Health insurers step up opioid management, treatment programs

pills spilling out of a bottle

With opioid abuse rapidly driving up healthcare spending, insurers have adopted comprehensive approaches to reduce the risk of addiction and successfully treat beneficiaries with substance use disorders.

Neighborhood Health Plan in Boston uses an algorithm to track where and how often members fill opioid prescriptions, then intervene if that number seems too high according to an article in Managed Healthcare Executive.

Similarly, Massachusetts-based CeltiCare Health Plan of Massachusetts has hired social workers to locate and support high-risk members and coordinate an integrated care management team to ensure members receive the care they need to overcome substance abuse issues, according to the magazine.

On the West Coast, Blue Shield of California has attacked the problem at its source--prescriptions for pain. The insurer set a goal in 2015 of a 50 percent drop in opioid prescriptions in three years. So far, it has reduced prescriptions by 15 percent and reduced the number of members receiving opioid prescriptions for more than 90 days by 11 percent, the article notes.

For its part, Cigna is working with the American Society of Addiction Medicine to analyze two years of de-identified actual claims to develop standardized metrics, baseline measures and opioid use goals, FierceHealthPayer has reported.

Cigna CEO David Cordani has also called for greater use of medication in substance abuse treatment, citing current research that indicates that 40 percent to 60 percent of substance abuse risk comes from genetic factors, the Hartford Courant reports.

Medication-assisted treatment--using suboxone, methadone or vivitrol--reduces substance use much more effectively than abstinence, the article notes. Cigna and Aetna combined forces to successfully lobby for the expansion of the number of patients a doctor can treat with suboxone from 100 to 275, saying the previous cap had limited the number of members who could obtain medication assisted treatment.

- read the Hartford Courant article
- read the Managed Healthcare Executive article