Highmark’s Three-Pronged Strategy Tackles The Opioid Crisis

by Rashi Venkataraman, Executive Director for Prevention & Population Health, AHIP

April 4, 2018

In 2017, Highmark found that one in 250 of its commercial members were addicted to opioids. In response to the crisis, the Pittsburgh-based health insurance provider launched a three-pronged public health approach to address the crisis and partnered with axialHealthcare to improve pain management practices and clinical outcomes for members. We sat down with Highmark’s Chief Medical Officer, Dr. Charles DeShazer, to learn more.

Tell us more about Highmark’s approach to the opioid crisis.

Dr. Charles DeShazer: We are leveraging a public health approach that focuses on primary, secondary, and tertiary prevention. Primary prevention is all about better managing pain, so patients don’t require opioids in the first place. For those patients who need opioids, we are focusing on secondary prevention which encourages safe prescribing practices and identifying early cases of opioid addiction. With tertiary prevention, the focus is on mitigating morbidity and mortality rates through ensuring access to effective addiction treatment.

How are you providing members with non-opioid options for managing pain?

Dr. DeShazer: We work closely with our partners at axialHealthcare to ensure our providers have access to evidence-based decision support tools for pain management. By leveraging our claims data, providers have additional insight into their own prescribing practices and how they compare against their peer group, so they can make changes if necessary. Providers receive potential care pathways for treating common pain complaints.

For those looking for alternative pain management, our benefit policies include coverage for other pain management approaches, like physical and occupational therapy, acupuncture, chiropractic services, and cognitive behavioral therapy (CBT). This makes several resources available to providers and patients as a part of their pain management strategy. We also partner with Tivity WholeHealth that manages a Complimentary and Alternative Medicine (CAM) network of more than 40,000 practitioners nationally.  Through this partnership, our members can receive discounts on yoga, tai chi, qi gong, Pilates, and other fitness classes.

How are you innovating to improve prescribing practices?

Dr. DeShazer: This year we implemented a new policy designed to limit the supply of opioids to first time recipients. We aligned our policy to the CDC Guidelines for Opioid Therapy for Chronic Pain and limited prescriptions to seven days for first time recipients (excluding those patients with cancer and other chronic conditions). We are also leveraging medical management techniques, such as prior authorization, quantity limits, and lock-in programs to better control, manage, and track opioid use across our membership.

As a part of our West Virginia pilot with axialHealthcare last year, we provided more than 250 providers with extensive, clinical consultation on pain management and saw that the number of patients who received opioids from multiple prescribers dropped by more than 28 percent.  

How are you expanding treatment for patients suffering from opioid-related substance use disorders?

Dr. DeShazer: We’ve leveraged the lessons learned from the Alleghany Health Network (AHN)’s Center of Excellence for Opioid Use Disorder, which is part of our provider system. The program was designed to support Medicaid patients with OUD to receive treatment to overcome addiction and maintain wellness. We also introduced a new tool with axialHealthcare available to providers in two states that gives patient-specific opioid-related risk information when they do an eligibility check on members, so they can make more informed care decisions.

Highmark clearly recognizes that our clinical strategy needs to address the complete member journey and be designed to ensure effective pain management, minimize dependence, and detect and address abuse.

Do you have any results you can share?

Dr. DeShazer: We know we’re on the right track. We know that overall prescribing per 1,000 commercially insured adults are down 15 percent from 2016 to 2017.

In West Virginia, we saw patients receiving opioids from multiple prescribers dropped by more than 28 percent. And patients receiving opioids alongside certain sedatives, which can be a deadly combination, fell by more than 25 percent.

Scaling these local best practices to our larger network will take a lot of work—but at Highmark, we all believe that there is always more to be done and always ways we can improve as it relates to the opioid crisis. This is a complicated epidemic with no one solution. But we are committed to doing our part to work with regulators, law enforcement, the community, and other organizations to take meaningful steps.

To learn more about health plan strategies for tackling the opioid crisis, please read AHIP’s Safe, Transparent Opioid Prescribing (STOP) Playbook.