The United States is battling an opioid crisis, and it is critically important that healthcare organizations do what they can to identify patients at high risk of suffering from the negative effects of this form of pain management.
One organization addressing this issue is Commonwealth Care Alliance (CCA), a not-for-profit healthcare organization that serves more than 32,000 low-income, disabled, and elderly patients across Massachusetts who are dually eligible for Medicare and Medicaid. These individuals are often referred to as “super-users” of the healthcare system, as they make up only 5% of the population but account for about half of healthcare spending. Because of their complex patient profile, 20% of CCA members take opioid medications—a number much greater than the general population.
This high rate, combined with the inherent challenges associated with managing pain and care with opioids, led to the creation of CCA’s statewide High Opioid Patient Engagement (HOPE) program, which manages the risk of overdose and reduced opioid dependence among members.
The HOPE program uses a high “touch” approach to ensure that members who are prescribed opioids receive support for safe management that also addresses their pain. First, CCA uses a set criteria to determine which members are most in need of engagement with the HOPE program. Members are identified as candidates for the program if they have chronic pain and are on high doses of opioids, are deemed “at risk” consistent with regulatory criteria, have lived with substance use disorders or overdosed in the past, or are identified through CCA’s predictive analytics as being vulnerable to overdose.
HOPE intervention typically begins with a one-on-one intake visit with a senior clinician from Addiction Services at CCA, and then, depending on the specific case, includes a series of interventions that best suit the individual member’s needs. These can include a prescription for Narcan®, quarterly urine substance screens, behavioral health referrals, Suboxone® treatment, an annual reassessment of pain and functionality, and monthly home visits from care providers.
For two years in a row, CCA’s HOPE program has reduced opioid dose among members: of the 2,183 CCA members on opioids in 2018 and 2019, 775 (35.5%) had a reduction in their opioid dose. This number does not include members that CCA weaned off of opioids completely between 2018 and 2019. CCA’s overdose rate is 1/1000 per year, which is equal to the average rate in Massachusetts.
The HOPE program is unique both in its approach and its results, says Robert MacArthur, MD, chief medical officer, CCA.
“The deeply personalized, high-touch care for members at risk of opioid addiction or death has proven critical to addressing individual needs. CCA leverages fully integrated care teams to provide care for members in their home, meaning that members learn to manage their opioid use as independently as possible, in their own environment, while still having highly accessible support.”
Given the formidable nature of the opioid crisis and the risk of addiction and death among opioid users, the HOPE program is unique in its ability to reduce opioid doses for members with complex medical, behavioral health, and social needs, including disabilities and chronic illnesses, and in some cases has the ability to help members wean off opioids entirely.
This program can serve as a model for other healthcare organizations that treat members with chronic health issues and that are at high risk of opioid abuse or overdose. With the opioid crisis still a looming threat, it is the responsibility of healthcare organizations to act now and address how this epidemic is impacting the patients they serve.