Health plans taking action to limit opioid prescribing

Feb 26 2018

Health plans taking action to limit opioid prescribing

One of the largest health insurance trade groups has released the results of the first analysis of the health care industry’s progress in combating the opioid crisis. America’s Health Insurance Plans (AHIP) is a national political advocacy and trade association with about 1,300 member companies that sell health insurance coverage to more than 200 million Americans.

The baseline analysis shows steps that clinicians and insurance providers have taken together, and identifies specific actions that can be taken to reduce addiction and abuse. Part of AHIP’s Safe, Transparent Opioid Prescribing (STOP) Initiative, the study “shows how further collaboration across the industry will help to improve care for patients who experience pain, prevent opioid misuse, and reduce the risk of addiction,” AHIP said in a statement.

“We can’t truly measure our progress until we know where we’re starting,” said Dr. Richard Bankowitz, M.D., chief medical officer of AHIP. “These initial results will help ensure we’re making a meaningful and measurable impact as we work hand-in-hand with hospitals, physicians, patients and their families to stop this epidemic.”

The overall STOP initiative, announced in October, was developed with the AHIP Opioid Work Group – consisting of more than 40 insurance providers – to encourage widespread adoption of the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain.

The STOP Measure methodology assesses performance for six of the 12 CDC recommendations. Using the methodology, AHIP analyzed health insurance claims data from 2009-2013 to create the industry’s initial baseline. The baseline will be used to measure the ongoing progress of the STOP initiative as insurance providers continue to collect and analyze their claims data.

AHIP said that, while the “vast majority” of opioid prescriptions for chronic pain were for immediate-release opioids, which is consistent with CDC recommendations, there are several critical measures that can be improved:

* Approximately one quarter of opioid prescriptions are above the CDC-recommended morphine milligram equivalent (MME) dosage.
* Only about 1 percent of patients underwent a urine drug test before being prescribed an opioid.
* 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.

AHIP said it has shared its methodology with insurance providers nationwide, so they can apply it to measure their own opioid prevention and management efforts. In the coming months, results from their assessments will be gathered and the AHIP Opioid Work Group will establish and share key strategies for tackling the opioid crisis, according to Richard Bankowitz said.

Bankowitz cited several examples of measures health plans across the U.S. have taken to address the opioid crisis.

After seeing that people were getting prescriptions for 1,000 opioid pills at a time, Kaiser Permanente doctors in Southern California “changed how their colleagues thought about and treated pain.” Inappropriate prescribing of opioids has dropped by 30 percent as a result of their efforts, Kaiser Permanente said.

UPMC Health Plans begins with childhood prevention and extends through a lifetime of interventions and treatment. – “Its comprehensive approach has led to continuous year-over-year reductions in the prescribing and use of opioids,” Bankowitz said.

Cigna has pledged to reduce opioid use among its customers by 25 percent by 2019. Next year, the plan will no longer cover most OxyContin prescriptions and will instead guide patients to a covered abuse-deterrent equivalent.