Highmark Inc. continues to enact significant programs and policy changes designed to help members as they battle opioid abuse and addiction in its community-focused and partner-driven war on opioids. Today, the company announced it will expand a successful program that focuses on assisting providers with pain management and safe opioid prescribing to improve clinical outcomes in Pennsylvania, as well as make additional prescription policy changes.
“Seeing the number of deaths and how this problem is impacting lives, it is truly a crisis and we are using all the resources we have to take on the problem,” said Deborah Rice-Johnson, president, Highmark Inc. “No single entity can do this alone. We are working with many partners outside of Highmark. Internally, our medical policy team, pharmacy team and fraud teams, among others, all are heavily invested in this effort.”
Leveraging claims data, Highmark is partnering with axialHealthcare to equip providers with evidence-based decision support tools on pain management and opioid therapy. Driven by analytics and supplemented by consultation with axialHealthcare’s licensed pharmacists, these tools will give providers insight into their own opioid prescribing patterns and guidance on clinical best practices for opioid prescribing, as well as provide access to patient safety alerts, care pathways for treating common pain complaints, and in-network referral support for complex cases that require personalized, high-quality care for pain or opioid misuse.
In the fall of 2016, Highmark partnered with axialHealthcare to implement this program in West Virginia and has seen impressive results to date:
- More than 250 providers received extensive, targeted clinical consultation on pain management.
- Patients receiving opioids from multiple prescribers has dropped by more than 28 percent.
- Patients receiving opioids alongside certain sedatives – a significant risk factor for opioid overdose – fell by more than 25 percent.
“We are very confident that our partnership with axial and doctors will drive meaningful change throughout our network, especially after experiencing such impactful results in West Virginia,” said Charles DeShazer, M.D., chief medical officer for Highmark Inc. ““We are going to need many tools to combat this terrible problem, and giving our providers access to evidence-based tools for pain care and opioid therapy will have a real impact. That is why we are expanding the program to Pennsylvania. We expect positive results here, just as we have seen in West Virginia.”
Effective February 1, Highmark expanded its partnership with axialHealthcare to Pennsylvania and this week, introduced a new tool to providers in both West Virginia and Pennsylvania that gives patient-specific opioid related risk information directly to providers real-time so they can make better informed care decisions.
Beginning in early March, Highmark will also implement a new policy for its commercial members who are prescribed opioid-based medications for the first-time. The policy, which is designed with member safety as the primary motivation, will limit members to a seven-day supply of medication and applies to members in Highmark’s core health insurance markets as well as nationally. This policy also addresses new prescriptions for extended release opioids. Specifically, for those members who have not been on an opioid recently, new prescriptions for extended release opioids will not be allowed without a prior authorization.
“Data from the CDC show that people who use opioids for just one day have a six percent chance of becoming addicted. For those who use opioids for more than a week, the chances increase to more than 13 percent,” said Sarah Marche, Pharm. D., vice president of pharmacy services for Highmark Inc. “By limiting the prescribed amount for patients who typically may have had a surgery or an acute incident, we hope to reduce the number of people who eventually become addicted to these powerful drugs. This approach is consistent with the recently released CDC safe prescribing guidelines.”
The new Highmark policy is designed to help people who have never used opioids before reduce their risk of dependence. This also adds further controls to the current policies which help ensure appropriate use in members already on chronic opioids through quantity limits, prior authorizations, and overuse monitoring.
“Even at low doses, taking an opioid for an extended period of time increases the risk of addiction. The idea of this program is to stop inappropriate, long-term use at the outset,” said Marche. “This policy is completely about the safety of our members and the communities that we serve.”
She also noted that there are some exceptions to the program, including those who have a condition that causes chronic pain that cannot be managed with other treatments or may need opioids for acute or chronic pain associated with cancer or other malignant conditions.
In addition to the changes announced today, Highmark Health has contributed some $600,000 in multi-year support for local programs and the Highmark Foundation has contributed another $120,000.
Also, The Highmark Caring Place, in Lemoyne, Cumberland County, Pa., recently co-hosted the PA Family Support Alliance, for a program on how to cope after the overdose death of a parent or children. This ongoing issue has seen families visiting the Caring Place because of this issue increase from only five in 2014 to 144 in 2017.
Allegheny Health Network (AHN) has also played a critical role in helping to address the opioid epidemic by providing patients the community-based care and support they need. Last year, AHN established its Center of Excellence for Opioid Use Disorder which connects patients with Medication Assisted Treatment (MAT) and other recovery services. With support of a $1 million state grant that was awarded to only three other medical institutions in Pennsylvania, the program has since expanded to a broader population and includes a new, hub-and-spoke model of care supported by a team of leading experts in addiction medicine. The care model reaches patients in the communities they live and wraps them with a range of evidence-based therapies and services that can help them recover from their illness and maintain long-term wellness.
Additionally, through its Perinatal Hope program, AHN provides comprehensive and coordinated treatment to addicted mothers-to-be. For the homeless and unstably housed population with addiction-related health issues, AHN’s medical respite program provides patients recovering from illnesses with a safe place to recuperate and receive ongoing non-acute care and support following a hospital stay.
