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Blue Cross NC Invests Millions In Solving Opioid Epidemic

by Chris Regal, AHIP Senior Health Research Associate

May 17, 2018

When Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced earlier this year that it was investing $50 million in community health initiatives, it earmarked $10 million specifically to address the opioid crisis. The investment is part of continuing efforts to fight the epidemic, with some of the funds going to community groups and partner organizations who can help make an impact.

AHIP spoke with Dr. Anuradha Rao-Patel, Medical Director at Blue Cross NC about how it’s preventing opioid abuse and misuse. A specialist in Physical Medicine and Rehabilitation by training, Dr. Rao-Patel has expertise in acute and chronic pain management. She is also well-versed in management of opioid use disorder, and she evaluates medical necessity, appropriateness, and value.

What prompted Blue Cross NC to make this investment to address the opioid epidemic?

Dr. Rao-Patel: Investment in our communities is consistent with our mission and with our strategy to address the opioid epidemic through prevention, intervention, and treatment. When we first analyzed levers that could be pulled and gaps that could be filled, we saw several opportunities for action.

For example, we educated our providers about best practices around opioid prescribing as indicated in the CDC Guideline. We’re working to inform and educate outlier prescribers on how they can adjust their prescribing to be consistent with those best practices.

We also looked at the pharmacy. In addition to the existing quantity limits on extended-release opioids, we set quantity limits on immediate-release opioids to seven days, and we added prior authorizations on extended-release opioids for members who have never taken opioids. Other steps include a point-of-sale edit at the pharmacy, to flag if someone is receiving inappropriate or even dangerous combinations or amounts of medications.

It’s important to help members who are at risk or have been diagnosed with substance use disorder get help, so we connect them to our care management programs. We continue to connect with members and educate them about their medicines and about things like safe use, storage, and disposal.

Finally, after implementing these changes, our Board of Trustees allocated funds to community health initiatives, including early childhood development, social determinants of health, primary care—and about $10 million was allocated to addressing the opioid epidemic. With this money, we were able to engage with community organizations.

How did you choose who to distribute funds to?

Dr. Rao-Patel: We looked at potential community partners and chose groups that are already doing great things. We wanted to expand on the work they were already doing.

We are investing in a partnership with the University of North Carolina School of Government (UNC SOG) to develop community-based solutions to the opioid epidemic in up to 10 North Carolina communities over the next 2 years.

We have also donated to TROSA, an innovative, multi-year residential program that enables people with substance use disorders to become productive, recovery individuals. The investment will help TROSA create new capacity in the Greensboro and Winston-Salem area that will serve the entire state and improve access to services for individuals in Western North Carolina.

We plan to make further investments and partner with organizations that are in position to make a difference.

What new and innovative actions can we take to combat this crisis?

Dr. Rao-Patel: Similar to other parts of the country, there is a huge shortage of providers in North Carolina.  We need to find and engage those providers who are already delivering services for at-risk patients. We know that providers have a million things going on, but primary care physicians are on the front lines and can really make a difference in the life of someone who may have a problem. And if a clinician is already providing medication-assisted treatment (MAT)—increase your load! We need providers to practice at capacity.

We need to close care gaps. Blue Cross NC is working with the Governor’s Institute, the North Carolina Medical Board, and specialty medical societies to provide better web-based resources for patients and their families. We need to have a unified message about opioids and help patients find the care they need, as well as helping providers understand the best ways to offer help.

We work with Prime Therapeutics, Walgreens Pharmacy, multi-specialty provider groups, the state, and other payers. We testified before the President’s Opioid Commission at the White House and emphasized the importance of having collaborative partnerships. Ultimately, our philosophy is that we need to bring together multiple partners—no one can do it alone.