) that will help our nation respond to the opioid crisis. The bipartisan 21st Century Cures Act and Comprehensive Addiction Recovery Act, which passed in 2016, made over a billion dollars in funding available to states and communities to increase prevention and treatment. At the local level, community groups and individuals are organizing “Drug Take-Back Days” to reduce the amount of prescription opioids that get into the wrong hands.
Insurance providers, with a 360 degree view into patient care, have a unique role to play. By combining effective education, prevention, behavioral health care and evidence-based treatment — all efforts that require coordination among all parties involved in patient care — health insurance providers are making real progress in addressing opioid addiction.