Access to broad snapshot of the patient’s pharmacy and medical data can help spot and address drug misuse.
"A. Bartley Bryt, MD
As the opioid epidemic blazes a deadly trail across America, one of the most at-risk demographics is the working age population-those between ages 25 and 54 years. The effects of this crisis are well known: emotional and financial devastation for individuals and their families, overwhelming demands on first responders and social service providers, and mounting losses for businesses that depend on this diminishing workforce.
The CDC estimates that the total cost of opioid misuse and abuse in the United States is nearing $80 billion a year-reflecting the costs of employee healthcare, lost productivity, and workplace injury. Amid this bleak outlook, however, there is hope. For employers and plan sponsors, patient data provides a rich resource that can help not just react to but stem the problem of opioid use and addiction among their health plan members.
As part of the administrative service that they provide, health plans may permit plan sponsors to access a broad snapshot of the patient’s pharmacy and medical data. This means plan managers can systematically identify members who are both new and chronic users, monitor behavior, and provide relevant outreach and intervention. For example, a plan manager can set parameters to identify members who have continually used opioids for more than a threshold number of days-often an indicator that they will become long-term users without some type of intervention. A plan manager can also set up alerts so that they know when members are filling multiple opioid prescriptions at different pharmacies-a pattern that can point to drug abuse or misuse.
Related: Four Facts Healthcare Execs Should Know About the Drug Crisis
Detecting misuse or risk of misuse, however, is only part of the battle. To effectively treat any individual struggling with opioids, it’s crucial to understand the path that brought them to opioid use in the first place. It is critical to engage the family and the patient to understand how usage started, and the issues that are driving usage today.
Pharmacy and medical data are of great utility here, too. The data reveal a chronology of diagnoses and treatments that help reveal the causal factors of a plan member’s opioid use-such as long-time chronic pain versus a recent injury. A persistent user who has been taking opioids for 60 days or more, for example, requires a different approach than someone newly prescribed opioids. Case managers use this information to better understand a patient’s situation from a medical and psychological point of view and develop the communication that is necessary to deliver an effective plan.
Some cases are well-managed with pharmacy-level utilization review alone, but others require this data along with a deeper level of understanding and additional resources to make progress that improves a patient’s well-being. By taking this hands-on approach and understanding that long-term behavior is not changed in an instant, managed care providers can develop personalized treatments to drive success.
Such treatment plans often involve working one-on-one with each patient to connect them to the proper care professionals such as social workers and physical therapists, who can help them address the underlying causes of opioid misuse, and pain management therapies such as acupuncture and medical cannabis. By meeting plan members where they are, health plans have the power to effect positive changes and arrange for comprehensive care to address all aspects of their opioid dependency.
Managed care plans already have an established framework to help lead the much-needed work to help improve opioid usage. The valuable data we have is an essential lever in that process. Let’s pull that lever.
A. Bartley Bryt, MD, is chief medical officer of Brighton Health Solutions, where he determines the clinical vision for both the Create and Magnacare health plan products.