Data, provider partnerships help Blue Cross Blue Shield plans combat opioid crisis

WASHINGTON—To Lisa Faust, senior medical director of Blue Cross Blue Shield of North Dakota, dealing with the opioid crisis is not unlike cleaning up after a hurricane. “It’s not going to be easy and it’s going to take a long time,” she said.

Faust and seven of her colleagues discussed the myriad steps their organizations are taking to address the crisis during an event held at the Blue Cross Blue Shield Association’s D.C. office on Wednesday.

A recent report from the federal Substance Abuse and Mental Health Services Administration estimated that 11.8 million people misused opioids in 2016, and about 2.1 million have an opioid use disorder. President Donald Trump has also declared the opioid crisis a national emergency.

One of the most valuable tools that health plans possess to combat the crisis is their own wealth of information, Blues plan leaders said. The key is to turn it into valuable insights.

“We know that big data is everything,” said Mary Ann Christopher, vice president of clinical operations and transformation for Horizon Blue Cross and Blue Shield of New Jersey. Her organization's data science team has developed a model that analyzes various sources of data, including social determinants, to predict individuals’ likelihood of developing opioid dependence. It is rolling the model out in a pilot project over the next several months, and "once we prove proof of concept, we’re going to share that more broadly," she said.

Data can also help insurers work to reduce unnecessary opioid prescription, noted Jeanne James, M.D., vice president and chief medical officer of Blue Cross Blue Shield of Tennessee. Her health plan uses its data to identify providers whose prescribing patterns don’t adhere to the Centers for Disease Control and Prevention’s guidelines, and conducts outreach to those providers.

RELATED: Anthem plans reduce filled opioid prescriptions by 30%

Blue Cross Blue Shield of Michigan, meanwhile, uses claims data and pharmacy data to identify provider shoppers whose habits the insurer will then follow over time, said Duane DiFranco, M.D., senior medical director of the Blue Care Network of Michigan. And it lets providers know when their patients are receiving opioid prescriptions from multiple doctors.

“A lot of times, they don’t know each other exists,” he said. “So we broker that information.”

Similarly, the Blue Cross Blue Shield Association’s National Anti-Fraud Department uses data to run its provider shopper case management program and pharmacy locking program, said Junius Nottingham Jr., the program’s managing director. Individuals are only entered into the latter if they meet certain criteria, like having a felony drug conviction.

There are plenty of nontechnical approaches Blues plans are taking, as well. Christopher noted that Horizon has funded a series of town halls in the communities it serves geared at removing stigma about opioid use disorder, prevention, education and the dissemination of best practices for dealing with the crisis.

Some of the nonclinical best practices it’s identified include creating bereavement support groups for families who have lost members to addiction, incarceration diversion programs and the use of recovery addiction specialists, she said.

Blue Cross and Blue Shield of North Dakota, meanwhile, is working on a documentary about the effects of the opioid epidemic in the state that it aims to use to mobilize awareness and public support for prevention and treatment efforts, Faust said.

Already, some Blues plans are seeing promising results from their efforts to address the epidemic. Blue Cross and Blue Shield of Massachusetts’s opioid management program—targeted at those being prescribed opioids for the first time—decreased utilization of short-acting opioids by 25% and long-acting opioids by 50%, said Clinical Pharmacy Director Thomas Kowalski.

Beyond just prevention, the insurer removed its prior authorization requirements for a key medication-assisted treatment drug, suboxone, which can help addicts as they work toward recovery.

One of the challenges that health plans and providers alike face in addressing the opioid crisis is to take a balanced approach, recognizing both opioids’ utility for treating pain but also their dangers.

“We have to treat pain but we have to avoid diversion and addiction,” DiFranco said. “The question is how do you get that pendulum resting in the middle.”

Treating providers like partners—rather than telling them what to do—has been a key component of striking this balance, DiFranco said. Both he and his colleagues agreed that given the scope and severity of the opioid crisis, providers are now open to doing their part to help mitigate it.

“I think most physicians now are waking up to this,” Faust said.

Editor's note: This article has been updated to correctly reflect which insurer has held town halls on the opioid crisis. It is Horizon Blue Cross Blue Shield of New Jersey.