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Independence Blue Cross’s Opioid Strategy Leads To 35% Fewer Opioid Prescriptions

posted by Rashi Venkataraman, Executive Director For Prevention & Population Health, AHIP

on June 28, 2018

In 2016, 1,700 people in southeastern Pennsylvania died from an opioid overdose. From July 2016 to July 2017, Pennsylvania had the fastest growing rate of drug overdose deaths nationwide, the CDC reports.

Philadelphia-based Independence Blue Cross has shown its commitment to addressing the opioid crisis, and has teamed up with doctors, hospitals, and community partners to reduce overprescribing and improve access to therapy for those in need.

One of the first strategies deployed by the Independence team was to refine medical policies and identify providers who may be over prescribing.

As a part of this effort, Independence:

  • limited high-dose opioid prescriptions to align with the CDC prescribing guidelines. Since 2015, doctors prescribing high doses of opioids were required to provide additional clinical documentation to ensure the criteria was met.
  • made targeted outreach to outlier prescribers. Focusing on the 1,250 network providers who had exceeded the CDC guidelines, Independence provided member-level detail to providers, resulting in nearly 60 percent of the providers changing or decreasing their prescribing habits.
  • encouraged information sharing to prevent doctor shopping and improper prescribing.
  • restricted first-time, low-dose opioid prescriptions to a five-day supply limit (exceptions for patients with cancer or terminal illness).

The results of these efforts speak for themselves. Since 2015, Independence has seen a major drop in opioid use, with a 45 percent reduction in opioid users, a 35 percent reduction in opioid prescriptions, and an 18 percent drop in morphine equivalent dose.

Beyond prescribing practices, Independence is also working to improve member access to treatments for opioid use disorder. Coverage for opioid use disorder can be complex and include programs for detoxification, rehabilitation, outpatient programs, counseling, and medication-assisted treatment (MAT). Treating opioid use disorder promptly and effectively is more than the right thing to do; it can also contain health care costs. Independence analysis shows that a member with unaddressed opioid use disorder uses about $10,000 more in health care services than a member with opioid use disorder who receives evidence-based treatment, such as buprenorphine or naltrexone.

“What this tells us is that for every 100 members we can guide into effective treatment, we’ll be saving our members $1 million in claims costs,” says Dr. Richard Snyder, chief medical officer of Independence Blue Cross. “We’re proud that our provider network includes more than 100 different substance abuse rehabilitation facilities and more than 5,000 behavioral health providers. Having the network of trained providers is a critical component of building out your treatment and recovery strategy.”

Independence Blue Cross serves over 8.4 million people in nearly 30 states, including more than 2.5 million people in Southeastern Pennsylvania. To learn more about its strategy for tackling the opioid crisis, visit www.ibx.com/fightopioidaddiction.

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