AmeriHealth Tackles the Opioid Crisis



Opioid overuse prevention strategies implemented by health systems are usually highlighted when it comes to solving this epidemic. However, health insurance payers such as AmeriHealth, Medicare, Aetna, and more, have also developed targeted measures to encourage safe and organized drug administration practices. Even though payers are one step removed from direct patient care, this national issue requires input from every side of the healthcare industry.

AmeriHealth is one of these payers that is making a concerted effort to change the way we manage opioids. The company has instituted pharmacy lock-in programs, which require certain patients to receive care from a single pharmacy and/or provider. This eliminates the possibility of one patient obtaining excessive quantities of prescribed drugs by visiting multiple doctors for the same clinical issue. AmeriHealth also instituted a daily supply limit and started enforcing maximum dosages for their members who recently received a new prescription. These pharmacy-level tactics are feasible in the way that they place a rational restriction on prescriptions.

Another step that AmeriHealth has taken is to supplement providers with comprehensive training and extra resources. Among those resources, are addiction specialists hired by the payer. According to AmeriHealth, some physicians only receive 9 hours of prescription training in medical school, so the accessibility of this knowledge is key to decreasing overprescription. Further, recovery specialists are employed to work with members who are at high risk for developing an addiction.

Payers are obviously instrumental in providing coverage for addiction issues, so many have expanded coverage for these problems. For example, AmeriHealth expanded access to naxolone, which treats narcotic overdose in emergency situations. Since then, naxolone use increased by over 270%. Similarly, Medicare expanded coverage for opioid use disorders and increased access to non-opioid pain treatments. Medicaid, which covers a significant portion of addiction patients, has focused on expanding its coverage by about 400%.

While all of these steps are impactful, one of the more innovative and preventive approaches is to use data to anticipate prescription and overdose trends. Studies have shown that overprescribing is certainly a part of the puzzle, but social and economic instability fuel the pervasive misuse of pharmaceuticals. Social determinants of health (SDOH) data can be used to find trends in population health and generate solutions based on them. For example, the Parkland Center for Clinical Innovation (PCCI) in Dallas, funded by Parkland Community Health Plan, takes on this issue in its analytics unit, which connects physicians with social services groups to coordinate care for the people in the area. PCCI uses predictive modeling to find the patients that are at risk, and treat them effectively. Also, Accountable Care Organizations (ACOs) have started to collect claims data from Medicaid and managed payers, as well as provider information from medical records, to pinpoint risk based on this information.

The way that payers are responding to the opioid epidemic marks a new wave of involvement from their side of the healthcare landscape. These decisions show that data analytics can help reveal prescribing patterns, overdose trends, and prevention effectiveness. Ultimately, monitoring and analyzing how these pills are getting passed along — from provider, to pharmacist, to patient, will help us discover the best, long-term solution.

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